A Simulation Model for Extensor Tendon Repair

Audience: This simulation model is designed for use by emergency medicine residents. Although we have instituted this at the PGY-2 level of our residency curriculum, it is appropriate for any level of emergency medicine residency training. It might also be adapted for use for a variety of other learners, such as practicing emergency physicians, orthopedic surgery residents, or hand surgery trainees. Introduction: Tendon injuries commonly present to the emergency department, so it is essential that emergency physicians be competent in evaluating such injuries. Indeed, extensor tendon repair is included as an ACGME Emergency Medicine Milestone (Milestone 13, Wound Management, Level 5 – “Performs advanced wound repairs, such as tendon repairs…”).1 However, emergency medicine residents may have limited opportunity to develop these skills due to a lack of patients, competition from other trainees, or preexisting referral patterns. Simulation may provide an alternative means to effectively teach these skills in such settings. Previously described tendon repair simulation models that were designed for surgical trainees have used rubber worms4, licorice5, feeding tubes, catheters6,7, drinking straws8, microfoam tape9, sheep forelimbs10 and cadavers.11 These models all suffer a variety of limitations, including high cost, lack of ready availability, or lack of realism. Objectives: We sought to develop an extensor tendon repair simulation model for emergency medicine residents, designed to meet ACGME Emergency Medicine Milestone 13, Level 5. We wished this model to be simple, inexpensive, and realistic. Methods: The learner responsible content/educational handout component of our innovation teaches residents about emergency department extensor tendon repair, and includes: 1) relevant anatomy 2) indications and contraindications for emergency department extensor tendon repair 3) physical exam findings 4) tendon suture techniques and 5) aftercare. During their PGY-2 year, emergency medicine residents are provided the learner responsible content/educational handout on a rotating basis. Residents are provided these materials approximately three weeks prior to a scheduled simulation lab session. The learner responsible content/educational handout are to be completed prior to the simulation lab session. The learner responsible content/educational handout are estimated to take residents one hour to complete. During the scheduled lab session, each resident is supplied two w