2.1
The METI Pelvic ExamSIM™ Opening the mind’s eye… Congratulations and welcome to the METI family of users! We are excited about your purchase of the METI Pelvic ExamSIM™ and are confident that our product will greatly improve the education process of healthcare students and practitioners. Until now, objective assessment of technical and hands-on clinical skills was virtually non-existent in the area of the female pelvic exam because you cannot measure what you cannot see. That’s why we introduced the METI Pelvic ExamSIM. By creating a platform that offers truly objective and measurable feedback, learners and instructors alike can know first-hand if they are ready to perform proficient and sensitive female pelvic examinations. Using patented Touch-Sensitive™ technology, licensed exclusively to METI, the ExamSIM opens the mind’s eye to provide a greater overall learning experience. One of the many things that make the ExamSIM unique as a teaching tool is the immediate visual feedback on performance during the exam. In addition, the ExamSIM can be used for assessing clinical skills by using data collection and processing capabilities. With this system, users can track their progress in doing the exam as they transition from a novice to a more experienced clinician over time. The ExamSIM creates formative assessment during the examination process by allowing the user to compare his or her performance ratings to a previously collected and analyzed database of over 400 novice examiners and over 700 experienced examiners. Additionally the system allows for a summative assessment that demonstrates the mastery of clinical skills.
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The ExamSIM was designed to represent variations of normal anatomy as well as pathology. The system is highly adaptable to represent various patient case types and clinical presentations, including a clinical setting. The use and implementation of this teaching tool is only limited to the instructor’s imagination! But to get you started, we have included four Learning Cards, which include examples of possible simulations you can create to enhance the learning experience for your students. At METI, we know that experience is often the best teacher, so we work hard to create patient simulators that are life-like and believable. It is our commitment to medical education that drives us to continually push the envelope of technology and create the finest products for the finest teaching institutions in the world. We look at our customer base as a family, and we take a vested interest in the medical education profession by creating partnerships that support our family of users. We stand behind you as well as our products. That’s the METI difference!
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How to use this User Guide This User Guide has been designed for quick access to information on how to use and maintain your METI Pelvic ExamSIM. Please make sure that you follow the Cautions & Warnings in this User Guide, which are listed in red and purple. This is for the safety of you and your students as well as for the protection of your simulator. Each tab has been designed to keep valuable information at your fingertips. We have included an Equipment Overview to make sure that you received all of the components of the ExamSIM system, and to help familiarize you with how these components are interrelated. We suggest that you take a careful inventory when you first receive your ExamSIM in order to ensure that you have everything you need to get started. The Set Up/Breakdown section provides simple step-by-step instructions along with images and screen shots to help illustrate the assembly of the mannequin, internal anatomy and the computer component. We recommend that you follow these steps each time you use your ExamSIM to ensure that the system is always set up properly and disassembled and stored correctly. The Quick Start section gives you a broad overview on how to operate the system. It is designed to get you up and running with general functionality. This section is only a quick reference to turn to for the most basic start up functions. For comprehensive usage instructions, please turn to the Using the System section. Here you will find pertinent terminology for using the system and various usage instructions. Additionally, complete software instructions are detailed with helpful screen shots and navigation steps. The Use for Learning section includes useful implementation suggestions and helpful content that encourages users to think outside the box and develop learning modules that meet individual educational goals. We encourage you to follow the guidelines in the Care/Maintenance section, as this will ensure that your ExamSIM is maintained to the highest standards. Maintenance issues are less likely to occur if your system is cared for properly. Additionally, this section includes instructions on minor user-supported maintenance steps.
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We have supplemented this User Guide with a set of four Pelvic ExamSIM Learning Cards. Designed to help you establish your own case studies, these cards outline how to evolve a learning module, right down to the very last detail. We encourage you to use these cards and then expand cases of your own. The remaining sections of this User Guide include an Index and Warranty & Customer Service content. Finally, we have included a Quick Start Chart to use for easy reference and to support independent student learning modules. This card provides all the key steps for set up and use of the ExamSIM in a convenient format.
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M e d i c a l E d u c a t i o n Te c h n o l o g i e s , I n c .
M e d i c a l E d u c a t i o n Te c h n o l o g i e s , I n c .
M e d i c a l E d u c a t i o n Te c h n o l o g i e s , I n c .
Medical Education Technologies, Inc. 6000 Fruitville Road Sarasota, FL 34232 941-377-5562 fax 941-377-5590 www.meti.com © 2003 METI Sarasota, FL
M e d i c a l E d u c a t i o n Te c h n o l o g i e s , I n c .
Simulation Innovation Exploration
Customer Service (Toll Free) 866-462-7920 or 941-342-5605
Medical Education Technologies, Inc. 6000 Fruitville Road Sarasota, FL 34232 941-377-5562 fax 941-377-5590 www.meti.com © 2003 METI Sarasota, FL
M e d i c a l E d u c a t i o n Te c h n o l o g i e s , I n c .
Introduction......................................................................................i How to Use this User Guide............................................................iii Cautions & Warnings....................................................................0.0 Equipment Overview.....................................................................1.0 Standard Equipment Inventory Chart...........................................1.2 Optional Equipment Inventory Chart.............................................1.3 Complete Inventory Overview.......................................................1.4 Female Pelvic Assembly..........................................................1.4 Fat Pad....................................................................................1.5 Interchangeable Internal Anatomy Components.....................1.6 Computer Workstation............................................................1.7 Silicone Oil..............................................................................1.8 Helix Connectors Kit................................................................1.8 Four Learning Cards................................................................1.8 ExamSIM Instrumented Internal Anatomy Spares Kit...................1.9 Female Pelvic Assembly with Computer Workstation and METI Pelvic ExamSIM Software..................................................1.9 Set Up/Breakdown.......................................................................2.0 Set Up...........................................................................................2.1 Configuring the Pelvic Assembly.............................................2.1 Configuring the Computer Workstation and Power Supply.....2.7 Breakdown — Lab Environment.................................................2.10 Shutting Down the Computer Workstation............................2.10 Disconnecting the Pelvic Assembly.......................................2.12 Breakdown — Non-Lab Environment.........................................2.13 Shutting Down the Computer Workstation............................2.13 Disconnecting the Pelvic Assembly.......................................2.15 Cleaning Considerations.............................................................2.15
M e d i c a l E d u c a t i o n Te c h n o l o g i e s , I n c .
Quick Start...................................................................................3.0 Quick Chart: Complete Pelvic ExamSIM Set Up...........................3.1 Quick Chart: Learning Mode.........................................................3.2 Quick Chart: Assessment Mode...................................................3.3 Quick Chart: After Action Review..................................................3.3 Quick Chart: Save As....................................................................3.4 Using the System.........................................................................4.0 Usage............................................................................................4.2 Mannequin Assembly Terminology...............................................4.2 Pelvic Assembly......................................................................4.2 Pelvic Cavity............................................................................4.2 Abdominal Skin Covering........................................................4.3 Abdominal Wall.......................................................................4.3 Internal Anatomy Components................................................4.4 Signal Box...............................................................................4.5 Simulator Electronics..............................................................4.5 USB Data Cable......................................................................4.5 Computer Workstation Terminology..............................................4.6 Computer Workstation...........................................................4.6 Software Terminology....................................................................4.6 Operating System...................................................................4.6 User Interface Window............................................................4.6 Software Terms.......................................................................4.6 Main User Interface Window...................................................4.7 Status Box...............................................................................4.7 Dialog Box...............................................................................4.8 Start Button.......................................................................4.8 Main User Interface Window Terminology.....................................4.9 File...........................................................................................4.9 Edit..........................................................................................4.9 Configuration.........................................................................4.10 Help.......................................................................................4.10 Open Report..........................................................................4.11 Exit........................................................................................4.12
M e d i c a l E d u c a t i o n Te c h n o l o g i e s , I n c .
Pelvic Image..........................................................................4.12 Exam Checklist......................................................................4.12 Pressure Indicator Bar...........................................................4.13 Threshold Indicator Sliders....................................................4.14 Purposeful Touch & Excessive Touch....................................4.14 Record Button.......................................................................4.15 Reset Button.........................................................................4.16 Save As.................................................................................4.17 Review...................................................................................4.18 After Action Review (AAR) Interface Window Terminology..........4.19 Exam Results.........................................................................4.19 Exam Results Sensor Graphs Chart......................................4.19 Exam Results Definitions.......................................................4.20 Graphical Comparisons.........................................................4.21 Detailed Statistics.................................................................4.22 Detailed Statistics Definitions................................................4.22 Select Comparison Configuration.........................................4.22 Pre-Use Test...............................................................................4.23 Printing Capabilities....................................................................4.24 Data Migration............................................................................4.26 Learning Modules.......................................................................4.27 The Learning Mode...............................................................4.27 The Assessment Mode..........................................................4.29 After Action Review...............................................................4.31 Use For Learning...........................................................................5.0 Basic Teaching Points...................................................................5.2 Adjunct Implementation................................................................5.3 Suggested Implementation...........................................................5.3 Independent Study Modules.........................................................5.4 Other Assessment Alternatives.....................................................5.5
M e d i c a l E d u c a t i o n Te c h n o l o g i e s , I n c .
