1. What is the purpose of the CIRCLES program?
The purpose of the CIRCLES program is to develop and implement a combined didactic and hands-on circumcision simulation course for pediatric residents. The aim is to improve their knowledge and confidence in performing neonatal circumcision, ultimately reducing serious preventable complications. The program also compares the effectiveness of in-person versus virtual coaching in skills and knowledge gaining, and self-efficacy perception of participants in the circumcision simulation. This intervention was developed in response to the lack of formal training available to healthcare practitioners performing newborn circumcision, with the goal of enhancing the training and safety of patients.
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2. How was the CIRCLES task trainer designed?
The CIRCLES task trainer was designed using CAD software to create a mold for the initial model. This mold was then 3D printed and silicone was used to cast the object. A base and lid were also designed and 3D printed to house the silicone trainer and act as a body for the trainer. The silicone model fit within the base, and the lid was secured over top. Both 3D printed parts were fixed together using acetone. Balloons were cut to the size of the silicone trainer, and a hole was cut at one end to accurately simulate the foreskin. A triangular piece of sponge was cut and secured to the bottom of the task trainer to simulate the correct angle and movement of the model. An opening was designed horizontally through each base to secure the trainer to the table using tape. A 3D-printed arm was designed, printed, and fixed to the bottom of the trainer to provide greater stability. The 3D-printed, high-fidelity, reusable silicone mold of an infant male penis 3 cm in length was attached to a soft plastic base simulating the lower abdomen, thighs, and scrotum. A latex sleeve was used to simulate the prepuce. The instruments used for the simulated circumcisions were the same as those used in real circumcisions.
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3. What is the purpose of the 3D printed silicone task trainer?
The 3D printed silicone task trainer serves as a teaching tool for anatomical landmarks and areas of needle insertion for the ring penile block. It provides a realistic model for practicing circumcisions, with features such as penopubic crease, penoscrotal junction, coronal edge, frenulum, and a balloon sleeve cut to simulate the foreskin. The trainer is designed to be secured to a table using an arm and tape for stability during training sessions. It is used in a clinical setting under faculty supervision to enhance the skills and confidence of medical professionals performing circumcisions.
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4. How did learners' skills and self-efficacy change after the course?
The Wilcoxon Sum Rank test showed a median increase of 20 points in participants' post-knowledge test scores compared with pre-knowledge test scores, indicating a significant improvement in skills and knowledge. Z score assessment for mean values (changes from baseline) favored post-CIRCLES, except for management of bleeding. Self-efficacy assessment showed mean change +- standard deviation from baseline, with learners feeling more confident in performing neonatal circumcision. Overall, learners reported increased understanding, ability, and confidence in performing neonatal circumcision on the simulator, with a majority choosing to perform circumcision with the Gomco clamp. The course also improved learners' ability to counsel on the procedure, manage complications, and evaluate suitability for circumcision.
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