What do eggs, peppercorns, wooden skewers, and dental picks have in common with embedded corneal foreign bodies? Far more than you might think.
The most practical way to teach removal of such a foreign body is with a simulation device, but that is easier said than done. A review of the published medical literature revealed two models: One used glass spheres coated with paraffin; another used polyvinyl and gelatin. (Acad Emerg Med 1995;2:831; Emerg Med J 2014;31:329.) These simulation models were objectively assessed to be adequate, but we felt they had inherent limitations that restricted their day-to-day use.
Both required significant time to develop, prepare, and execute, and we deemed the cost too high to permit routine usage. Instead, we developed a model that incorporated the use of the slit lamp with the actual removal process. This technique was specifically chosen to teach optimal control and maximize patient safety.
We discovered after our study was completed that Michael Cassara, DO, an associate professor of emergency medicine at Hofstra North Shore-LIJ School of Medicine, had done similar research. (Acad Emerg Med 2011;18[Suppl 1]:S255; Simul Healthc 2012;7:547.)
All medical, nursing, pharmacy, physician assistant, EMS, and public health students at the University of Toledo are part of the Emergency Medicine Docent Program, a structured, multidisciplinary educational endeavor. Students enrolled in the month-long emergency medicine clerkship rotation not only participate in patient care activities, but also receive formalized didactic training, simulated clinical education with human simulators, and skills training with simulation models.
It wasn't long before these students mastered the slit lamp, and began asking how to remove an embedded corneal foreign body. This is not an unusual query because many of the health care students in the program intend to specialize in emergency medicine. The opportunity to see the technique in actual practice is pure serendipity, actually attempting it even less so. That is usually the domain of the junior EM resident.
These considerations led us to conceive a novel simulation that was easy to construct, quick to deploy, and inexpensive. Enter the egg, peppercorns, dental picks, and skewer. You will need to hard boil an egg to mimic the eye, and roll it on a bed of crushed peppercorns to mimic foreign bodies. Insert one skewer through the egg, and temporarily attach it onto the chin and forehead rest of the slit lamp. Adjust the chin rest to ensure that the egg and peppercorns are within the visual axis of the viewer, and secure the device with tape. Use a dental pick to demonstrate removal of a peppercorn fragment.
This simulation model takes only minutes to assemble, and is constructed so that multiple students can participate at one educational setting. The dental pick was chosen instead of a needle or burr to minimize expense and the risk of an accidental stick. We trialed the technique on medical and nonmedical faculty and students, and found it to be an efficacious educational device. It takes less than half an hour for a student to learn how to use the slit lamp and the technique for removing an embedded corneal foreign body. It also reassures educators that students are actually using the slit lamp correctly by being able to see and remove a peppercorn fragment from the egg's surface. The method was viewed positively by faculty and students even when compared with the gelatin simulation model that was described in the medical literature.
We have been so heartened by our findings that we have encouraged public health, nursing, and pharmacy students to participate in our slit lamp and foreign body removal education. This is especially important in times of catastrophe or pandemic when physicians, nurses, and midlevel providers are in short supply and health care delivery may be in the hands of nontraditional responders.
We are at the feasibility stage with the model and technique. A research study is planned to assess whether learning from the model would improve the emergency medicine resident's comfort level and prowess when dealing with an actual patient.Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.