Care/Maintenance.......................................................................6.0 The Pelvic Assembly.....................................................................6.1 The Ancillary Equipment...............................................................6.1 The Computer Component...........................................................6.2 Troubleshooting Steps..................................................................6.3 Damaged Sensors........................................................................6.3 Index.............................................................................................7.0
Personal Safety Items The following are personal safety items pertaining to the set up, breakdown and use of the Pelvic ExamSIM. Please read and understand these warnings before you begin using the system.
LATEX CAUTION: The METI Pelvic ExamSIM contains natural rubber latex, which may cause allergic reactions. Users with latex allergies need to take necessary precautions.
Electrical Personal Safety Issues
ª
Only operate the system on 100-240 VAC at 50-60 Hertz (cycles per second).
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International users will will need to use the supplied AC Plug Adapter Kit.
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Do not adjust or tamper with electrical systems.
Mannequin Personal Safety Issues
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Do not disassemble factory-assembled components of the mannequin.
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Make sure that the mannequin is set up on a stable, sturdy work surface to avoid causing injury to users.
Computer Components Personal Safety Issues
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Make sure the computer equipment is set up in a stable work area to avoid tipping.
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Do not drop, step up on or stack anything on the computer case.
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Do not spill fluids of any kind in or on the computer component.
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Do not attempt to service equipment.
0.1
System Safety Items The following are system safety items pertaining to the set up, breakdown and use of the Pelvic ExamSIM. Please read and understand these warnings before you begin using the system.
System Safety Issues – Electrical System
ª
Only operate the system on 100-240 VAC at 50-60 Hertz (cycles per second).
ª
International users will will need to use the supplied AC Plug Adapter Kit.
ª
Do not adjust or tamper with electrical systems.
System Safety Issues – Mannequin
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Non-sterile exam gloves MUST be worn at all times when performing examinations on the simulator. Additionally, it is a good idea to use nonsterile exam gloves anytime you will be handling the abdominal skin covering to avoid absorption of oils into the material.
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Only use the supplied Silicone Oil as lubricant.
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Only use a Pederson speculum for cervical exam. Do not use a Graves.
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Only use a plastic spatula for cervical cultures. Do not use a wooden spatula.
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Only perform invasive procedures as supported by the system (see Using the System section of this User Guide for more detail).
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Make sure that mannequin is set up on a stable, sturdy work surface to avoid causing damage to the mannequin.
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Do not introduce foreign substances into the mannequin – with the exception of small amounts of supplied lubricant.
0.2
System Safety Issues – Computer Components
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Make sure the computer equipment is set up in a stable work area to avoid tipping.
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Do not drop, step up on or stack anything on the computer components.
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Do not spill fluids of any kind in or on the computer.
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Do not install other software applications on the computer.
0.3
Equipment Overview The METI Pelvic ExamSIM uses minimal equipment to achieve a high degree of learning. The basic system components include a female pelvic cavity, interchangeable internal anatomy and a laptop Computer Workstation. These basic elements work together to create a realistic representation of the female pelvis. Use the following equipment overview to help identify all of your ExamSIM system components. Use the Inventory Chart to ensure that you received all of the equipment components. If you determine that you are missing any items, please contact your METI sales representative.
IMPORTANT: It is important that you keep all of your original METI Pelvic ExamSIM shipping materials including the boxes. All warranty and repair items must be return shipped to METI in the original packaging.
1.1
Inventory Char t The following is an inventory list for the Standard Pelvic ExamSIM equipment components.
Standard Equipment (Product # EXM-100) One Female Pelvic Assembly* Removable Abdominal Skin covering with upper thighs Removable Abdominal Wall Internal Pelvic Cavity attached to a black base plate One Fat Pad Four Interchangeable Internal Anatomy Components
(with Touch-Sensitive™ technology)
Clinical Uterus with Normal Anatomy Clinical Uterus with Ovarian Cyst Clinical Uterus with Fibroid Clinical Retroverted Uterus One Computer Workstation (laptop) One Silicone Oil Helix Connectors Kit Four Learning Cards** *The Clinical Uterus with Normal Anatomy comes pre-installed inside the Pelvic Assembly. **The Learning Cards are found in the back of this User Guide.
1.2
Optional Equipment Pelvic ExamSIM Instrumented Internal Anatomy Spares Kit* (#EXM-150) Clinical Uterus with Normal Anatomy (#EXM-151) Clinical Uterus with Ovarian Cyst (#EXM-152) Clinical Uterus with Fibroid (#EXM-153) Clinical Retroverted Uterus (#EXM-154) Female Pelvic Assembly with Computer Workstation and Pelvic ExamSIM Software (#EXM-110) Silicone Oil (#EXM-120) *The Spares Kits may be purchased as an entire kit or each assembly separately.
1.3
Complete Inventory Overview The following content provides more specific detail regarding each of the ExamSIM system components. Female Pelvic Assembly The Pelvic Assembly presents an accurate anatomical and tactile representation of the female pelvis to create realistic hands-on examinations and the diagnosis of pathologies and abnormalities. It can be used for many levels of learning ranging from undergraduate to graduate level studies and is capable of supporting self-learning modules.
Figure 1 Female Pelvic Assembly
As the primary student interface for bimanual pelvic examinations and digital vaginal exams, the Pelvic Assembly helps isolate critical learning skills designed to raise the level of patient care provided by clinicians. The realistic design of the Pelvic Assembly supports the recognition of anatomy and appropriate landmarks, creating the ability to hone specific exam skills including: the use of a cervical speculum for cervical smear procedures; dry catheterization; and rectal exam procedures. Mounted to a black base plate, the Pelvic Assembly includes a removable abdominal skin covering, a specially designed removable abdominal wall and an internal mounted pelvic cavity. Made of a soft, lightweight material, the abdominal skin covering represents the female external abdominal and upper thigh area. This covering is easily removed by twisting the black clips that attach the skin to the base. In addition to the abdominal skin, a removable abdominal wall, which is made of a foam pad, provides the appropriate abdominal density for a realistic look and feel.
1.4
Figure 2 Removable Abdominal Skin Covering
Figure 3 Removable Abdominal Wall
Underneath both of these abdominal coverings is the internal pelvic cavity, which houses the various Internal Anatomy Components. This cavity also includes the housing for true-to-life female genitalia including a soft perineum, clitoris, labia, and a realistic anus.
Figure 4 Pelvic Cavity
Also attached to the Pelvic Assembly is a signal box and simulator electronics, located on the backside of the base plate. Remove the simulator electronics cover to locate both of these components. The simulator electronics connect to the Computer Workstation via the supplied USB data cable. This connection links the two system components in order to display all of the biofeedback readings on the Computer Workstation, as well as to capture recorded data during an assessment module.
Figure 5 Signal Box/ Simulator Electronics
The simulator electronics cover is not shown in this figure.
Fat Pad Performing a bimanual examination on an overweight patient presents different skill requirements for clinicians. The tactile accuracy is decreased by virtue of the added girth in the abdominal area, making it important for learners to know how to palpate under these conditions. By adding the fat pad, learners are exposed to the variation in touch when patient weight is an issue.
Figure 6 Fat Pad
1.5
Interchangeable Internal Anatomy Components The Pelvic ExamSIM comes standard with four interchangeable uteri, each offering different clinical assessment applications. The unit is shipped with the Clinical Uterus with Normal Anatomy already configured. Each of the individual uteri include the same basic anatomical features: perineum with labia and anus; fallopian tubes and ovaries; urethra, bladder and uterus; vagina with cervix; and the lower portion of the bowel. Starting with the Clinical Uterus with Normal Anatomy, this component represents a “normal” patient with healthy anatomical markers.
The Clinical Uterus with Ovarian Cyst presents a large cyst that is easily palpated when the bimanual exam is performed correctly.
The Clinical Uterus with Fibroid presents a tangerine-sized fibroid that is also easily palpated using the correct examination procedures.
And finally, the Clinical Retroverted Uterus represents a healthy, but Retroverted uterus, which must be palpated using a rectal exam.
