Low‐cost simulation models for teaching episiotomy/laceration repair and venous cutdown

⁎ Corresponding author. Department of Gynecology and Obstetrics, Groningen University Medical Center, PO Box 30.001, 9700 RB, Groningen, The Netherlands. Tel.: +31 50 3613000; fax: +31 50 3611806. E-mail address: luc@vanlonkhuijzen.com (L. van Lonkhuijzen). Recently, there has been progress in reaching the fifth Millennium Development Goal, which is to reduce maternal mortality by threequarters between 1990 and 2015 [1]. However, manywomen still die as a result of obstetric complications; thesedeaths couldbepreventedwith appropriate and timely treatment. Several courses exist that aim to improve emergency obstetric care, some of which are available free of charge on the Internet [2]. These courses recommend simulation and role play as a way to practice technical and non-technical skills. Using a simulationmodel topractice skills has the advantage that the skill canbe acquired at a convenient time and, moreover, that patients do not need to be exposed to inexperienced learners. However, most commercially available models may not be affordable in a low-resource setting. The present paper describes 2models—1 for teaching episiotomy repair and 1 for venous cutdown—both of which can be locally produced at low cost. Instructions on how to construct and use the models are available free of charge on the Internet or through the WHO HINARI program. Themodel for practicing perineal repair is constructed from a large sponge [2]. Instructions on how to make and use the model, in addition to a useful presentation of the required skills for learners, are available online [3]. Learners can practice handling the suturing instruments and repairing perineal lacerations and fourth-degree tears. This method has been successfully used to train physicians, with learners subsequently reporting increased confidence [4]. The venous cutdown model is constructed from a length of wood (approximately 20×3×0.5 cm) covered by cast padding to simulate subcutaneous tissue [5]. A 6-mm penrose drain is placed lengthwise between the layers of padding—to simulate the vein—and stapled at both ends. The padding is covered by adhesive tape to simulate the skin. Bicycle valve tubingmay be used as an alternative to the penrose drain. Klofas [5] described and illustrated thevenous cutdownprocedureusing a wire, dilator, and catheter. The same model can be used to practice venous cutdown using a more traditional approach, as illustrated in the WHO IMPAC guide [6], which is available in 7 languages.