EM - ORIGINAL Cadaver-based training is superior to simulation training for cricothyrotomy and tube thoracostomy James Kimo Takayesu 1 • David Peak 1 • Dana Stearns 1 Received: 6 November 2015 / Accepted: 14 March 2016 Ó SIMI 2016 Abstract Emergency medicine (EM) training mandates that residents be able to competently perform low-fre- quency critical procedures upon graduation. Simulation is the main method of training in addition to clinical patient care. Access to cadaver-based training is limited due to cost and availability. The relative fidelity and perceived value of cadaver-based simulation training is unknown. This pilot study sought to describe the relative value of cadaver training compared to simulation for cricothyro- tomy and tube thoracostomy. To perform a pilot study to assess whether there is a significant difference in fidelity and educational experience of cadaver-based training compared to simulation training. To understand how important this difference is in training residents in low- frequency procedures. Twenty-two senior EM residents (PGY3 and 4) who had completed standard simulation training on cricothyrotomy and tube thoracostomy partici- pated in a formalin-fixed cadaver training program. Par- ticipants were surveyed on the relative fidelity of the training using a 100 point visual analogue scale (VAS) with 100 defined as equal to performing the procedure on a real patient. Respondents were also asked to estimate how much the cadaveric training improved the comfort level with performing the procedures on a scale between 0 and 100 %. Open-response feedback was also collected. The response rate was 100 % (22/22). The average fidelity of the cadaver versus simulation training was 79.9 ± 7.0 vs. 34.7 ± 13.4 for cricothyrotomy (p \ 0.0001) and 86 ± 8.6 vs. 38.4 ± 19.3 for tube thoracostomy (p \ 0.0001). Improvement in comfort levels performing procedures after the cadaveric training was rated as 78.5 ± 13.3 for tube thoracostomy and 78.7 ± 14.3 for cricothyrotomy. All respondents felt this difference in fidelity to be important for procedural training with 21/22 respondents specifically citing the importance of superior landmark and tissue fidelity compared to simulation training. Cadaver- based training provides superior landmark and tissue fide- lity compared to simulation training and may be a valuable addition to EM residency training for certain low-fre- quency procedures. Keywords Procedures Á Competence Á Patient care Á Patient simulation Á Cadaver Á Airway management Á Graduate medical education Á Residency Á Emergency medicine Introduction Emergency medicine training mandates that residents be able to competently perform low-frequency critical pro- cedures upon graduation [1–3]. Training in low frequency procedures such as cricothyrotomy and tube thoracostomy relies on the use of simulation models to supplement clinical exposure in settings where an insufficient number of these procedures are done in clinical practice [4]. Using cadavers for teaching purposes is often limited to medical student anatomy class, and may involve as much non- technical learning as technical learning [5, 6]. Cadaver- based procedural training can provide a valuable opportu- nity to residents for learning and demonstrating compe- tence in the performance of procedures prior to transitioning those skills to actual patients [7, 8]. Skills demonstrated in cadaveric models have been demonstrated & James Kimo Takayesu jtakayesu@partners.org 1 Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA 02114, USA 123 Intern Emerg Med DOI 10.1007/s11739-016-1439-1