1.6
Figure 7 Clinical Uterus with Normal Anatomy
Figure 8 Clinical Uterus with Ovarian Cyst
Figure 9 Clinical Uterus with Fibroid
Figure 10 Clinical Uterus with Retroverted Uterus
Each anatomy component includes specially designed sensors attached to key locations within the structure. Using patented Touch-Sensitive technology, these sensors detect the locations touched along with the accuracy and pressure of the touch. The sensor signals are relayed to the Computer Workstation and the data is displayed and then compiled for review and comparison.
Computer Workstation The Computer Workstation is comprised of a laptop computer, which connects to the simulator electronics on the back of the Pelvic Assembly. This component of the ExamSIM configuration serves as the hub for all biofeedback and data assessment capabilities.
Figure 11 Computer Workstation
The Computer Workstation can be used as a monitor for learners to assess their palpation skills during a given exam. (NOTE: This mode is called the Learning Mode. For more specifics, see Learning Modules in the System Usage section of this User Guide.) The sensors located inside the Internal Anatomy Components measure the location, quality and pressure of the palpation during a given exam. Sensor Pressure Bars that correspond to the accurate palpation sites inside the pelvic cavity rise and fall on the screen of the Computer Workstation measuring the performance of the learner. Each sensor bar falls within a range that assesses the pressure used during the exam. Additionally, a small check list on the user interface checks off each of the palpation sites to ensure that the learner hits every mark. At the end of the exam, the results can be recorded and compared to a p reviously collected and analyzed database of examiners ranging from novice to experienced.
Figure 12 Exam Feedback
1.7
By turning the Computer Workstation around, it is possible to create learning modules in which the learner does not see the biofeedback on the user interface. (NOTE: This mode is called the Assessment Mode. For more specifics, see Learning Modules in the System Usage section of this User Guide.) Using this mode allows learners to begin applying their examination skills directly, creating confidence and a deeper level of skill acquisition. Instructors can monitor the learner’s performance during the exam and then compare the results against the database. Silicone Oil The ExamSIM comes standard with a bottle of Silicone Oil. This is the only lubricant supported by METI when using this simulator. Other lubricants, including clinically acceptable lubricating jellies, are not safe to use on the mannequin materials and can cause damage to the look and feel of the Pelvic Assembly and abdominal skin covering. To re-order additional oil, contact your METI sales representative.
Figure 13 Silicone Oil and Helix Connectors Kit
Helix Connectors Kit This kit includes a variety of small white helix connectors used to configure the Internal Anatomy Components inside the pelvic cavity. Each of the four anatomy components comes with proper fittings, but this kit is meant to augment your supply in case a replacement is needed. Four Learning Cards The METI Pelvic ExamSIM includes four learning cards designed to help you make the most of your learning sessions. Each of the four cards outline how to evolve an examination learning module, including every important detail. These cards are located in the back of this User Guide.
1.8
Figure 14 Learning Cards
Pelvic ExamSIM Instrumented Internal Anatomy Spares Kit With the purchase of the ExamSIM Internal Anatomy Spares Kit, it is possible to replace the entire Internal Anatomy Component. Each of the spares in this kit are complete Internal Anatomy Components meaning that there is no assembly requirements prior to use. The ExamSIM Internal Anatomy Spares Kit may be purchased as an entire package or each part separately. Pelvic ExamSIM Instrumented Internal Anatomy Spares Kit Clinical Uterus with Normal Anatomy Clinical Uterus with Ovarian Cyst Clinical Uterus with Fibroid Clinical Retroverted Uterus
Female Pelvic Assembly with Computer Workstation and METI Pelvic ExamSIM Software With the purchase of an additional METI Female Pelvic Assembly, Computer Workstation and ExamSIM software, multiple learning stations are easily implemented. With these additions, it is possible to set up multiple ExamSIM’s using the Internal Anatomy Components that are included with your original purchase. This creates the ability to set up multiple learning stations that isolate specific course objectives.
1.9
Set Up/Breakdown The following information guides you through the set up and breakdown procedures for the Pelvic ExamSIM. Refer to the helpful images throughout this section to ensure that you are properly configuring your system for use. IMPORTANT: It is important that you keep all of your original METI Pelvic ExamSIM shipping materials including the boxes. All warranty and repair items must be return shipped to METI in the original packaging.
IMPORTANT: The Computer Workstation laptop is pre-configured for use with the Pelvic ExamSIM. There are no configuration steps required. Do not install other software or use any other applications on your Computer Workstation.
IMPORTANT: It is important that you do not turn on any of the computer or equipment components until you are instructed.
Set Up Before you begin setting up all of the ExamSIM equipment components, it is important to establish your work area. Your attention to this detail plays an important part in the effectiveness of your learning modules. You want to ensure that there is enough room for your equipment, while providing easy access for students to watch and learn from one another (when used in a group learning environment). Use the following steps each time you set up your Pelvic ExamSIM: Start by configuring the Pelvic Assembly:
1.
You will need to have a sturdy work surface or tabletop to place the Pelvic Assembly and the Computer Workstation. Place both components on your work surface as shown. (NOTE: You will need to make sure that your work area includes an available power outlet for both the Pelvic Assembly and the Computer Workstation.)
Figure 15 First Step
2.1
2.
3.
Select the Internal Anatomy Component for your given session. (NOTE: In this example, we will be using the Clinical Uterus with Ovarian Cyst.)
Figure 16 Clinical Uterus with Ovarian Cyst
Remove the existing Internal Anatomy Component by using the following steps:
a. Remove the abdominal skin covering by twisting the black clamps along the base of the ExamSIM unit and carefully set aside.
Figure 17 Abdominal Skin
b. Remove the white abdominal wall padding and set aside. Figure 18 Abdominal Wall Removal
c. Carefully remove the white pegs holding the internal anatomy in place. There are attachment pegs located along the top of the pelvic cavity as well as along the uteral-sacral ligament at the base of the pelvic cavity. (NOTE: For these lower attachment sites, it may be easier to push the peg fittings from the underside of the pelvic floor by using a flathead screwdriver or a coin for leverage.)
2.2
Figure 19 Peg Removal
d. Remove the Simulator Electronics Cover and set aside. Unplug the sensor connectors attached to the black signal box. Unplug all seven of the signal leads within the signal pigtail.
Figure 20 Signal Lead Unplug
e. Carefully slide the Internal Anatomy Component through the pudendum area of the pelvic cavity. You will need to detach the velcro patches located on the labia fitting before you slide the entire Internal Anatomy Component through the inferior opening of the pelvic cavity. Make sure to carefully feed the signal pigtail through the opening.
f.
Figure 21 Remove Internal Anatomy Component
Figure 22 Signal Pigtail
Store the detached anatomy in a cool dry place to avoid damage to the sensors when not in use.
2.3
4.
Attach the new Internal Anatomy Component by using the following steps:
a. Starting with the signal pigtail, carefully guide the desired anatomy through the inferior opening of the pelvic cavity. Align and secure the anatomy into place by gently placing it inside the pelvic structure*. Attach the labia fitting by using the Velcro patches.
Figure 23 Internal Anatomy Component Install
b. Using the white helix pegs, secure the anatomy into place. i. To attach the uteral-sacral ligaments to the Pelvic Cavity, press the white pegs straight down onto the floor of the Pelvic Cavity on either side of the rectum. See Figure 24. (NOTE: This attachment site is the METI recommended location.)
ii.
To attach the ovaries to the Pelvic Cavity, press the the white pegs into the first attachment point to the right and left of the midline. See Figure 25. (NOTE: These attachment sites are the METI recommended locations.)
*When inserting the Retroverted Uterus, make sure to carefully place the anatomy component into the Pelvic Assembly without cramping the colon. If the component is not properly situated inside the Pelvic Cavity, the anterior sensor may create inaccurate feedback.
2.4
Figure 24 Lower Ligaments
Figure 25 Peg Install
c. Once the Internal Anatomy Component is properly attached, connect the signal pigtail leads to the corresponding lead ports on the signal box. (NOTE: Each of the leads is numbered and should be plugged into the corresponding signal port.)
Figure 26 Signal Attachment
d. Route the signal pigtail leads via the notch in the vertical plate of the Pelvic Assembly as shown.
Figure 27 Signal Wires
e. Replace the white abdominal wall pad.
Figure 28 Replace Abdominal Wall
2.5
f.
Add the Fat Pad at this time, if desired.
Figure 29 Add Fat Pad
g. Replace the abdominal skin covering and reattach by twisting the black clamps.
5.
2.6
The Pelvic Assembly is now ready to support the bimanual exam of a patient with an Ovarian Cyst.
Figure 30 Replace Abdominal Skin
Next, configure the Computer Workstation and Power Supply:
6.
