HUMANISTIC TRAINING TECHNIQUES: THE USE OF ANATOMIC MODELS

The use of humanistic training techniques contributes to better clinical training. A major component of humanistic training is the use of anatomic models, which closely simulate the human body, and other learning aids. Initially working with models rather than with patients allows participants to learn and practice new skills in a simulated setting. This reduces stress for the participant as well as risk of injury and discomfort to the patient. Thus, effective use of models (humanistic approach) is an important factor in improving the quality of clinical training and, ultimately, service provision. Before a participant performs a clinical procedure with a patient, two learning activities should occur. The clinical trainer should demonstrate the required skills and patient interactions several times using an anatomic model, role plays, or simulations. Under the guidance of the trainer, the participant should practice the required skills and patient interactions using the model, role plays, or simulations and actual instruments in a setting that is as similar as possible to the real situation. Only when skill competency has been demonstrated should participants have their first contact with a patient. Before any participant provides services to a patient, it is important that s/he demonstrate skill competency using models, role plays, or simulations, especially for core skills. When mastery learning, which is based on adult learning principles and behavior modeling, is integrated with competency-based training, the result is a powerful and extremely effective method for providing clinical training. And when humanistic training techniques, such as using anatomic models and other learning aids, are incorporated, training time and costs can be significantly reduced. INSTRUCTIONS FOR USING ANATOMIC MODELS The following anatomic models are suggested for use with this learning package for teaching clinical skills in simulated situations: Spinal injection simulator Newborn resuscitation model Arm model for IV cannulation
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Cardiopulmonary resuscitation (CPR) model Other locally available models or models created with local resources SPINAL INJECTION SIMULATOR The Life/form1 Spinal Injection Simulator is a human torso model that has been designed to provide realism in the simulator so that as participants work with the unit, the visual and tactile sensations provide a positive transition to procedures with patients. The Spinal Injection Simulator consists of two basic parts. The first part, or inner core, is a clear lucite window in which the first and second lumbar vertebrae are prominently displayed. It also includes the intervertebral disc, the nerve roots, the ligamentum flavum, and lumbar sympathetic chain. The second part of the simulator is the functional unit. This incorporates all soft tissue and bony structures from the level of the third lumbar vertebrae down to the tip of the coccyx. Both midline and lateral approaches to spinal injection may be practiced on the simulator. Participants will experience a typical feeling of puncture in their fingertips as they pierce the dura mater. The dura can be filled with an aqueous solution. This allows visual confirmation of correct technique when the dura is entered. Fluid will exit through the spinal needle. The local anesthetic solution can be injected into the space as in a patient. The Life/form Spinal Injection Simulator is ideal for demonstrating and practicing lumbar puncture and spinal anesthesia. Procedure with Spinal Injection Simulator The learning guide and checklist for lumbar puncture and spinal anesthesia should be used for conducting the procedure. The local infiltration step should be demonstrated using a 2 mL syringe with needle. A 25-gauge needle may be used, without using a needle introducer, while working with models as well as with patients. Introducers are not supplied with spinal needles. An 18-gauge intravenous needle can be used as a substitute. The disadvantage of using the introducer on the model is that it leaves behind a visible hole on the skin of the model and subsequent punctures are done through this hole. This interferes with the step of identifying the anatomic landmark (intervertebral disc space) for lumbar puncture.

Manufacturers name and name given to the spinal puncture model Anesthesia for EmOC Learning Resource Package

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Care and Maintenance of the Models The following information applies to all anatomic models that will be used for this training program. The models are constructed of a material that approximates skin texture. Therefore, in handling them, use the same gentle techniques as you would in working with a patient. Clean the models after every training session using a mild detergent solution, and rinse with clean water. Store the models in the carrying case and plastic bag provided with your kit. Do not wrap the models in other plastic bags, newspaper, plastic wrap, or any other kinds of material, as these may discolor their skin. Do not write on the models with any type of marker or pen, as these marks may not wash off. Do not use alcohol, acetone, Betadine or any other antiseptic solution that contains iodine on the models. They will damage or stain the skin. Do not use a hypodermic needle larger than 20-gauge. Keep needles as sharp as you would for a patient. Large bore and dull needles cause excessive wear to unit. NEWBORN RESUSCITATION MODEL This model is designed to assist in teaching the processes and skills needed to resuscitate a newborn using mouth-to-mouth resuscitation or a bag and a mask. The model includes the following: Item Newborn Lungs (plastic bags) Quantity 1 3

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Instructions for Use When the model is used for practicing mouth-to-mouth resuscitation, the plastic bag should be changed for each user. Replacement plastic bags are available in packages of 100. Airway Installation Fold the left side of the face shield end of the plastic bag toward the center of the bag (see figure below). Do the same for the right side. Insert the plastic bag through the mouth of the newborn. Tilt the head back and lay the plastic bag flat against the chest. Snap the chest overlay into place. Form the face shield to cover the newborns face from nose to chin.

Airway Removal First, unsnap the chest overlay from the shoulders and peel down. Then, pull the plastic bag through the face. INTRAVENOUS INJECTION ARM The injection arm model allows realistic training to teach competencies in: Venipuncture for blood sampling Intravenous injections Positioning of an intravenous catheter for intravenous infusion. In the absence of a manufacturers arm model, an anatomic model of the arm can be easily created with locally available resources (e.g., a wooden block) with space to hold plastic or rubber tubes (e.g., urinary catheters), which can simulate a blood vessel. The wooden arm and

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rubber tubes can be kept in a casing of thin rubber sheets, which can be procured locally in most places. CARDIOPULMONARY RESUSCITATION MODEL A cardiopulmonary resuscitation model provides anatomically correct landmarks and realistic compressions/ventilations for learning the CPR technique. Both bag and mask ventilation and mouth-to-mouth ventilation techniques are possible. The use of a CPR model gives participants the opportunity to practice the following: Realistic lifting and tilting of the head for airway maintenance Clearing of the mouth and pharynx Introduction of airway tube Visual inspection of chest movement Identification of the trachea Feeling of the rib cage and xiphisternum to enable correct positioning for chest compression Chest compression and mouth-to-mouth ventilation Visualization of site for defibrillator paddles

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