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Research Article
Low-cost synthetic phlebotomy model: An alternative learning tool for medical students
1 Medical Sciences Course, Health Sciences School, Faculdade Ceres (FACERES), São José do Rio Preto, SP, Brazil
2 Neurosurgeon, Member of the Brazilian Society of Neurosurgery, Santa Mônica Hospital, Goiânia, GO, Brazil
Address correspondence to:
Pedro Nogarotto Cembraneli
FACERES, Avenida AnÃsio Haddad, 6751, CEP 15090-305, São José do Rio Preto, SP,
Brazil
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Article ID: 100019C04PC2020
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Cembraneli PN, Cavalcante JBF, Cembraneli IN, Cavalcante RBF, Valente VF, Cavalcante JES, Caparroz FA, Rocha BPC, Costa CDS, Raphe R. Lowcost synthetic phlebotomy model: An alternative learning tool for medical students. Edorium J Cardiothorac Vasc Surg 2020;7:100019C04PC2020.ABSTRACT
Aims: Practicing surgical skills has been gaining space in medical courses, with emphasis on synthetic experimental models. Biological training materials have some disadvantages compared to animal models such as higher cost, smaller durability, more difficult storage, less possibility of reuse, and protection by animal societies. Therefore, a low-cost synthetic phlebotomy model, intended to enable students to practice the surgical technique exhaustively without the need for new materials and avoiding the use of animals, was created for theoretical/practical training in medical schools. This study aimed to assess the effectiveness of a low-cost synthetic model for training the phlebotomy technique.
Method: A synthetic model of phlebotomy was created and offered to medical students, who voluntarily accepted the conditions presented in the Free, Prior, and Informed Consent, for theoretical/practical training. They practiced the surgical technique using the synthetic model and evaluated it through a questionnaire.
Results: The research involved 52 medical students. Most of them (78.84%) reported that the synthetic model is a good option compared to the biological one because it can be reused and is available for training as many times as necessary. However, all the participants affirmed that the synthetic model does not exclude the use of the biological one.
Conclusion: Low-cost synthetic models are an excellent option for practicing surgical skills.
Keywords: Experimental model, Low cost, Phlebotomy, Simulation training, Synthetic
INTRODUCTION
One of the pillars of surgical practices is the acquisition of techniques and skills. The use of low-cost synthetic models in medical schools aims to cease the problems imposed by the limited time to reconcile theory with practice and overcome the difficulties in obtaining human and/or animal resources. Additionally, this prevents the use of animals in teaching and research, a well-known polemic issue [1],[2],[3],[4],[5].
Phlebotomy consists of dissection, isolation, catheterization, and, in most cases, distal ligation of a vein, performed under local anesthesia. For this purpose, numerous superficial veins such as the basilic and saphenous veins, or deep veins such as the brachial veins can be used. This procedure is indicated mainly in emergency situations, when it is not possible to obtain peripheral venous access promptly, to avoid multiple venipuncture attempts and suffering [6],[7],[8],[9].
Nowadays, in medical education, students develop cognitive and technical/motor skills using a range of different methods. Cognitive competences are developed from a theoretical basis, with the acquisition of knowledge through active search, featuring a linear sum of improvements. In turn, technical skills are developed exponentially at first, followed by stabilization and steady improvement. Precisely because of this characteristic, technical skills demand hands-on training, with exhaustive repetition after this first moment, to achieve improvement. In this scenario, bench model training using models that allow continuous repetition and reevaluation, with no time and place limitations, are practical and suitable for the technical development of medical students, so that they can acquire fundamental, technical, surgical, and decision-making skills [10],[11].
In view of the current evolutionary context of medical training mentioned above and taking into consideration the importance for medical students to acquire practical skills to perform phlebotomy, we developed a low-cost synthetic model for training this technique, intended to enable students to practice this surgical technique exhaustively without the need for new materials and avoiding the use of animals. Therefore, the current study aimed to assess the effectiveness of a low-cost synthetic model for training the phlebotomy technique.
MATERIALS AND METHODS
Our team created a low-cost synthetic phlebotomy model to be used for surgical skills training on a life-like model. The materials were chosen to simulate the structures approached during the phlebotomy procedure, namely: skin, subcutaneous tissue, muscles, and vascular-nervous structures. Such materials were arranged in an overlapping manner, using artificial skin, foam for the subcutaneous tissue, a layer of red ethylene vinyl acetate (EVA) to simulate the muscle tissue, and colored plastic straws for the vascular-nervous structures (Figure 1, Figure 2, Figure 3, Figure 4). In the blue straw, corresponding to the venous structure, a latex balloon containing red liquid dye was placed at the proximal end to simulate blood and verify the effectiveness of the procedure.