7.
8.
9.
Place the Computer Workstation beside the Pelvic Assembly.
With the Simulator Electronics cover still removed, connect the supplied USB data cable to the simulator electronics located next to the signal box on the back of the Pelvic Assembly base. Then connect the remaining end to the Computer Workstation.
Plug in the power supply for the Pelvic Assembly*. The power cord port is located on the signal box. Replace the Simulator Electronics cover and plug the Power Cord into an AC power outlet. International users will need to use the supplied AC Plug Adaptor Kit. Use the supplied power cord for the Computer Workstation to supply power to the laptop*. Plug the Power Cord into an AC power outlet. International users will need to use the supplied AC Plug Adaptor Kit.
Figure 31 Configure Computer Workstation and Pelvic Assembly
Figure 32 USB Data Cable
Figure 33 Power Cord
Figure 34 PC Power Cord
*(NOTE: Please make sure that you are using the correct power cord adapter for the Pelvic Assembly and the Computer Workstation. Both power cords have similar plug fittings, but the system will not run properly if the cords are interchanged.) 2.7
10. Flip the power switch located on the signal box into the On position.
Figure 35 On
11. Turn on the Computer Workstation by pressing the power button.
Figure 36 PC Power On
12. The laptop will take a moment to boot up. Once the desktop is visible, if the software application does not automatically boot up, locate the ExamSIM icon on the computer desktop. Double click on the icon to launch the software.
Figure 37 Desktop Icon
2.8
13. Once the software is launched, the Main User Interface Window will appear on the screen of the Computer Workstation.
Figure 38 Main User Interface Window
14. The system is now ready for use. (NOTE: Please note that before you use the ExamSIM for a learning module, you will need to do a test to ensure all of the sensors are working properly. For complete details on completing the system test, refer to the Using the System section. Look for Pre-Use Test.)
Figure 39 Ready for Use
2.9
Breakdown — Lab Environment If you are using the Pelvic ExamSIM in a lab environment, breaking down your system for storage may not be necessary. Use the following guidelines for ending a session when your simulator does not require complete breakdown and/or storage.
Start by shutting down the Computer Workstation:
1. 2.
Stop recording your current session (if applicable) and save your data if desired. To exit the software, make sure you are viewing the Main User Interface Window and click on the Exit button. This will close the software application only.
Figure 40 Exit Software
2.10
3.
4.
To shut down the computer, click on the Start button in the lower left corner of the screen. To the right, there will be two small icons at the bottom: Log Off and Turn Off Computer. Click Turn Off Computer.
Figure 41 Turn Off
Another window will appear—select Turn Off. Figure 42 Turn Off
5.
Wait until the computer fully shuts down before closing the laptop. (NOTE: Even in a lab environment, it is a good idea to at least store the laptop component for safekeeping. When storing, be sure to disconnect the USB cable and store the computer and supplied power cord in a secure location.)
2.11
Disconnecting the Pelvic Assembly: It is not necessary to remove the attached Internal Anatomy Component at the end of a given session, making the breakdown process for the Pelvic Assembly fairly simple, especially in a lab environment. But it is important to follow a few breakdown steps to ensure the integrity of your Pelvic Assembly at the end of your learning session.
1.
2. 3.
4.
2.12
Flip the power switch on the signal box to the Off position.
Unplug the power source for both the Pelvic Assembly and the Computer Workstation.
Carefully position the Pelvic Assembly on the work surface so that it is not easily bumped or damaged during down time. We recommend that you cover the Pelvic Assembly with a drape when not in use to prevent damage to the abdominal wall from dirt and debris.
Be sure to store the three unattached Internal Anatomy Components and the fat pad in a suitable location. It is important that Internal Anatomy Components are handled with care to prevent damage to the internal sensors.
Figure 43 Off
Breakdown — Non-Lab Environment If you are using your Pelvic ExamSIM in a setting where it is necessary to pack and store the system, the breakdown procedures are fairly basic. Use the following guidelines for ending a session and preparing the simulator for storage.
Start by shutting down the Computer Workstation:
1. 2.
Stop recording your current session (if applicable) and save your data if desired. To exit the software, make sure you are viewing the Main User Interface Window and click on the Exit button. This will close the software application only.
Figure 44 Exit Software
2.13
3.
4.
5. 6.
7.
2.14
To shut down the computer, click on the Start button in the lower left corner of the screen. To the right, there will be two small icons setting at the bottom: Log Off and Turn Off Computer. Click Turn Off Computer.
Another window will appear—select Turn Off.
Figure 45 Turn Off
Figure 46 Turn Off
Wait until the computer fully shuts down before closing the laptop.
Disconnect the USB Data Cable from the computer Workstation.
Store the laptop along with the supplied power cord in a secure location.
Figure 47 Disconnect USB Data Cable
Disconnecting the Pelvic Assembly: It is not necessary to remove the attached Internal Anatomy Component at the end of a given session, making the breakdown process for the ExamSIM fairly simple. It is important to follow a few breakdown steps to ensure the integrity of your Pelvic Assembly at the end of your learning session.
1.
Flip the power switch on the signal box to the off position. Figure 48 Off
2. 3. 4. 5.
Unplug the power source for both the Pelvic Assembly and the Computer Workstation.
Keep the signal pigtail connected to the signal box—this will prevent the leads from getting damaged during storage and/or transport. (NOTE: Make sure the Simulator Electronics cover is in place.) Place the Pelvic Assembly in the original shipping box for storage. To help prevent wear, we recommend that you cover the assembly with a drape before placing it in the box. Be sure to store the three unattached Internal Anatomy Components and the fat pad in a suitable location. It is important that Internal Anatomy Components are handled with care to prevent damage to the internal sensors.
Cleaning Considerations: If the abdominal skin covering shows signs of dirt after a learning session, you may want to clean it before the start of your next session. For general cleaning, use mild wet wipes to remove dirt. For a deeper clean, the abdominal skin can be machine-washed on the gentle cycle using a mild detergent. (NOTE: Do not wash other items with the abdominal skin.) Allow to air dry. (NOTE: For detailed care instructions, please refer to the Care/Maintenance section of this User Guide.)
2.15
2.1
Quick Start The following Quick Start is designed to give you fast and easy set up and usage instructions. This section includes just the basic steps to get your Pelvic ExamSIM up and running. For more complete details, please refer to the Using the System section.
Quick Start Chart Complete Pelvic ExamSIM Set Up
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
Prepare Work Area Place Pelvic Assembly and Computer Workstation on Work Surface Select Internal Anatomy Component Remove Abdominal Skin Covering and the Internal Abdominal Wall Remove Existing Internal Anatomy Component Attach Desired Internal Anatomy Component Attach Pigtail Signal Leads to Signal Box Replace Internal Abdominal Wall Add the Fat Pad (if desired) Replace and Attach the Abdominal Skin Covering Connect USB Cable from Computer Workstation to the Simulator Electronics Configure Computer Workstation and Pelvic Assembly for Power Power Up the Computer Workstation* Power Up the Pelvic Assembly Launch the Software Application* Complete Pre-Use Test Ready for Use
*See the Computer Power On Quick Chart
3.1
Use the following Quick Charts to help you set up your simulator system for the three basic modes: Learning Mode, Assessment Mode, and After Action Review.
Quick Chart Learning Mode
1 2 3
3.2
Configure Computer Workstation for easy viewing by the learner(s) Ensure that Computer Workstation is configured for the Internal Anatomy Component connected for the given session Allow learners to practice palpation exercises while viewing the display of the Computer Workstation
Quick Chart Assessment Mode
1 2
Configure the Computer Workstation in one of the two Assessment Configurations: View Exam Mode or Blind Exam Mode Ensure that Computer Workstation is configured for the Internal Anatomy Component connected for the given session
3
When the learner is ready to begin the exam, click the Record button
4 5 6
When the learner is finished with the exam, click the Stop button
on the Main User Interface Window
Review Exam Results Save the data file when prompted
Quick Chart After Action Review
1 2 3
Select Open Report button on the Main User Interface Window A dialog box will appear on the screen—select the saved file you want to review and click Open Review Exam Results
4
Click on Graphical Comparison selection to see comparison of a
5
Click on Detailed Statistics to see a variety of statistics comparing a
6
Select other comparison values within each of these review windows
7
Review Exam Results
given learner versus a Novice Student and an Experienced Clinician
given learner to complied data of Novices and Clinicians
by changing the selection of the Internal Anatomy Component
3.3
Quick Chart Save As
1 2 3 4
3.4
Click the Stop button when you are finished recording the exam The Save As dialog box will appear Find the specific folder you wish to save to Name the exam file and click Save
2.1
Using the System
When using the METI Pelvic ExamSIM, there are several important considerations. First, it is important to know and fully understand how to use the simulator system and all of the individual components. This includes understanding the software application and how it integrates with the simulator. Second, it is essential to know and understand how to apply this teaching tool to meet your learning objectives. This includes understanding the various learning modes. To meet these objectives, this section is divided into two main parts: Usage and Learning Modules. Each of these parts provides important content to make using and applying the ExamSIM easy and practical.
