Anales de la RANM

202 A N A L E S R A N M R E V I S T A F U N D A D A E N 1 8 7 9 SIMULATED PERIPHERAL VEIN CATHETERIZATION SKILL Guasch E, et al. An RANM. 2024;141(03): 201 - 208 INTRODUCTION Practical skills acquisition is an important aspect of medical education in high income countries (HICs) and in LMICs. Medical students, nurses and non-physician anesthesia providers (NPAPs), must learn some basic competences. Among these skills, we can find peripheral vein canulation (PVC). PVC is usually taught to medical students and other learners using simulation on plastic mannequins, that may be similar, or not, to real patients. Frequently mannequins may have been used by too many students, so it may be difficult to learn this skill. The problems with this conventional model are, the cost of the mannequins, the repeated use of them, the number of punctures at the same place and lack of realism of the model. Mannequins are expensive, and are not available in many countries, or at peripheral hospitals or centers. Placenta as a simulation model has been described for neurosurgical and vascular techniques (1) We have recently described and published a new model to teach medical students peripheral vein canaliza- tion using fresh human placenta. (2) The placenta model is a “closed blood circuit” full of veins in the fetal side of it, that are available to be used by tutorized medical students. Training in practical skills can follow different methods. From the classic model that is the “see-one, do-one, teach-one” (3) to nowadays, the learning models have changed significatively. Learning must be based on the competences and acquisition of skills (4). Each student, or resident, requires indivi- dual attention, which is not necessarily the same in all cases. The use of objective evaluation tools facilitates this individualization, while allowing planning the average number of procedures necessary to acquire the selected competence that is going to be evaluated. To analyze the acquisition of competencies, while learning different techni- ques in some particular fields, such as anesthesia (5) and surgery, the Cumulative Sum (CUSUM) statistical method is frequently used (6). CUSUM method allows the development of learning curves that reflect how the performance of the technique improves over time, after successive attempts. The proposed hypothesis is that the placenta is as reliable as the conventional method with mannequins, or even more reliable than the simula- tion mannequin for learning PVC. Our goal is to validate the simulation model with placenta, compared with the use of mannequins, for learning PVC in a group of sixth-year medical school students. METHODS After Local Hospital and University Research Ethics Committee/Institutional Review Board approval (PI-4991. Madrid, November 29 th 2021. President Ethics Committee Dr. Emma Fernandez- Uzquiano) and written informed consent obtained of all women and students, we designed a unicen- tric observational study based on a teaching activity called “peripheral vein cannulation” (PVC) included in the official program of our medical school in conventional simulation mannequins and in human fresh placenta after delivery. We used 20G standard iv cannulas. We studied the performance on this skill, PVC, of 10 volunteer students at 6 th year medical school. We divide the students in 2 groups of 5 persons each. Group 1 started the PVC at the hospital obstetric delivery suite with human placenta specimens obtained from recently delivered women. Group 2 started the PVC with conven- tional mannequins in the simulation department (room) of our medical school. Once persons in every group had performed 10 attempts of PVC in their initially assigned model, they exchanged to the other one and they performed 10 additional attempts of PVC. The placentas were selected according to the following criteria: Informed consent of the mother and the student, regular size of the specimen (excluded small specimens and coagulated placental vessels), integrity of the placental tissue and its venous net and a working cord clamp closing the cord, to avoid placental exsanguina- tion. An exclusion criterion was if the placenta had to be sent to the pathology department for any reason. Resultados: El modelo placentario demostró ser tan útil como los maniquíes para el aprendizaje de la técnica. La mayoría de los estudiantes adquirieron la competencia en PVC, con una tasa de éxito de al menos un 80%, tras diez procedimientos. para que así los estudiantes evalúen su proceso de aprendizaje. La mayoría de ellos expresaron haber aprendido mejor con el modelo placentario y encontraron el uso de la simulación muy positivo para la formación de los estudiantes de medicina. Discusión: El nuevo modelo de placenta era al menos tan bueno como el estándar. 10 intentos de PVC fueron suficientes para aprender la habilidad en la mayoría de los estudiantes con cualquiera de ambos modelos. La disponibilidad de placenta es económica y se puede utilizar dondequiera que se realicen partos.