Students of the eleventh and twelfth terms of the medical course at FACERES, who had already taken the surgical skills discipline, were invited to participate in this study (Project approved by the Research Ethics Committee—CEP of FACERES, no. 12359819.9.0000.8083). After signing the Free, Prior, and Informed Consent, they were asked to carry out phlebotomy training in animal parts and in the synthetic model created for this purpose, following the surgical technique guide shown in Table 1. Subsequently, the participants answered a questionnaire about the usefulness and efficacy of the new teaching model using a 5-point Likert scale, ranging from “I strongly disagree” (1) to “I strongly agree” (5).
RESULTS
The project resulted in the creation of a reusable synthetic phlebotomy model, which cost approximately US$ 0.58 each. In total, 52 medical students participated in the research. Most of the participants were male (51.92%), 75% of them were 20–24 years old, and 40.38% were interested in the surgical area.
According to their answers to our questionnaire, 82.69% thought that the material used for making the model is good quality and 76.92% affirmed that the model has good anatomical similarity to the human body. Many participants (92.3%) reported that the synthetic model allows learning the proposed phlebotomy technique, 73.07% of them considered it adequate to be used as an alternative learning tool for training this surgical technique, and 94.23% of the respondents recognized that it brings benefits to the teaching-learning process compared to theoretical knowledge alone.
The synthetic phlebotomy model was described by 78.84% of the participant students as a good alternative tool compared to the biological model, since it can be reused several times and is available for training as many times as necessary. However, all the participants reported that the synthetic model does not exclude the use of the biological model. Finally, 75% of the respondents affirmed that prior training using the synthetic model is extremely important for medical practice.
DISCUSSION
In Brazil, the curricular guidelines of undergraduate schools establish that general practitioners must be capable of performing both clinical and surgical procedures. Because of this, the surgical skills discipline has been increasingly gaining importance in medical schools [12],[13].
Although animal models have been used for a long time in the medical teaching–learning process, they require a series of ethical principles, are difficult to maintain, cost more, and may not be advantageous for certain surgical procedures [14]. Nowadays, investing in alternative models for teaching and respecting the humanitarian principles of animal experimentation has been a worldwide trend. This provides a focus for introducing new methods to replace, reduce, and/or refine animal use. Due to this change, medical students should be offered opportunities to train and improve surgical techniques using synthetic and reusable models, with no limitations to their learning process [15],[16],[17].
The model proposed in this study revealed numerous positive points, including learning the technique better, training as many times as necessary in the same piece, and feeling more confident to perform the procedure in vivo posteriorly. There was also criticism regarding the stiffness of the materials used compared to the animal model, but good anatomical similarity was reported by the participants.
Therefore, practicing surgical skills in synthetic models brings the opportunity of offering medical students an environment very close to the real one in a safe manner. The students can have an exhaustive and comprehensive hands-on training in order to prevent iatrogenesis during the in vivo procedure [18],[19].
CONCLUSION
The synthetic phlebotomy model emerged as an excellent alternative learning and training tool for medical students to practice surgical skills. The model allows exhaustive theoretical/practical training and improvement of the technique without impairing academic learning. Although the synthetic model cannot totally replace anatomical parts and animal models, it is in line with the worldwide trend of making great efforts to develop and implement non-animal approaches as replacements for animal-based teaching and training models.
REFERENCE
1.
Amoretti R. A educação médica diante das necessidades sociais em saúde. Rev Bras Educ Med 2005;29(2):136–46. [CrossRef]
2.
Gomes AP, Rego S. Transformação da educação médica: é possÃvel formar um novo médico a partir de mudanças no método de ensino-aprendizagem? Rev Bras Educ Med 2011;35(4):557–66.
3.
Marcondes CA, de Pinho Pessoa SG, de Pinho Pessoa BBG, Dias IS, Guimarães MGM, de Castro SN. Sistematização do treinamento teórico e prático de técnicas em suturas para acadêmicos de medicina da disciplina de cirurgia plástica da Universidade Federal do Ceará – UFC. Rev Bras Cir Plást 2014;29(2):289–93. [CrossRef]
4.
Gomes R, de Faria Brino R, Aquilante AG, da Silva de Avó LR. Problem-based learning in medical education and the development of traditional medicine: A review of the literature. Rev Bras Educ Med 2009;33(3):444–51. [CrossRef]
5.
Anastakis DJ, Regehr G, Reznick RK, et al. Assessment of technical skills transfer from the bench training model to the human model. Am J Surg 1999;177(2):167–70. [CrossRef]
[Pubmed]
6.
Chappell S, Vilke GM, Chan TC, Harrigan RA, Ufberg JW. Peripheral venous cutdown. J Emerg Med 2006;31(4):411–6. [CrossRef]
[Pubmed]
7.
Marques RG. Técnica operatória e Cirurgia Experimental. Rio de Janeiro: Guanabara Koogan; 2005.
8.