4.1
Usage The content in this section is a hybrid of terminology and computer-oriented instructions that pertain to the system as a whole. Use the following terminology to help define the usage instructions within this section.
Terminology Mannequin Assembly Terminology ª Pelvic Assembly — This is the main mannequin assembly of the Pelvic ExamSIM. This system component serves as the primary student interface for practicing and honing examination skills. The Pelvic Assembly represents a female pelvis with accurate anatomy and appropriate landmarks. The assembly is made up of a removable abdominal skin covering, which includes the suggestion of the upper thigh region; a removable abdominal wall; and a mounted internal pelvic cavity. In addition to these three components, a signal box and simulator electronics are mounted to the base. These two components serve as the hub of electrical and computer activity between the Pelvic Assembly and the Computer Workstation.
Figure 49 Pelvic Assembly
ª
Pelvic Cavity — Attached to the base of the Pelvic Assembly, the Pelvic Cavity serves as the cradle for the interchangeable uteri. Along the upper edge and throughout the floor of the cavity, there are insertion sites for the various Internal Anatomy Components. These small black attachment sites hold the uteri in specific locations to create realistic variances portrayed by the individual anatomy parts. Additionally, there is an inferior passageway located in the pudendum area, which is the attachment site for the perineum with clitoris, labia and anus portion of the individual Internal Anatomy Components.
4.2
Figure 50 Pelvic Cavity
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Abdominal Skin Covering — Made of a lightweight foamy material, the abdominal skin creates a realistic exam experience for the learner. The skin is soft to the touch and is removable by twisting a series of black clips located along the Pelvic Assembly base. The molding of the material includes the suggestion of the upper thigh areas and a sloping abdomen. Made of a durable, machine washable fabric, the abdominal skin covering is easy to care for and provides added realism to the ExamSIM.
Figure 51 Removable Abdominal Skin Covering
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Abdominal Wall — Made of a thick, pliable foam material, the abdominal wall is the white removable internal pad that provides the appropriate abdominal density for a realistic look and feel.
Figure 52 Removable Abdominal Wall
4.3
ª
Internal Anatomy Components — The ExamSIM comes standard with four interchangeable instrumented uteri, each offering different clinical assessment applications. The system is shipped with the Clinical Uterus with Normal Anatomy already configured. Each of the individual uteri include the same basic anatomical features: perineum with labia and anus; fallopian tubes and ovaries; urethra, bladder and uterus; vagina with cervix; and the lower portion of the bowel. In addition, each of the uteri has seven special sensors attached to the appropriate palpation sites for the given anatomy*. (NOTE: See the following chart for exact palpation locations supported by the sensors.) Each of these sensors is connected to lead wires that are collected into a bundle known as the signal pigtail. The signal pigtail connects to the signal box on the back of the assembly to translate palpation activity to the Computer Workstation. Figure 53a Clinical Uterus with Normal Anatomy
Figure 53b Clinical Uterus with Retroverted Uterus
Figure 53c Clinical Uterus with Fibroid
Figure 53d Clinical Uterus with Ovarian Cyst
(NOTE: The ExamSIM vaginal vault is long and narrow. Users will need to keep this in mind as they perform the bimanual exam to account for this normal variation of anatomy.) Sensored Palpation Sites within the Internal Anatomy Components
Cervix
Fundus
Anterior
Apex
OS
Adnexa
Right Posterior
Right
Left Posterior
Left
*In alliance with clinical exam guidelines outlined in physical exam textbooks, sensors were placed inside the simulator on the cervix, uterine fundus, and adnexa. Textbook references are as follows: 1 Bates B. Bates’ Guide to Physical Examination and History Taking, 7th ed. Philadelphia, Lippincott, 1999 2 Siedel, Ball, Dains, Benedict. Mosby’s Guide to Physical Examination. St. Louis, Mosby, 1987, pp 407-445
4.4
ª
Signal Box — Located on the backside of the Pelvic Assembly (under the black Simulator Electronics cover) is a black box with 16 labeled signal ports. Ports correspond to specific palpation sites within each of the given Internal Anatomy Components. The signal pigtail from the individual uteri connects to the signal box to transfer palpation activity from the simulator to the Computer Workstation. Currently, there are only seven leads per Internal Anatomy Component, meaning that a properly configured signal box has nine open sensor ports. This allows for future development and expansion of ExamSIM functions.
Figure 54 Signal Box/ Simulator Electronics
ª
Simulator Electronics — The Simulator Electronics box is the communication hub for the Pelvic Assembly. The USB data cable connects to the simulator at this site. The Simulator Electronics cover is not shown in this figure.
ª
USB Data Cable — The USB Cable connects the Computer Workstation to the Pelvic Assembly. This cable plugs in to an open port on the laptop and an open port along the side of the simulator electronics box.
4.5
Computer Workstation Terminology ª Computer Workstation — The Computer Workstation includes a laptop computer , the ExamSIM software (already installed) and a power cord. As the primary assessment interface, the Computer Workstation displays palpation activity from the Pelvic Assembly, providing valuable feedback to learners and instructors about palpation skills. Additionally, the Computer Workstation can record and compile data for a given learning module and create assessment parameters that measure a learner’s progress.
Software Terminology ª Operating System — The Pelvic ExamSIM software runs on Microsoft Windows XP™ — a PC based operating system. The software uses basic windows keystrokes and commands.
ª
User Interface Window — The User Interface Window defines the various ExamSIM software screens that are currently in use during a session.
4.6
Figure 55 Computer Workstation
ª
Main User Interface Window — This is the screen of the ExamSIM software that shows the pelvic image, pressure indicator bars and the Exam Checklist. This is the primary assessment screen for a learner operating in the Learning Mode, and for instructor’s operating in the Assessment Mode. It is also the opening screen when the software first boots up.
Figure 56 Main User Interface Window
ª
Status Box — There is a Status Box located on the Main User Interface Window that lets you know the current status of the software. There are three main software states: Not Recording, Recording and Offline. The following describes the conditions of each:
Not Recording — The Pelvic Assembly and the Computer Workstation are properly configured, but you are not recording any data.
Figure 57 Status Box
Recording — The Pelvic Assembly and the Computer Workstation are properly configured, and you are recording a given exam. Offline — The Pelvic Assembly and the Computer Workstation are either improperly configured or you are using the Computer Workstation independently and there is no data exchange between the computer and the simulator. Additionally, the Status Box shows the current status of the assembly configuration (i.e. Normal Uterus, Retroverted Uterus, etc.) and the current threshold setting (i.e., Standard or Custom.) The Standard state reflects the thresholds that are preconfigured by METI. The Custom state reflects a user-defined set of thresholds. (NOTE: For specific detail regarding the threshold settings, please refer to the Threshold Indicator Slider definition within this section.)
4.7
ª
Dialog Box — When the software needs to prompt the user to complete a certain task, a dialog box will appear with user instructions. For example, after recording a given session, if the user wants to exit the software, a dialog box will appear on the screen prompting the user to Save the recorded data or Cancel the save.
Figure 58 Dialog Box
ª
Start Button — Located in the lower left corner of the computer screen, there is a Start button that will pop into view when you pull the cursor down. The Start button has two main functions (as it pertains to the ExamSIM application).
1.
2.
You can launch the software by clicking on the Start button and scrolling up to the ExamSIM icon (Shortcut to Pelvic ExamSIM) You can shut down the Computer Workstation by going to the Start button, selecting Turn Off Computer and then selecting Turn Off in the dialog box.
Figure 60 Turn Off Computer
4.8
Figure 59 Start Button Feature
Main User Interface Window Terminology ª File — Along the upper portion of the Main User Interface Window, there is a menu bar. Starting on the left, the first selection is File. This menu selection allows you to open a saved report (Open Report) and Exit the system. (NOTE: Both of these functions are also included directly on the interface window of the software.)
Figure 61 File
ª
Edit — Currently, there are no menu selections to choose from in the Edit menu.
Figure 62 Edit
4.9
ª
Configuration — This menu selection is used to adjust the software reading for the specific Internal Anatomy Component installed in the Pelvic Assembly for a given session. The default setting for the configuration is the Clinical Uterus with Normal Anatomy. Be sure to adjust the configuration to match the anatomy you are using, so the computer reading will be accurate.
