Development of Simple and Advanced Adult Proximal Tibia Simulators for a Decentralized Simulation-Based Education Model to Teach Paramedics-in-Training the Intraosseous Infusion Procedure

Abstract

Introduction During the COVID-19 pandemic, public health had advised practicing social distancing which led to the temporary shutdown of simulation laboratories or centralized simulation-based education model, shared spaces that healthcare workers such as paramedics use to train on important hands-on clinical skills for the job. One such skill is intraosseous (IO) access and infusion, the delivery of fluids and medication through the marrow or medullary cavity of the bone which provides fast and direct entry into the central venous system. This skill is critical in emergencies when peripheral access is not immediately available. To continue the training of paramedics in life-saving skills like IO infusion in the post-pandemic era, a decentralized simulation-based education (De-SBE) model was proposed. The De-SBE relies on the availability of inexpensive and flexible simulators that can be used by learners outside of the simulation laboratory. However, to date, there is a paucity of simulation design methods that stimulate creativity and ideation, and at the same time, provide evidence of validity for these simulators. Our exploratory research aimed to test a novel approach that combines components of development-related constraints, ideation, and consensus (CIC) approach to develop and provide content validity for simulators to be used in a De-SBE model. Materials and methods The development of the IO simulators was constrained to follow a design-to-cost approach. First, a modified design thinking session was conducted with three informants from paramedicine and medicine to gather ideas for the development of two IO simulators (simple and advanced). Next, to sort through, refine, and generate early evidence of the content validity of the simulators, the initial ideas were integrated into a two-round, modified Delphi process driven by seven informants from paramedicine and medicine. In addition, we surveyed the participants on how well they liked the CIC approach. Results The CIC approach generated a list of mandatory and optional features that could be added to the IO simulators. Specifically, six features (one mandatory and four optional) for the existing simple IO simulator and eight (three mandatories and five optional) for the advanced IO simulators were identified. Following a design-to-cost approach, the features classified as mandatory for the simple and advanced IO simulators were integrated into the final designs to maintain the feasibility of production for training purposes. The surveys with the participants showed that the CIC approach worked well in the group setting by allowing for various perspectives to be shared freely and ending with a list of features for IO simulator designs that could be used in the future. Some improvements to the approach included flagging for potential users to determine what works best concerning the mode of delivery (online or in person), and duration of the stages to allow for more idea generation. Conclusion The CIC approach led to the manufacturing of simple and advanced IO simulators that would suit a training plan catered to teach the IO access and infusion procedure decentrally to paramedics-in-training. Specifically, they have been designed in a manner that allows them to be made easily accessible to the trainees i.e., low costs and high mobility, and work cohesively with online learning management systems which further facilitates the use of a De-SBE model.

Keywords: 3d-printing; additive manufacturing; emergency medicine; intraosseous infusion; pediatric emergency medicine; pediatrics; simulation-based medical education; simulator; three-dimensional printing; training.

Figure 1. The CIC approach

CIC: Constraints-ideation-consensus

Figure 2. Simple IO simulator on a stand

IO: Intraosseous

Figure 3. Solidworks rendering of advanced IO simulator with a cut in the top part of the leg that goes from the knee to the middle of the shin to create a small box where the bones can slide in

IO: Intraosseous

Figure 4. Solidworks rendering of advanced IO simulator modified with a small platform underneath to make the bones more stable at the moment of use

IO: Intraosseous

Figure 5. Solidworks rendering of advanced IO simulator showing the leg and the bone insert together

IO: Intraosseous

Figure 6. 3D-printed advanced IO simulator

IO: Intraosseous

Figure 7. 3D-printed advanced IO simulator with foam as fat

IO: Intraosseous

Figure 8. Silicone skin attachment for the 3D-printed advanced IO simulator

IO: Intraosseous

Figure 9. 3D-printed advanced IO simulator with silicone skin attachment on a 3D-printed stand

IO: Intraosseous