A Low-Cost Task Trainer Constructed from Silicone Nipple Covers

This low-cost task trainer is intended for the education of medical students, advanced practice providers and surgical subspecialties interns, including emergency medicine.

Superficial soft-tissue abscesses are a frequent chief complaint in any emergency department, with up to 3.2 % of patients presenting with this issue.1 The preferred method for treatment is incision and drainage (I&D) because antibiotics alone are often insufficient.2,3 There are two common methods for draining abscesses. The first is a single linear incision over the length of the abscess that is either left open or packed with gauze which is removed 24-48 hours later.4 The second is the loop technique, which uses two smaller parallel incisions with a sterile rubber or plastic tube threaded through them and tied into a circle.5,6While abscess drainage is a common procedure for surgical and sub-surgical specialties, it is not often taught in medical schools or to residency prior to performing in the patient care setting. Frequently, this is due to the to lack of access to affordable commercial task trainers, which range in cost from $19.99 up to $171.00 per single use device.7,8 Other published low-cost task trainers require cadavers or are more time intensive or require creative set up.9,10 This nipple cover task trainer gives a realistic feel for anesthetizing and incising abscesses using affordable material and requires minimal preparation time. Even centers with limited simulation capabilities can create and use this task trainer because it uses material that is readily available.

By the end of this training session, learners will be able to anesthetize an abscess, perform incision and drainage, develop manual dexterity maneuvering instruments to break up the abscess, and place packing using both the linear incision and loop techniques.

The abscess task trainers were fabricated using pre-made nipple covers, plastic wrap, and unscented hand lotion. The nipple covers come with a sticky backside that can allow adherence to plastic wrap. The plastic wrap is then filled with hand lotion and folded to prevent leakage. The nipple covers can then be anesthetized and incised. The time to fabricate each abscess was approximately one to two minutes.

Eight PGY-1 emergency medicine residents completed a pre-simulation survey evaluating their confidence in draining an abscess using a five-point Likert scale (1=strongly disagree, 5 = strongly agree). Residents observed the instructor demonstrate the procedure, and then they performed two abscess drainages on separate nipple covers, one using a single linear incision and the other the loop technique. After the simulation, the resident confidence levels were reassessed using the same five-point Likert scale. Residents were also asked to rate the fidelity of the task trainer, compared to a real abscess (1= strongly disagree, 5 = strongly agree).

Residents reported an increase in their mean confidence in draining an abscess, with an increase from the pre-simulation score of 3.5 to 4.875 (p=0.0038). Residents also felt that the model was realistic, with a mean score of 4.875. Every resident recommended using this model for future learners.

Overall, this affordable and simple task trainer was well received by the learners and improved beginner confidence with a frequently performed procedure. With minimal preparation time and resources, this nipple cover task trainer can be used to teach residents how to anesthetize, incise, drain, and pack abscesses.

Abscess, incision and drainage, simulation, task trainer.