Figure 63 Configurations
ª
Help — When you select help, a dialog box appears, providing specific information regarding the software. By selecting “About Pelvic ExamSIM” you can obtain pertinent information regarding the software version number and other related information.
Figure 64 Help
4.10
ª
Open Report Button — The Open Report button allows you to open an existing recorded file. When you click on this button, a dialog box appears. Select the desired file you wish to review. Once you select a file and open the file, a new window will appear on the screen over the top of the Main User Interface Window. This screen is called an After Action Report (AAR). (NOTE: See the After Action Report terminology for more details.)
Figure 65a Open Report
Figure 65b Dialog Box
(NOTE: METI recommends that all exam files are saved in the My Documents folder.)
4.11
ª
Exit — The Exit button provides a quick way to close the software. If you were recording a session prior to clicking on the Exit button, a dialog box will appear, prompting you to Save or Cancel the recorded file.
Figure 66 Exit Button
ª Pelvic Image — On the Main User Interface Window, there is a graphic representation of the female pelvic cavity. When the Computer Workstation and the Pelvic Assembly are connected (via the USB cable), the pelvic image will illuminate locator dots at each of the seven-palpation sites, as they are touched. The dots will illuminate green when the sensors detect a touch that is considered to be “purposeful” (i.e., within the appropriate range). The dots will illuminate red with the sensors detect a touch that is “excessive” (i.e. inappropriate). (NOTE: See Purposeful Touch & Excessive Touch for more details on touch measurement.)
Figure 67 Pelvic Image
ª
Exam Checklist — On the Main User Interface Window, there is a box on the right labeled Exam Checklist. This digital checklist provides the learner (and the instructor) with a check in the box next to the palpation site he or she palpated. If the learner fails to palpate a given site, no mark will appear in the checklist next to the name/location of that site. If the learner does palpate the site, the checklist will qualify the pressure of the touch as excessive (indicated by a red x next to the name/location of the palpation site) or purposeful (indicated by a green dot next to the name/location of the palpation site). 4.12
Figure 68 Exam Checklist
ª
Pressure Indicator Bar — Along the lower portion of the Main User Interface Window, there are seven data fields with slider adjustments and numeric readers known as pressure indicator bars. These bars are divided into three categories: Cervix, Fundus and Adnexa. There are four pressure indicator bars within the Cervix section, one pressure indicator bar within the Fundus section, and two pressure indicator bars within the Adnexa section. Each pressure indicator bar is also individually labeled to identify the palpation location being measured within that field. When a learner is performing a bimanual exam, the pressure indicator bars indicate the pressure used by the learner when palpating the given site. The slider adjustments on either side of each of the pressure indicator bars denote a range of “purposeful” and “excessive” touch. (NOTE: Refer to the chart below for the palpation sites that correspond to the individual Pressure Indicator Bars on the Main User Interface Window.)
Figure 69 Pressure Indicator Bars
1. Cervix – Anterior 2. Cervix – OS 3. Cervix – Right Posterior 4. Cervix – Left Posterior 5. Fundus – Apex 6. Adnexa – Right 7. Adnexa – Left
4.13
ª
Threshold Indicator Sliders — On each of the seven Pressure Indicator Bars, there are two threshold adjustment sliders and a small number counter at the base. These sliders move up and down to define the pressure unit at which a “purposeful” and/or “excessive” touch is measured. The minimum “purposeful” touch is defined by the left slider (with a green value indicator) and the “excessive” touch is defined by the right slider (with a red indicator). The number counter registers the threshold measurement. This feature allows you to redefine the thresholds for any of the given sensors to meet your own specifications.
Figure 70 Threshold Indicator Sliders
(NOTE: The Pelvic ExamSIM software comes preconfigured with pressure thresholds. The maximum pressure threshold is based upon the average max pressure applied by the Experienced Clinicians. The minimum pressure threshold is defined as 2 PU (Pressure Units) by definition.)
ª Purposeful Touch & Excessive Touch — When a learner is performing a bimanual exam, one of the learning objectives is to help establish the level of pressure needed to appropriately palpate the anatomy while considering both the assessment requirements for the exam and the comfort level for the patient. Using the pressure indicator bars for assessing the learner’s palpation skills is a matter of watching the bars light up as the learner palpates each site. For a touch to be purposeful, the indicator bar must register a measurement reading that falls between the lower slider adjustment (left slider) and the higher slider adjustment (right slider) on the pressure indicator bar. Anything below the lower slider adjustment is considered to be not purposeful. If the pressure indicator bar registers a touch that exceeds the higher slider adjustment, the touch is considered to be excessive. The slider adjustments allow instructors to pre-adjust the pressure thresholds for a given session. Each configuration has a pre-set value based on the averages obtained from analyzing experienced clinician exams. (NOTE: In this example the Left Posterior Cervix Pressure Indicator bar is registering an “excessive” palpation pressure whereas the Fundus Apex pressure indicator bar is registering a “purposeful” palpation pressure.)
4.14
Figure 71 Pressure Bars
ª
Record Button — Along the bottom of the Main User Interface Window, there is a Record button. In order to gather the data used in the Assessment Mode, the Record button must be selected. When the Record button is selected, it will automatically reset to a pre-exam state but does not recalibrate the sensors. Therefore, it is a good idea to hit the Reset button prior to recording a session to ensure that all of the pressure sensors are normalized.
Figure 72 Record Button
4.15
ª
Reset Button — The Reset button is used in the Learning Mode and prior to the Assessment Mode to reset the Exam Checklist and to recalibrate and normalize the pressure sensors. While in the Record mode, the Reset button turns into the Stop button for that mode.
Figure 73 Reset Button
Figure 74 Stop Button
4.16
ª
Save As — When recording a given exam, you will need to click on the Stop button to end the exam. After you click on the Stop button, the Save As dialog box will appear on the screen. At this time, you will be prompted to save the exam. We recommend that all saved exam files are stored in the My Documents Folder that is already set up on the Computer Workstation hard drive. Within this folder, you can create any number of sub-folders to organize your data files based on your own needs. To create a new folder, click on the yellow file folder icon (Create New Folder) in the upper right corner of the Save As dialog box.
Figure 75 Stop/Save As Dialog Box
(NOTE: If you are supporting independent learning modules, it is a good idea to require learners to save their work. You may want to set up a folder with a specific name within the My Documents folder so your students know where to save their exam results for your review.) Use the following chart for complete Save As steps:
1 2 3 4
Select the Stop button when you are finished recording the exam The Save As dialog box will appear Find the specific folder you wish to save to Name the exam file and select Save
4.17
ª
Review — After recording a given exam, you can select the Review button and it will take you to the After Action Review (AAR) Interface Window and display data collected from the completed exam. (NOTE: See the After Action Review terminology for more details.) The Review button is only active if the exam session is recorded.
Figure 76 Review Button
4.18
After Action Review (AAR) Interface Window Terminology
Figure 77 AAR Interface Panel
ª
Exam Results — After you open a saved file, the AAR Interface Window will appear as a second window on the screen. The name of the file compiled for review is shown in the window bar as well as on the graph. The Exam Results selection is the default selection that provides a quick overall view of a given examination. Within this selection, there is a color-coded Sensor Graph matrix representing the given session. Each of the seven palpation sites is represented by a colored line that shows the pressure measurements of each site and the time (in seconds), which measures the touch value and duration of the exam. The Sensor Graphs checklist to the right of the graph allows you to evaluate the performance of the learner on individual palpation sites. If the box to the left of the palpation site name has a check in it, that site is represented on the graph with a color-coded line. Use the following chart for the color-coding of the lines in the Sensor Graph: Anterior
Dark Blue
OS
Pink
R. Posterior
Red
L. Posterior
Light Blue
Fundus Apex
Purple
R. Adnexa
Brown
L. Adnexa
Green
Exam Results Sensor Graphs Char t
4.19
Below the graph, there is a table representing the exam results of the given session. Additionally, these results are compared to an average of Novices and Experienced Clinicians for assessment and comparison. The matrix displays the following comparison values: Exam Time:
The time at which the last sensor was touched minus the time at which the first sensor was touched
Number of Touched Locations:
The number of sensors that recorded a “purposeful touch”
Mean Max Pressure:
Mean Frequency:
The mean maximum pressure recorded (average maximum pressure recorded on all sensors purposefully touched) The mean frequency recorded (average of all seven sensors)
(NOTE: For our purposes, the definition of Frequency is as follows: Frequency represents the number of samples recorded that, while recording a “purposeful touch,” are within 1 PU (Pressure Unit) of the maximum pressure recorded on that sensor.)
