IntroductionCertifying boards mandate that its candidates be taught, and demonstrate competence in, the performance of certain diagnostic and therapeutic procedures. There are many disadvantages to the traditional methods used to teach procedures.

MethodsWe include the practical set up of the cadaver labs themselves including a list of supplies and space needed and a bibliography of pertinent literature. We provide: residency year-specific goals and objectives; notification letters to participants and faculty facilitators; handouts; and competency measurement instruments.

For lower level residents, we arrange for 2-3 residents and one faculty per cadaver. Residents are asked to prepare by reviewing the indications, contraindications, materials needed, landmarks and performance of the procedures from readily available references. We notify residents in advance of the format and evaluation criteria for each lab. We provide faculty facilitating the laboratory with the same materials and notifications and with the goals and objectives to be accomplished. Faculty also receive a scripted procedure to follow requesting the resident to role-play obtaining informed consent including listing indications and contraindications. The bulk of the time is spent on one-on-one supervision of the resident performing the procedure. Atlases and procedure texts are at each cadaver for real-time reference.

The “credentialing” laboratory is for graduating residents to document procedure performance competency. Faculty use a standardized evaluation instrument which includes time limits for some procedures and which becomes part of the resident’s file.

ResultsDuring 6 years of using this resource with little modification, we have found that scheduling instruction and evaluation during controlled workshops with a set curriculum and objective evaluation criteria on realistic, unembalmed cadavers allows for predictability, consistency, reproducibility, and thoroughness, and provides a framework upon which to document competence. The curriculum and set up maximizes use of resources, including the cadavers themselves, supplies, lab space and learner and faculty time.

We have studied and reported upon excellent learner acceptance of the laboratory and its significant effect on self-perceived confidence and competence.

SummaryWe provide a turn-key resource to replicate our successful unembalmed cadaver model for teaching procedures. We provide additional recommendations based upon lessons learned from our experience.

Selected Associated Scholarship Messina, F., Wilbur, L., Bartkus, E., Cooper, D., Huffman, G., (2008). A

Fresh Frozen Cadaver Procedure Laboratory. MedEdPORTAL: http://services.aamc.org/jsp/mededportal/retrieveSubmissionDetailById.do?subId=794

Pettit K, Bartkus E, Wilbur L, Messina F, et. al. The Use of a Fresh-Frozen Cadaver Lab to Assess Emergency Medicine Resident Perceived Procedural Competence and Comfort. American Academy of Emergency Medicine Scientific Assembly, 2008 Amelia Island, FL

Wilbur L, Messina F, Cooper D, Barroso, E. Use of an Embalming Machine to Create a Central Venous Access Model in Human Cadavers. Society for Academic Emergency Medicine Annual Meeting, New Orleans, LA 2009.

Messina F, Cooper D, Wilbur L, Bartkus E, Huffman G. Use of an Embalming Machine to Create a Fascial Compartment Pressure Monitoring Model in Human Cadavers. Society for Academic Emergency Medicine Annual Meeting, Phoenix, AZ 2010.

Table 2. Pre-lab and post-lab averages for both comfort (C) and perceived competence (PC) for PGY-2 residents. A p-value of less than 0.0025 indicates statistical significance.

A Fresh Frozen Cadaver Procedure LaboratoryFrank Messina MD, Dylan Cooper MD, Lee Wilbur MD, Edward Bartkus MD, Gretchen Huffman RN, MBA

Department of Emergency Medicine, Indiana University School of Medicine

Contact informationFrank Messina, M.D.E-mail: fmessina@iupui.edu317-630-7276

Publication DescriptionThis educational resource is a model and a curriculum using thawed, freshly-frozen cadavers to teach procedural skills to, and test their performance by, residents and other learners. The procedures include:

Table 1. Pre-lab and post-lab averages for both comfort (C) and perceived competence (PC) for incoming PGY-1 residents. A p-value of less than 0.0025 indicates statistical significance.

We have also since developed and reported upon several improvements to the laboratories. Using a fresh, never frozen, cadaver infused with standard embalming fluid, we have found that teaching upper body central line insertion is even more realistic and predictable because the intravascular space is more reliably filled. The leg into which the embalming fluid infuses becomes tense and serves as a realistic model to teach compartment pressure measurement. We no longer teach lumbar punctures because the cadavers are too difficult to position properly. Using a chamois cloth as replacement “skin”, allows us to teach cricothyrotomy multiple times on one cadaver.

• Cricothyrotomy • Pericardiocentesis • Lateral canthotomy

• Needle thoracostomy • Tube thoracostomy • Endotracheal intubation

• Arthrocentesis and joint

injection (shoulder, knee, wrist, ankle

• Central venous catheter insertion (subclavian, supraclavicular, internal jugular, femoral)

• Compartment pressure measurement• Intraosseous needle insertion

Figure 1: Embalming machine set-up for augmented central venous insertion and compartment pressure measurement.

Figure 2: Using chamois cloth for repeated cricothyrotomies.

Figure 3: Central Venous Catheter Insertion