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      Effectiveness of cadaver‐based educational seminar for trauma surgery: skills retention after half‐year follow‐up

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          Abstract

          Aim

          In Japan, trauma surgery training remains insufficient, and on‐the‐job training has become increasingly difficult because of the decreasing number of severe trauma patients and the development of non‐operative management. Therefore, we assessed whether a 1‐day cadaver‐based seminar is effective for trauma surgery training.

          Methods

          Data were collected from 11 seminars carried out from January 2013 to March 2014, including a 10‐point self‐assessment of confidence levels ( SACL) for 21 surgical skills and an evaluation of the contents before, just after, and a half‐year after the seminar. Statistical analysis was undertaken using the paired t‐test at P < 0.0167.

          Results

          A total of 135 participants were divided into three groups based on experience and clinical careers. The SACL improved in all skills between before and just after the seminar, however, they decreased between just after and a half‐year after the seminar. The SACL did not change significantly in all skills between just after and a half‐year after the seminar in highly experienced and experienced group members belonging to an emergency center.

          Conclusions

          A cadaver‐based seminar provided more self‐confidence just after the seminar for participants at all experience levels. This effect was not maintained after a half‐year, except in participants who can practice the skills at an emergency center. Practicing and participating in the seminar repeatedly is suggested to be effective for skills retention in trauma surgery.

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          Most cited references12

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          History and future of human cadaver preservation for surgical training: from formalin to saturated salt solution method.

          Traditionally, surgical training meant on-the-job training with live patients in an operating room. However, due to advancing surgical techniques, such as minimally invasive surgery, and increasing safety demands during procedures, human cadavers have been used for surgical training. When considering the use of human cadavers for surgical training, one of the most important factors is their preservation. In this review, we summarize four preservation methods: fresh-frozen cadaver, formalin, Thiel's, and saturated salt solution methods. Fresh-frozen cadaver is currently the model that is closest to reality, but it also presents myriad problems, including the requirement of freezers for storage, limited work time because of rapid putrefaction, and risk of infection. Formalin is still used ubiquitously due to its low cost and wide availability, but it is not ideal because formaldehyde has an adverse health effect and formalin-embalmed cadavers do not exhibit many of the qualities of living organs. Thiel's method results in soft and flexible cadavers with almost natural colors, and Thiel-embalmed cadavers have been appraised widely in various medical disciplines. However, Thiel's method is relatively expensive and technically complicated. In addition, Thiel-embalmed cadavers have a limited dissection time. The saturated salt solution method is simple, carries a low risk of infection, and is relatively low cost. Although more research is needed, this method seems to be sufficiently useful for surgical training and has noteworthy features that expand the capability of clinical training. The saturated salt solution method will contribute to a wider use of cadavers for surgical training.
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            Saturated Salt Solution Method: A Useful Cadaver Embalming for Surgical Skills Training

            Abstract This article evaluates the suitability of cadavers embalmed by the saturated salt solution (SSS) method for surgical skills training (SST). SST courses using cadavers have been performed to advance a surgeon's techniques without any risk to patients. One important factor for improving SST is the suitability of specimens, which depends on the embalming method. In addition, the infectious risk and cost involved in using cadavers are problems that need to be solved. Six cadavers were embalmed by 3 methods: formalin solution, Thiel solution (TS), and SSS methods. Bacterial and fungal culture tests and measurement of ranges of motion were conducted for each cadaver. Fourteen surgeons evaluated the 3 embalming methods and 9 SST instructors (7 trauma surgeons and 2 orthopedists) operated the cadavers by 21 procedures. In addition, ultrasonography, central venous catheterization, and incision with cauterization followed by autosuture stapling were performed in some cadavers. The SSS method had a sufficient antibiotic effect and produced cadavers with flexible joints and a high tissue quality suitable for SST. The surgeons evaluated the cadavers embalmed by the SSS method to be highly equal to those embalmed by the TS method. Ultrasound images were clear in the cadavers embalmed by both the methods. Central venous catheterization could be performed in a cadaver embalmed by the SSS method and then be affirmed by x-ray. Lungs and intestines could be incised with cauterization and autosuture stapling in the cadavers embalmed by TS and SSS methods. Cadavers embalmed by the SSS method are sufficiently useful for SST. This method is simple, carries a low infectious risk, and is relatively of low cost, enabling a wider use of cadavers for SST.
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              An improved low-formaldehyde embalming fluid to preserve cadavers for anatomy teaching.

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                Author and article information

                Contributors
                honchu@tokyo-med.ac.jp
                Journal
                Acute Med Surg
                Acute Med Surg
                10.1002/(ISSN)2052-8817
                AMS2
                Acute Medicine & Surgery
                John Wiley and Sons Inc. (Hoboken )
                2052-8817
                19 July 2016
                January 2017
                : 4
                : 1 ( doiID: 10.1002/ams2.2017.4.issue-1 )
                : 57-67
                Affiliations
                [ 1 ] Department of Emergency and Critical Care Medicine Tokyo Medical University Shinjuku‐ku Tokyo Japan
                [ 2 ] Department of Anatomy Tokyo Medical University Shinjuku‐ku Tokyo Japan
                [ 3 ] Department of Primary Care and Emergency Medicine Graduate School of Medicine and University School of Medicine Kyoto University Kyoto Kyoto Japan
                [ 4 ] Emergency Department Ikoma City Hospital Ikoma Nara Japan
                [ 5 ] Shock and Trauma Center Chiba Hokusoh Hospital Nippon Medical School Inba Chiba Japan
                [ 6 ] Department of Emergency and Critical Care Medicine Nihon University School of Medicine Itabashi Hospital Itabashi‐ku Tokyo Japan
                [ 7 ] Department of Traumatology and Reconstruction Surgery Fukushima Medical University Fukushima Fukushima Japan
                [ 8 ] Advanced Disaster Medical and Emergency Critical Care Center Niigata University Medical and Dental Hospital Niigata Niigata Japan
                [ 9 ] Department of Gastroenterological Surgery II Hokkaido University Graduate School of Medicine Sapporo Hokkaido Japan
                Author notes
                [*] [* ]Corresponding: Hiroshi Homma, MD, PhD, Department of Emergency and Critical Care Medicine, Tokyo Medical University, 6‐7‐1 Nishishinjuku, Shinjuku‐ku, Tokyo, 160‐0023 Japan. E‐mail: honchu@ 123456tokyo-med.ac.jp .
                Author information
                http://orcid.org/0000-0002-8254-3716
                Article
                AMS2230
                10.1002/ams2.230
                5667279
                29123837
                e4183486-bcd0-4351-9ff4-8f816ddefb28
                © 2016 The Authors. Acute Medicine & Surgery published by John Wiley & Sons Australia, Ltd on behalf of Japanese Association for Acute Medicine.

                This is an open access article under the terms of the Creative Commons Attribution‐NonCommercial‐NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.

                History
                : 05 March 2016
                : 12 June 2016
                Page count
                Figures: 2, Tables: 5, Pages: 11, Words: 7220
                Categories
                Original Article
                Original Articles
                Custom metadata
                2.0
                ams2230
                January 2017
                Converter:WILEY_ML3GV2_TO_NLMPMC version:5.2.1 mode:remove_FC converted:02.11.2017

                cadaver,educational seminar for trauma surgery,half‐year follow‐up,self‐assessment of confidence levels (sacl),skills retention

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