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Sábado, 25.07.15

Simulation tool teaches clinical breast examination

Simulation tool teaches clinical breast examination

 

Despite the use of ever-increasingly advanced technology to diagnose breast cancer, the role of the clinical breast examination is as important as ever. To further advance the hands-on technique, a new sensor-based tool has been designed to improve the technique.

Carla Pugh, MD, PhD, and her group at the University of Wisconsin (UW) Health Clinical Simulation Program are known for innovating the use of simulation-based tools for teaching and evaluating surgical and examination techniques. They have explored sensor-based techniques for cast placement and removal, for learning ultrasound examination of the thyroid, and for teaching pelvic examinations in the developing world.1-3 Recently, Pugh's team focused on refining the clinical breast examination. Pugh, a surgeon, is clinical director of the UW Health Clinical Simulation Program and director of patient safety and education at the University of Wisconsin Hospital and Clinics. She is a proponent of using haptic skills in medicine, and to that end she has created a variety of simulative models for teaching clinicians effective manual examination techniques.

HAPTICS

In a talk at TedMed 2014, Pugh described haptics as “the art and science of touch. Knowing how to touch something. Knowing how things are supposed to feel.” It is the ability to discern the difference between what is normal and what is not normal. The tricky thing about haptics is that we do not have a sure-fire way of teaching it; nor do we have a way of measuring it. Therefore, we have no way of measuring an operator's competency in the technique, Pugh explained.4

“How could clinicians learn the technique? How can a body of knowledge be mastered when some of its most important aspects cannot be taught in a lecture, read in a book, or even be experienced—such as in an emergency, when situation can change so quickly?”4

CLINICAL BREAST EXAMINATION

The current method for training a clinician to perform a clinical breast examination is to have an experienced practitioner observe the trainee palpate the breast. Visual observation, however, does not convey the degree of pressure the trainee is using to palpate the breast and whether it is enough to detect a mass, which is the crucial point of the examination. To this end, Pugh and her team devised a sensor system that registers the amount of force applied. The device creates a map of the trainee's palpation that shows blue where the least pressure was applied and red where the most pressure was applied.

The UW group conducted a study in 2013 and 2014 to see how much more accurate the haptic sensor-equipped training device is compared with an examination conducted by an experienced clinician.5 For the project, practicing physicians performed simulated clinical breast examinations exactly the way they would on a symptomatic patient who presents in an office visit. The fictional patient claims to have felt a mass on self-examination but is currently unable to locate the lesion.

 

The researchers recruited a total of 553 physician attendees from three annual clinical meetings: the American Society of Breast Surgeons (136 doctors), the American Academy of Family Physicians (236 doctors), and the American College of Obstetricians and Gynecologists (181 doctors). The participants used the Pugh devices specifically developed to teach breast examination techniques. There were four models.

  • Model A had a soft, superficial mass measuring 2 cm by 2 cm.
  • Model B was the same as model A, except the mass was smaller (2 cm by 1 cm).
  • Model C had a hard, 2-cm mass located near the chest wall.
  • Model D was the same as model C, except the mass was molded from a soft silicone derivative.

The videos, combined with sensor-map recordings, show successful and unsuccessful techniques for clinical breast examinations. The least successful technique was associated with a light palpation; that technique placed the physicians at significant risk for missing deep-tissue lesions near the chest wall.

This study underscores the potential that sensor technology has for teaching proper technique and thereby extending the lives of patients who might otherwise be lost to breast cancer.

 


Bette Weinstein Kaplan is a medical writer based in Tenafly, New Jersey. 


 REFERENCES

1.  Maag AL, Laufer S, Kwan C, Cohen ER, Lenhart RL, Stork NC, Halanski MA, Pugh CM. Sensor-based assessment of cast placement and removal. Stud Health Technol Inform. 2014;196:259-61.

2: Kwan C, Cohen E, Pugh C. Application of a new adaptable thyroid model for ultrasound and hands-on skill assessment. Stud Health Technol Inform. 2014;196:230-2.

3: Kwan C, Cohen E, Salud L, Pugh C. Modification of the pelvic examination simulator for the developing world. Stud Health Technol Inform. 2014;196:222-4.

4. TedMed 2014: Carla Pugh. Available at: http://www.tedmed.com/talks/show?id=292997. Accessed April 12, 2015

5: Laufer S, Cohen ER, Kwan C, D'Angelo AL, Yudkowsky R, Boulet JR, McGaghie WC, Pugh CM. Sensor technology in assessments of clinical skill. N Engl J Med. 2015 Feb 19;372(8):784-6.. 

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