4.20
Exam Results Definitions
ª
Graphical Comparisons — This is the second selection of the AAR Interface Window and provides the ability to graphically compare and review the given exam against compiled statistics from the database that represents both novice and experienced clinician users. There are two graphs within this view — one graph presents the results of the given exam (and is labeled with the file name) and the other shows how the exam compared to a Novice Student* (based on representative Novice Student data from within the database) and an Experienced Clinician** (also based on representative Experienced Clinician data from within the database). Using the Sensor Graphs checkboxes, you can isolate and compare individual palpation sites.
Figure 78 Graphical Comparison
*Novice — For our purposes, a "Novice User" is considered to be a medical student still in training. **Experienced — For our purposes, an "Experienced User" is considered to be a practicing OB/GYN. (NOTE: The Experienced User data was collected at several professional conferences where the attendees where currently practicing OB/GYNs.)
4.21
ª
Detailed Statistics — This selection presents the same data from the Graphical Comparisons selection only in statistical form. The standard deviation values of the Novice and Experienced Clinician data are compiled from a database of users (which is comprised of over 400 student novices and over 700 experienced clinicians). The following is the breakdown of the data:
Exam Time:
The time at which the last sensor was touched minus the time at which the first sensor was touched
Number of Touched Locations:
The number of sensors that recorded a “purposeful touch”
Maximum Pressure:
The maximum pressure recorded on each sensor
Frequency:
The frequency recorded on each sensor
Locations Touched:
Indication on which sensors recorded a “purposeful touch”
(NOTE: Recorded “purposeful touches” represent all acceptable and excessive readings on the sensor. “ -- ” represents statistical data that is currently unavailable.)
ª
Select Comparison Configuration — This selection window allows you to change the internal anatomy configuration and see how this change affects the comparisons and assessment readings. For a true representation and adequate comparison, it is important to adjust this window to match the anatomy used during the given session you are assessing.
4.22
Figure 79 Detailed Statistics and Select Comparison Configuration
Detailed Statistics Definitions
Pre-Use Test Once your simulator is configured for use and your Computer Workstation is on and the software is launched, it is essential to do a Pre-Use Test to ensure that the sensors are working properly. Use the following chart to complete the test prior to the start of your learning session. Pre-Use Test Chart
1
Click the Reset button on the Main User Interface Window. This will recalibrate the sensors and reset the assessment fields on the monitor.
2
Set the software to the appropriate Internal Anatomy Component configuration by selecting Configurations from the menu bar. Select the appropriate setting.
3
Perform a standard bimanual pelvic exam. Make sure to monitor the Computer Workstation to ensure that the pressure indicator bars are registering your palpations and that the Exam Checklist is accounting each touch for the specific palpation locations.
4
If all of the pressure indicators are working and the checklist is complete, the system is ready for your learning session. If not, proceed to steps 5-7.
5
If you notice that the pressure indicator bars and the checklist field are not registering your palpations, check the signal box on the back of the simulator to make sure that all of the signal leads are properly connected.
6
If the leads are properly connected and you still are not getting feedback on the display at any of the seven palpation sites, remove the abdominal skin covering and abdominal wall and reconfirm the positioning of the Internal Anatomy Component. Make sure that you verify that the attachment sites are configured appropriately for the uteri chosen. Reattach the abdominal skin covering and abdominal wall and re-test.
7
If the system still fails to register palpation activity at any of the seven sites, you may have a damaged sensor. Check for abnormal calibrations by applying pressure in each of the seven palpation areas and confirm the indicator bars have a full range of pressure. If your pressure bars are not indicating a full range, contact METI Customer Service toll-free at 866-462-7920.
(NOTE: If you are testing the system with the Retroverted Uterus in place, make sure that the colon portion of the Internal Anatomy Component is not wadded up underneath the retroverted sensor. This can cause faulty pressure on the anterior sensor.)
4.23
Printing Capabilities — On any of the AAR selections (i.e. Exam Results, Graphical Comparisons, and Detailed Statistics), there is a Print button located in the upper right portion of the screen. When you click on the Print button, a dialog box will appear that provides you with two options: Print Current Page or Print Entire Report. If you select the Print Current Page option, you will only get a hard copy of the current data displayed on the screen. If you select Print Entire Report, you will get a complete printed version of the Exam Results, Graphical Comparisons and Detailed Statistics for the given exam.
Figure 80 Print Options
Note: When printing the entire report, the printed data represents the complete analysis of all seven palpation results compared to the Novice and Experienced Clinician data in the various formats, (i.e., Exam Results, Graphical Comparisons and Detailed Statistics). If you choose Print Current Page (which is essentially a “print screen” feature), it is possible to isolate specific palpations comparisons within the Exam Results and Graphical Comparison selections. By clicking on the palpation site(s) in the Sensor Graphs checklist, you can view selected comparisons and then hit the Print button, select Print Current Page, and view a hard copy of these results.
4.24
After selecting either Print Current Page or Print Entire Report, a second dialog box will appear, allowing you to select a printer, the number of copies you want to print and the page range.
Figure 81 Printer Dialog Box
IMPORTANT: In order to print the exam results in either configuration, you will need to connect a printer to the Computer Workstation. Please contact your local computer support staff for assistance in attaching your printer.
4.25
Data Migration — All of the data that is collected and saved on the Computer Workstation can be migrated into other software applications to help extrapolate various comparisons. The AAR files are stored in a standard tab-delimited format for use with third-party applications such as Microsoft™ Excel and MATLAB™. To find saved exam results, click on the Start button at the bottom of the screen and scroll up to the My Documents folder. This is where METI recommends that you keep all your exam results for easy access. (NOTE: Consult your specific third-party application user information for importing data.)
4.26
Learning Modules There are three main learning modules when using the ExamSIM: the Learning Mode, the Assessment Mode and the After Action Review. Each of these modules sup-
Figure 82 Learning Mode
port specific learning objectives that provide exceptional skills acquisition and newfound confidence in learners. The following content outlines the basics for each learning module starting with the Learning Mode.
The Learning Mode The Learning Mode provides learners with the kind of feedback they need to safely and effectively perform a bimanual pelvic and rectal exam. Whether used in a group-learning environment or independent study module, the Learning Mode allows the student to practice examination skills and palpation at their own pace with immediate feedback to help them learn the proper palpation sites and palpation pressures. There are two key usage distinctions to note in the Learning Mode:
1. The Computer Workstation is positioned for easy viewing by the learner, surrounding students and the instructor. 2. The exam sessions are not recorded or reviewed in the AAR mode. These two distinctions set the Learning and Assessment Modes apart. To set up a Learning Mode Module, use the following steps:
1. Configure the simulator and the Computer Workstation for use. 2. 3.
(NOTE: For specific set up details, see the Set Up/Breakdown section or Quick Start section.) The instructor needs to perform a Pre-Use Test prior to the start of the learning module to ensure that the sensors are working properly. (NOTE: For detailed steps, see Pre-Use Test.) Ensure that the Computer Workstation is within clear view of the learner(s) when performing the bimanual exam.
4.27
4. Allow the learner to start the exam: (NOTE: The learner must wear non-sterile exam gloves at all times when performing an exam on the simulator.)
a. Start with an external inspection of the external genitalia. b. Perform a speculum exam. (NOTE: Only use the supplied Silicone Oil as a lubricant for the speculum). The Learner will need to: i. Locate the cervix ii. Evaluate the vaginal vault iii. Practice culture techniques (NOTE: Do not use a Graves speculum—use the smallest Pederson. Additionally, do not use a wooden spatula for the culture—plastic helps maintain the durability.)
c. Perform the Bimanual Exam: i. Instruct the learner to view the monitor while palpating ii. Draw the learner’s attention to the pressure indicator bars iii. Draw the learner’s attention to the Exam Checklist d. Instruct the learner to perform a rectal-vaginal exam.
(NOTE: A rectal-vaginal exam MUST be performed when the Retroverted Uterus is in use. Additionally, a uterine fibroid can be detected by performing a rectal-vaginal exam and should be included when this anatomy is in use.)
e. Click Stop on the Main User Interface Window to end the session. f. Click Reset to begin another Learning Mode.
Instructors may choose not to tell learners which Internal Anatomy Component is configured in the simulator before the start of a module. This approach is considered to be slightly more advanced and should be used only when appropriate for the learning objectives. When in the Learning Mode, the main learning objectives are clear: The learner is given the opportunity to discover the intricacies of the female pelvic cavity and test their own knowledge and skills while palpating. The Learning Mode is a valuable tool for less experienced students and helps to greatly increase their knowledge and confidence levels.
