Simple Auricular Hematoma ("Cauliflower Ear") Task Trainer

This auricular hematoma task trainer is designed to instruct emergency medicine (EM) residents, fellows, and medical students. Otolaryngology trainees may also benefit from this simulator.

Auricular hematomas are relatively infrequent but require timely intervention to prevent complications such as infection, cartilage necrosis, or permanent ear deformity ("cauliflower ear").1 Although these injuries make up only a small part of all otologic complaints in the emergency department, they are one of the most frequent ear injuries in contact sports, with wrestlers, boxers, and rugby players being the most at-risk.2 Not only can they occur in sports, one urban level I trauma review found 42% of auricular hematoma presentations were due to interpersonal violence or assault,3 making timely drainage a core skill now listed in the 2022 Model of the Clinical Practice of Emergency Medicine.4 EM residents often have limited opportunities to gain hands-on experience with this procedure in a controlled learning environment, with a low reported baseline confidence level highlighting a persistent training gap.5 Traditional models are expensive and single-use, with each one costing up to $60-100.6 This innovation was developed to address a training gap by providing a simple, affordable, and reproducible task trainer that enables learners to practice landmark identification, drainage, and post-procedure care of auricular hematomas with confidence.

By the end of this session, learners will be able to: 1) identify the landmarks used to drain auricular hematomas, 2) demonstrate the ability to numb, incise, and drain an auricular hematoma, and 3) review methods for applying dressings to auricular hematomas.

Residents were given a five-minute in-person demonstration of how an auricular hematoma is drained using one of the models. They were then able to walk through the steps of incising, draining, and dressing the ear themselves using material found in the emergency department. The EMRAP instructional video was reviewed by the attending conducting the demonstration prior to teaching.7.

Eleven participants were instructed to incise and drain an auricular hematoma. The Michigan Standard Simulation Experience Scale (MiSSES) was used for anonymous feedback on the task trainer immediately after the simulation. Participants scored the simulator in five categories: Self-efficacy, fidelity, educational value, teaching quality, and the overall rating on a 5-point Likert scale, 1 = Strongly Disagree, 5 = Strongly Agree. The scale is a freely available, validated subjective-assessment tool created at the University of Michigan to standardize the evaluation of simulation-based education. In the scale, there are six domains for evaluation, and they demonstrated good internal consistency at initial psychometric testing.8 Variables were summarized using the mean and standard deviation.

The eleven participants were composed of 7 PGY 1 EM residents and 4 EM attendings. They all completed the simulation and filled out the MiSSES form. Of the residents, none had any previous experience with auricular hematoma drainage. Of the attendings, all had done one previously, but none more than 3. Using the MiSSES, the model received an overall positive rating of 5.0. The highest rating was on teaching quality (5.0) and educational value (5.0). For fidelity, the trainer received a 4.9/5.

Overall, the residents felt that this simulation was a good training tool for auricular hematoma, which is a lower occurrence but time-sensitive procedure. We created a reusable and cheap simulator model that scored high in a standard simulator's assessment survey.

Auricular hematoma, incision and drainage, cauliflower ear.