Abstract
Background: Procedural competency is a vital component of emergency medicine (EM) residency. Chest tube thoracostomy can be an emergent lifesaving procedure that all graduating EM residents should be competent in performing. Simulated task trainers for tube thoracostomy are commercially available and described in the literature, however, financial constraints and anatomical inconsistencies represent drawbacks of these devices.
Methods: TITUS (Thoracic Intervention Training Unit Simulator) was developed to create a chest tube thoracostomy model that is easy to assemble, realistic, portable and affordable. TITUS is comprised of a plastic mannequin torso and basic hardware supplies and can be assembled for under $50. Using TITUS, we performed a cross-sectional survey-based study as part of procedure education session.
Results: A total of 29 EM residents completed the survey. Most participants had little prior experience placing open chest tubes or pigtail catheters. Using the TITUS model, participant comfort levels rose from 2.6 + 0.98 (where 1= not at all comfortable and 5= extremely comfortable) before the educational session to 3.7 + 0.85 (p < 0.001, z = -0.49). Participants rated TITUS to be more realistic than other chest tube simulators (n=28, average= 4.2 where 1=much less realistic and 5=much more realistic) and rated it to be highly realistic compared to cadavers or live patients (n=22, average=3.8 where 1=much less realistic and 5=much more realistic). Participants reported that the educational session improved their ability to place chest tubes (average=4.2, where 1=decreased and 5=greatly improved).
Conclusions: Our results indicate that TITUS provides a realistic, affordable, and easy-to-assemble alternative to currently available thoracostomy simulators.