It seems that every medical student does his or her first sutures on pig’s feet. Although pragmatic, students quickly learn that there are many differences between the the texture and thickness in pig skin compared to live human tissue. For many procedures, especially those that are rare like the thoracotomy or surgical airway, these differences may preclude the learner from having a good sense of how to do the procedure in real life.
Many Emergency Medicine training programs have an annual or biannual cadaver lab to teach their residents the intricacies of major procedures and to introduce or refine the motor skills required. This Feature Educational Innovation (FEI) was originally posted by the CAEP EWG FEI Team on November 14, 2014 and answers the question: “Do clinical grade cadavers allow an economical and realistic replication of live human tissue?” A PDF version is available here. A CAEP cast is available here.
Name of Innovation
Using Clinical Grade Cadavers for High Fidelity Simulation
Description of the Innovation
The procedural skills learning adage of “see one, do one, teach one” is no longer acceptable to learners, educators and the public. Simulation has come a long way as an educational adjunct to improve both procedural skills learning and clinical decision-making.
Access to mannequins and other higher-fidelity patient simulators is increasing. These simulators are often costly, can be limited in function, and may not be suitable for learning many procedures. Historically, donated human cadavers have been used for learning purposes, but the fixation process used to preserve these specimens results in rigid unrealistic tissue. Access to non-preserved cadaveric specimens can be challenging for various reasons.
Since 2007, the Dalhousie Division of Anatomy, in collaboration with the Departments of Emergency Medicine and General Surgery, have been using “clinical grade cadavers” (CGC). These CGCs are preserved using a newly-adapted embalming technique that retains a natural compliance and texture that is very similar to that of living human tissues. This embalming process preserves the body’s clinical condition for up to a month after the donor’s death.
The result is a truly realistic model that can replace or augment the use of other simulators. At our institution, CGCs are now being used in a hospital setting to provide a multidisciplinary simulation environment for learners.
There is no higher-fidelity simulation than one that uses the human body as a medium for learning. Clinical cadavers provide a cost-effective, safe solution for teaching and learning lifesaving skills and address an experience/competency gap where educational opportunities are inadequate or simply not available in adequate numbers to attain or maintain competency.
Does your EM training program hold a cadaver lab? What aspects do your leaners find particularly valuable? Are there ways in which your group is seeking to improve the educational experience?
More About the CAEP FEI
This post was originally authored for the Canadian Association of Emergency Physicians (CAEP) Feature Educational Innovations project sponsored by the CAEP Academic Section’s Education Working Group and edited by Drs. Teresa Chan and Julien Poitras. CAEP members receive FEI each month in the CAEP Communiqué. CanadiEM will be reposting some of these summaries, along with a case/contextualizing concept to highlight some recent medical education literature that is relevant to our nation’s teachers.