K. Maciolek1, A. Terry1, R. Ray1, S. Laufer1, P. Barlow1, C. Pugh1 1University Of Wisconsin School Of Medicine And Public Health,Department Of Surgery,Madison, WI, USA
Introduction: The clinical breast examination (CBE) poses a unique teaching challenge. Students are uncomfortable and ill prepared to perform the CBE at the end of training. Simulation technology provides a readily available learning platform for training CBE skills. However, current commercial simulators have a homogenous appearance and consistency that lack realism crucial for trainees to achieve competency. The study aim was to assess the visual and tactile realism of three silicone breast skins for improvement of the skin currently used for one CBE simulator.
Methods: Study participants (N=42) included a convenience sample of clinicians at an academic training program: nurses (N=23), medical students (N=9), pharmacy staff (N=6) and physicians (N=3). Participants performed CBEs on three breast models prepared from the same mold but using different silicone materials (Smooth-On, Inc., Easton, PA). Material A was a single layer of Soma Foma 15, material B was a single layer of EcoFlex 30, and material C was three layers, two made with Dragon Skin 10 and a middle layer containing 200% Slacker. On day one, the breast skins were filled with a hard breast positive, and on day two a soft silicone mastectomy insert (Nearly Me Technologies, LLC, Waco, TX). After performing the CBE, participants completed a survey to assess the realism of the shape, softness and elasticity of the breast and nipple (4-point Likert scale: 0 = Not at all realistic; 3= Highly realistic) and ranking the models on visual appearance, tactile characteristics and overall realism. Repeated measures ANOVA tested if the samples differed in realism. A Chi-Square was performed on the rank questions of visual, realistic feel and overall preference.
Results: All forty-two participants (90.4% female) performed CBEs on all three of the different materials. Soma Foma was rated as much more realistic than EcoFlex and Dragon skin on all measures (shape, softness and elasticity) with the exception of the shape of the nipple, p>.05 (Table 1). Soma Foma was ranked higher on visual appearance, tactile characteristics and overall realism compared to EcoFlex and Dragon skin (p<.001). These results were independent of the breast insert that was placed under the skin (p>0.05).
Conclusion: This study was successful at collecting useful discriminating information about different silicone materials used to fabricate CBE simulator skins. Overall, participants preferred the skin comprised of Soma Foma. Review of participant comments suggests that Soma Foma’s superiority may result from the idealistic youthful appearance and overall heat retention at room temperature. Further work is needed to assess the role of how psychosocial factors effect evaluations of simulator realism.