Carlotti APCP. Acesso vascular. Medicina (Ribeirão Preto) 2012;45(2):208–14.
9.
American College of Surgeons. Advanced Trauma Life Support® (ATLS®): Student Course Manual. 9ed. Chicago: American College of Surgeons; 2012.
10.
DiMaggio PJ, Waer AL, Desmarais TJ, et al. The use of a lightly preserved cadaver and full thickness pig skin to teach technical skills on the surgery clerkship—a response to the economic pressures facing academic medicine today. Am J Surg 2010;200(1):162–6. [CrossRef]
[Pubmed]
11.
Syed K, Shakib A, Sayedi H, et al. The effect of bench-model training on cognitive learning in the operating room. Orthop Proc 2012;94-B(Suppl 38):199.
12.
Ministério da Educação Conselho Nacional de Educação Câmara de Educação Superior. Resolução nº 3, de 20 de junho de 2014. Institui Diretrizes Curriculares Nacionais do Curso de Graduação em Medicina e dá outras providências. BrasÃlia, DF: 2014. [Available at: http://portal.mec.gov.br/index.php?option=com_docman&view=download&alias=15874-rces003-14&category_slug=junho-2014-pdf&Itemid=30192]
13.
Carter YM, Wilson BM, Hall E, Marshall MB. Multipurpose simulator for technical skill development in thoracic surgery. J Surg Res 2010;163(2):186–91. [CrossRef]
[Pubmed]
14.
Olshaker JS, Brown CK, Arthur DC, Tek D. Animal procedure laboratory surveys: Use of the animal laboratory to improve physician confidence and ability. J Emerg Med 1989;7(6):593–7. [CrossRef]
[Pubmed]
15.
Filho G, de Assis Vaz F. Apresentação de um novo modelo sintético para treinamento em neuroendoscopia [PhD thesis]. São Paulo: Universidade Federal de São Paulo; 2012.
16.
Dantas AK. Avaliação do aprendizado em técnica cirúrgica empregando três estratégias de ensino [PhD thesis]. São Paulo: Faculdade de Odontologia, Universidade de São Paulo; 2010.
17.
Nuffield Council on Bioethics. The ethics of research involving animals. London: Nuffield Council on Bioethics; 2005.
18.
Specer Netto FAC, Sommer CG, de Mello Constantino M, Cardoso M, Cipriani RFF, Pereira RA. Teaching project: A low-cost swine model for chest tube insertion training. [Article in Portuguese]. Rev Col Bras Cir 2016;43(1):60–3. [CrossRef]
[Pubmed]
19.
da Cunha CMQ, Frota Júnior JAG, Ferreira JD, Troiani Neto G, Félix DF, de Menezes FJC. Montagem e aplicação de modelo de baixo custo de dissecção venosa. Rev Med 2017;96(4):220–4.
SUPPORTING INFORMATION
Author Contributions
Pedro Nogarotto Cembraneli - Conception of the work, Design of the work, Acquisition of data, Analysis of data, Drafting the work, Revising the work critically for important intellectual content, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Julia Brasileiro de Faria Cavalcante - Conception of the work, Design of the work, Acquisition of data, Analysis of data, Drafting the work, Revising the work critically for important intellectual content, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Italo Nogarotto Cembraneli - Conception of the work, Design of the work, Acquisition of data, Analysis of data, Drafting the work, Revising the work critically for important intellectual content, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Renata Brasileiro de Faria Cavalcante - Conception of the work, Design of the work, Acquisition of data, Analysis of data, Drafting the work, Revising the work critically for important intellectual content, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Volmer Fernandes Valente Junior - Conception of the work, Design of the work, Acquisition of data, Analysis of data, Drafting the work, Revising the work critically for important intellectual content, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
José Edison da Silva Cavalcante - Conception of the work, Design of the work, Acquisition of data, Analysis of data, Drafting the work, Revising the work critically for important intellectual content, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Fabio Azeredo Caparroz - Conception of the work, Design of the work, Acquisition of data, Analysis of data, Drafting the work, Revising the work critically for important intellectual content, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Bruno Peron Coelhoda Rocha - Conception of the work, Design of the work, Acquisition of data, Analysis of data, Drafting the work, Revising the work critically for important intellectual content, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Carlos Dario da Silva Costa - Conception of the work, Design of the work, Acquisition of data, Analysis of data, Drafting the work, Revising the work critically for important intellectual content, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Raphael Raphe - Conception of the work, Design of the work, Acquisition of data, Analysis of data, Drafting the work, Revising the work critically for important intellectual content, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Guarantor of SubmissionThe corresponding author is the guarantor of submission.
Source of SupportNone
Consent StatementWritten informed consent was obtained from the patient for publication of this article.
Data AvailabilityAll relevant data are within the paper and its Supporting Information files.
Conflict of InterestAuthors declare no conflict of interest.
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