Educational project : low cost porcine model for venous cutdown training

Objective: to describe and evaluate the acceptance of a porcine experimental model in venous cutdown on a medical education project in Southwest of Brazil. Method: a porcine experimental model was developed for training in venous cutdown as a teaching project. Medical students and resident physicians received theoretical training in this surgical technique and then practiced it on the model. After performing the procedure, participants completed a questionnaire on the proposed model. This study presents the model and analyzes the questionnaire responses. Results: the study included 69 participants who used and evaluated the model. The overall quality of the porcine model was estimated at 9.16 while the anatomical correlation between this and human anatomy received a mean score of 8.07. The model was approved and considered useful in the teaching of venous cutdown. Conclusions: venous dissection training in porcine model showed good acceptance among medical students and residents of this institution. This simple and easy to assemble model has potential as an educational tool for its resemblance to the human anatomy and low cost.


INTRODUCTION
S imulation based teaching has become popular in training of professional skills in several areas and a powerful learning tool in the medical area [1][2][3] .Simulation allows the practice of procedures in a controlled environment, where the error is seen as an opportunity to improve learning, giving autonomy to the student, reducing the risk to patients, as well as being attractive to students [2][3][4][5] .
Venous cutdown is a relatively simple medical procedure that may be required in a trauma victim as a venous access option.According to the Advanced Trauma Life Support -ATLS® 6 , along with central venous access and intraosseous access, venous cutdown appears as second option of venous access if peripheral venous access is not possible.The choice of the method should be related to the performer's experience and pa-

Teaching Project Steps
Each training session comprised groups of about ten students or residents and was divided into the following steps: 1) discussion of the indication and complications of venous dissection, as well as the description of the technique according to ATLS6; 2) practice of the procedure by the participant under tutor supervision with critical and corrective analysis technique; 3) assessment questionnaire completing the model by participant.

Porcine Model of Venous Cutdown
In each training session, two models containing a porcine piece composed of skin, subcutaneous tissue and muscle each were made.The porcine pieces were previously purchased in licensed local market and adequate for human consumption, according to the sanitary surveillance rules.For these models, leftovers from other skills laboratory models (chest drainage) were used, with no specific cost falling on them.Each piece was used to training five to nine students.
Each porcine piece was fixed by stitches, in a rigid wood surface (Figure 1).A nasogastric tube # 14 del for training medical students and residents.Some of the answers of the questionnaire were not object of this study, but used in order to improve the model and its application to graduation.Specifically, evaluations were requested of the overall quality of the model (robustness criteria, ease of handling and tissue similarity) and anatomical correlation (similarity to the expected anatomy in humans), both with scores ranging from 0 to 10.The questionnaire was prepared by the lead author and was not previously validated.All information obtained by the questionnaire were grouped into tables using Microsoft Excel® and analyzed with averages and percentages.

RESULTS
This project included 69 participants.
Of these, 61 were graduate students of medicine (88.4%) and eight were medical residents (11.6%).
Among the participants, the mean age was 25.8

R E S U M O
tient characteristics.This article reports a low-cost and low-technology experimental porcine model used for venous cutdown training and analyzes its acceptance among medical students and residents of the institution.METHODS The study was conducted at Universidade Estadual do Oeste do Paraná -Unioeste, from June 2013 to June 2014, as part of a registered education project (Prograd CR 40119/2013) 7,8 .It attended 61 Medicine students (last year) and eight resident physicians of Internal Medicine Program.Participants used porcine models for resuscitation procedures training and evaluated them through a questionnaire.
was passed between the muscle layer and subcutaneous tissue with the aid of a Kelly clamp, becoming palpable to perform the technique.The nasogastric tube was connected to an artificially colored IV solution system to simulate blood.The remaining materials were used in the Medical Skills Laboratory, obtained by donation at no cost.Details about the building of this model can be found in this site: https://www.youtube.com/watch?-v=oLAQ1e61Bdc.

(
23 to 33).None of the study participants had performed a venous cutdown before.As for quantifying the quality of the model, the average grade was 9.16 (7 to 10).The anatomical correlation between the model and the human anatomy was considered 8.07 (5 to 10).All participants judged the simulated training in experimental model useful before performing venous cutdown procedure in patients, as well as other procedures for obtaining venous access for fluid resuscitation.This model was accepted by most of the participants (68/69 -98,6%) as an adjunct in the training of venous dissection.DISCUSSIONThe use of simulators in several fields -medicine, nursing, engineering, aviation -have gained supporters, but it is still not universally used, since many factors are involved with its implementation as cost, teachers training, physical space, integration and critical evaluation of what is taught, in order to incorporate the simulation in curriculum repertoire of undergrads9-12 .

Figure 1 .
Figure 1. Materials and porcine model ready for use.