Introduction Penetrating cardiac injuries have higher mortality due to occult injuries. The subxiphoid pericardial window, with almost 100% accuracy, is vital for timely management. Due to lack of low-cost, low-fidelity models available for residents to practice this procedure, we designed a novel low-cost model for residents to practice in a simulation-based curriculum and to improve their skills in an easy and reproducible way. Methods A low-cost model (Fig. <InternalRef RefID="Fig1">1</InternalRef>) was created using a cardboard box (depicting the chest), balloon (depicting the heart), plastic wrap (depicting the pericardium layers), corrugated box and cotton (depicting the xiphoid and fibrinous tissue) and felt (skin and subcutaneous tissue). This model was initially introduced to the PGY4 residents and later to the PGY3 residents in the following year. Participants performed a simulated pericardial window procedure on this model during their bi-annual Surgical X-Games assessments. They were evaluated using a 22-point checklist (score out of 5) assessing both skill and knowledge. Results Forty-five residents completed simulated training on the model. Their mean overall scores (out of 5) improved from 2.3 in the fall to 3.2 in the spring X-Games, though statistical not significant (p > 0.05). All residents correctly incised the xiphoid process in both assessments. In the fall, 48.9% residents retracted the lower sternum and dissected in the correct plane, increasing to 60% in the spring. Commonly missed steps included patient preparation and the cardiac bypass machine backup. Throughout the years, only five residents punctured the balloon, resulting in penalties. The residents performed better in the knowledge section compared to the skills section and their mean knowledge score did not show a statistically significant improvement from fall to spring (p > 0.05). In the fall X-Games, 75.6% residents acknowledged the importance of a sternotomy in an unstable patient whereas in the spring X-Games, 97.8% residents mentioned this step. Conclusion Our study demonstrates the potential of low-cost, low-fidelity simulation models in enhancing residents’ proficiency in subxiphoid pericardial window procedures. While further research is needed to validate these findings and address existing limitations, simulation-based training remains a valuable tool for preparing residents to navigate complex surgical scenarios and ultimately improve patient care.

Teaching a surgical skill, using a novel subxiphoid pericardial window model

期刊论文
发表日期：

2025年1月30日

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Fazal Khan,
Hania Ahmer,
Nizamuddin Shaikh,
Mariela Rivera,
John Stulak

摘要

Introduction

Penetrating cardiac injuries have higher mortality due to occult injuries. The subxiphoid pericardial window, with almost 100% accuracy, is vital for timely management. Due to lack of low-cost, low-fidelity models available for residents to practice this procedure, we designed a novel low-cost model for residents to practice in a simulation-based curriculum and to improve their skills in an easy and reproducible way.

Methods

A low-cost model (Fig. 1) was created using a cardboard box (depicting the chest), balloon (depicting the heart), plastic wrap (depicting the pericardium layers), corrugated box and cotton (depicting the xiphoid and fibrinous tissue) and felt (skin and subcutaneous tissue). This model was initially introduced to the PGY4 residents and later to the PGY3 residents in the following year. Participants performed a simulated pericardial window procedure on this model during their bi-annual Surgical X-Games assessments. They were evaluated using a 22-point checklist (score out of 5) assessing both skill and knowledge.

Results

Forty-five residents completed simulated training on the model. Their mean overall scores (out of 5) improved from 2.3 in the fall to 3.2 in the spring X-Games, though statistical not significant (p > 0.05). All residents correctly incised the xiphoid process in both assessments. In the fall, 48.9% residents retracted the lower sternum and dissected in the correct plane, increasing to 60% in the spring. Commonly missed steps included patient preparation and the cardiac bypass machine backup. Throughout the years, only five residents punctured the balloon, resulting in penalties. The residents performed better in the knowledge section compared to the skills section and their mean knowledge score did not show a statistically significant improvement from fall to spring (p > 0.05). In the fall X-Games, 75.6% residents acknowledged the importance of a sternotomy in an unstable patient whereas in the spring X-Games, 97.8% residents mentioned this step.

Conclusion

Our study demonstrates the potential of low-cost, low-fidelity simulation models in enhancing residents’ proficiency in subxiphoid pericardial window procedures. While further research is needed to validate these findings and address existing limitations, simulation-based training remains a valuable tool for preparing residents to navigate complex surgical scenarios and ultimately improve patient care.