VCOM Carolinas Research Day 2023

Simulation and Technology

PRODUCTION OF A LOW-COST, ULTRASOUND-CAPABLE SHOULDER MODEL FOR INJECTION AND ASPIRATION SIMULATION Kyle Kleiman, OMS-II, Nicholas Minner, OMS-II, Michael Parks, NREMT, Tarraz Woodruff, RN, Dr. Tom Lindsey, DO . VCOM-Carolinas, Spartanburg, SC Abstract Results Results

Abstract # SIM-2

Shoulder osteoarthritis is a major cause of morbidity. Studies show benefit to medical intervention, such as steroid injection, in patients with osteoarthritis. Simulation training provides a risk-free training method for shoulder injection. Medical students can be introduced to the skills necessary to perform a shoulder injection in a low-stress and low stakes environment prior to injecting a patient. Traditional shoulder injection models for simulation purposes can be quite expensive, ranging from $1,000 to $4,500. Additionally, many contemporary shoulder models do not feature ultrasound capability. The aim of the project was to create a low-cost, reproducible, ultrasound-capable shoulder trainer for medical students to practice joint injections and aspirations. An anatomically accurate shoulder was used as a template to create a reusable, primary mold of the shoulder joint and surrounding tissue. The primary mold was filled with a quick drying, semi-rigid plastic to create a usable model of the anatomically accurate shoulder. The casted shoulder model acted as an outer shell to house the bones and bursa sac. The shoulder bony anatomy was re-created by casting anatomically accurate bones of the scapula and humerus with a low viscosity silicone rubber to create a reusable, mold. New bones were casted using a liquid plastic mixture poured into the mold. To make the trainer ultrasound capable, a mold was uniquely designed to act as a refillable bursa sac where joint injections would take place between the scapula and the humerus. The bones and injectable bursa sac were placed and surrounded by ultrasound capable silicon with life-like contours and color. The injectable mold was placed on the casted shoulder model and was covered with silicon life-like skin. Methods

Shoulder injection is a common procedure. It is important for students to gain comfort with the intervention in a low-stress setting. A low-cost, ultrasound-capable shoulder injection trainer should facilitate practice of this procedure due to removal of potential cost barriers. The goal of simulation training for medical students is to better prepare students to perform during their future clinical practice. Future research will further examine the usage of this trainer in medical education, as well as the difference between ultrasound guided and landmark guided shoulder injections. The finished product was found to be ultrasound capable and featured anatomically palpable and ultrasound landmarks. The trainer featured capability for usage of simulation of joint bursa injection and fluid aspiration. Total cost for the project creation was less than 1,000.00 USD and reproducible cost of 500.00 USD per shoulder model. Conclusions

Figure 1. Photos of the design process. Primary mold (left), support shell for primary mold (center), and casted shoulder model (right). The casted shoulder is the platform for the replaceable joint injector chicklet to set on and will then be covered with and outer skin layer.



Table 1 . Table 1 compares cost and features of contemporary shoulder trainer models. The VCOM Shoulder model will have all the features of the most expensive model for a fraction of the price.

1.Stanborough RO, Bestic JM, Peterson JJ. Shoulder Osteoarthritis. Radiol Clin North Am. 2022 Jul;60(4):593 – 603. 2.Okuda Y, Bond W, Bonfante G, McLaughlin S, Spillane L, Wang E, et al. National growth in simulation training within emergency medicine residency programs, 2003-2008. Acad Emerg Med. 2008 Nov;15(11):1113 – 6. 3.Al-Elq AH. Simulation-based medical teaching and learning. J Family Community Med. 2010 Jan;17(1):35 – 40.


Figure 2 . Total cost savings for VCOM to acquire ultrasound-capable shoulder models. For procedural skills, each of the four campuses would need 6 models. The VCOM shoulder trainer would be approximately 1/10th of the price of the current commercially available shoulder trainers. The calculated savings for using this shoulder model estimated to $100,000.

We would like to thank the Simulation Center at VCOM for their investment in VCOM students and support of this project.


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