4.28
The Assessment Mode The Assessment Mode takes the Learning Mode to the next level by recording the exam results and giving the learner and the instructor the opportunity to review these results. There are two basic Assessment Mode configurations:
Figure 83 Blind Exam Mode
1. The instructor can choose to allow the learner to view the computer during the exam to monitor pressure readings and checklist progress while recording the exam. We will call this the View Exam Mode.
2.
OR The instructor can choose to turn the monitor so that the computer screen is out of the learner’s view, giving the instructor the ability to assess the learner’s palpation skill acquisition. We will call this the Blind Exam Mode.
In either configuration, the instructor is able to review the exam results immediately after the exam and save these results to be reviewed in an After Action Review (AAR) at a later time.
To set up an Assessment Mode Module, use the following steps:
1. Configure the simulator and the Computer Workstation for use. (NOTE: For specific set up details, see the Set Up/Breakdown section or Quick Star t section.)
2. The instructor needs to perform a Pre-Use Test prior to the start of the learning module to ensure that the sensors are working properly. (NOTE: For detailed steps, see Pre-Use Test.)
3. Decide which monitor configuration to use for your session: a. Allow the student to view the monitor for View Exam Mode b. Set up the Computer Workstation for Blind Exam Mode 4. Click the Reset button on the Main User Interface Window and then select Record.
4.29
5. Allow the learner to start the exam: (NOTE: The learner must wear nonsterile exam gloves at all times when performing an exam on the simulator.) a. Start with an external inspection of the external genitalia. b. Perform a speculum exam. (NOTE: Only use the supplied Silicone Oil as a lubricant for the speculum). The Learner will need to: i. Locate the cervix ii. Evaluate the vaginal vault iii. Practice culture techniques c.
(NOTE: Do not use a Graves speculum—use the smallest Pederson. Additionally, do not use a wooden spatula for the culture—plastic helps maintain the durability.) Perform the Bimanual Exam in the Blind Exam Mode.
OR
d. Perform the Bimanual Exam in the View Exam Mode: i. Instruct the learner to view the monitor while palpating ii. Draw the learner’s attention to the pressure indicator bars iii. Draw the learner’s attention to the Exam Checklist e. Instruct the learner to perform a rectal-vaginal exam. (NOTE: A f. g.
rectal-vaginal exam MUST be performed when the Retroverted Uterus is in use. Additionally, a uterine fibroid can be detected by performing a rectal-vaginal exam and should be included when this anatomy is in use.) Click Stop on the Main User Interface Window to stop recording. A dialog box will prompt you to Save or Cancel the exam results. (NOTE: You will need to Save the exam results to view them in the AAR mode.) Click the Review button to review the results of the exam.
Again, the instructor may choose not to tell learners which Internal Anatomy Component is configured in the simulator before the start of a module. This approach is considered to be slightly more advanced and should be used only when appropriate for the learning objectives. When in the Assessment Mode, the learning objectives are more defined: Does the learner know how to palpate all the sites and with a purposeful amount of pressure? Whether you chose to use the View Exam Mode or the Blind Exam Mode, the Assessment Mode provides the review capabilities that isolate critical and objective appraisal of the exam.
4.30
After Action Review The After Action Review (AAR) capabilities help instructors and students alike see how a given recorded exam compares to a database of over 400 novice and over 700 experienced examiners. This comparison provides an objective basis for measuring a learner’s skill acquisition when performing the bimanual pelvic exam. Please keep in mind, for our purposes, a “Novice User” is considered to be a medical student still in training and an “Experienced User” is considered to be a practicing OB/GYN. (NOTE: The Experienced User data was collected at several professional conferences where the attendees where currently practicing OB/GYNs.) There are several different ways to compile the data for comparison purposes. Use the following information to open a given recorded exam and to review each of the three specific reports: Exam Results, Graphical Comparison and Detailed Statistics.
1. To review a given exam, click on the Open Report button located on the Main User Interface Window.
2. Select the desired exam you wish to evaluate from the dialog box and then click the Open button. 3. The AAR Interface Window will appear as a second window on the screen. It will include:
a. The name of the file complied for review in the menu bar b. The three data configuration choices (NOTE: Exam Results is the default selection.)
c.
The Select comparison configuration selection window
4. Start by selecting the appropriate Internal Anatomy Component configuration for the exam you are reviewing by adjusting the Select component configuration accordingly. To do this, simply click on the down arrow in the selection window to see a menu of the four Internal Anatomy Components. Select the appropriate component for your review. The AAR is now properly set up to begin the review. Use the following information to make the most of each of the three reports that make up the AAR.
4.31
Exam Results: This report is the default for the AAR Interface Window and includes a helpful breakdown of exam comparisons and results. Starting with the color-coded Sensor Graph, this matrix provides a quick overall graphic review of the given examination. Each of the seven palpation sites is represented by a color-coded line that shows the pressure measurements of each site and the time (in seconds), which measures the touch value and duration of the exam. (NOTE: For more information regarding the color-coded lines, see the Exam Results Sensor Graph Chart included in the AAR Interface Window Terminology portion of this section.) The Sensor Graphs checklist to the right of the matrix allows you to evaluate the performance of the learner on individual palpation sites. Simply select or de-select the given palpation site and the matrix will display only the palpation sites you wish to review. This provides valuable data to the instructor when comparing and evaluating a learner’s understanding of specific palpation requirements. In addition to the matrix, the Exam Results window includes a basic table that displays and compares the exam results to an average of Novices and Experienced Users. This simple chart provides important information including Exam Time, Number of Touched Locations, Mean Max Pressure and the Mean Frequency. The report breaks this data down by showing the chosen exam results in one column, an average of Novices exam results in the middle column, followed by an average of Experienced Clinician exam results in the final column. (NOTE: For more information regarding the Exam Results table, see the Exam Results Definitions table included in the AAR Interface Window Terminology portion of this section.) Graphical Comparisons: The Graphical Comparisons report is the second selection of the AAR Interface Window and provides the ability to graphically compare and review the given exam against compiled statistics from the database. There are two types of graphs in this selection – one graph that presents the results of the given exam and one that provides a comparison of those results to representative Novice Student data and Experienced Clinician data from within the database.
4.32
The first graph — which is labeled with the file name — provides an individual review of the given exam results. The Sensor Graphs checklist to the right of the graph allows you to evaluate the performance of the learner on individual palpation sites. Simply select or de-select the given palpation site and the matrix will display only the palpation sites you wish to review. The graph will display the pressure measurements of each site and the time (in seconds), which measures the touch value and duration of the exam. The second graph, which falls below the first graph, provides two options: Representative Novice and Representative Experienced Clinician. When either one of these are selected, the graph displays the given exam results compared to representative data from the database. Additionally, you can review this data by palpation site by using the Senor Graphs checklist to the right of the graph to view a comparison of specific palpation sites. The graph will display and compare the pressure measurements of each site and the time (in seconds), which measures the touch value and duration of the each exam represented on the graph. Detailed Statistics: This selection presents the same data from the Graphical Comparisons selection only in statistical form. This view provides the standard deviation values of the Novice and Experienced Clinician data that is compiled from a huge database of users (including over 400 students novices and over 700 experienced clinicians). This report provides a very comprehensive look at how the given exam results compare, helping to measure how the learner’s performance is progressing and to isolate areas that need improvement. In this format, the data is again broken down for review by displaying the Exam Time, Number of Touched Locations, Mean Max Pressure and the Mean Frequency. This consistent breakdown of the data provides continuity for all three of the AAR reports and isolates critical information used to assess the learner’s progress. (NOTE: For more information regarding the statistical breakdown, see the Detailed Statistic Definitions table included in the AAR Interface Window Terminology portion of this section.)
4.33
2.1
Use For Learning The METI Pelvic ExamSIM was designed to be a powerful teaching tool to support the goals and objectives of individual programs. While there are a few basic set up and usage principles involved when integrating the simulator for use, the flexibility of the system allows instructors to create modules that best support their own learning objectives and curriculum goals. The following content was designed to inspire different implementation possibilities and ways to incorporate the ExamSIM into various education programs. This section is not meant to be a typical usage section. At METI, we encourage our family of users to discover new and innovative ways to assimilate our technology into their own programs, making learning the focus — not the technology. For that reason, the items included in this section are suggested ways to utilize the ExamSIM within the context of your own needs.*
*At METI, we want to know how and what you are doing to make your learning sessions more meaningful to your students. To share how you are implementing the ExamSIM into your curriculum, contact the METI Education & Training department at
[email protected].
5.1
Basic Teaching Points To create the most effective learning modules, learners using the ExamSIM for the first time should have a general understanding of the female pelvic anatomy and should know which organs they are expected to examine during the procedure. This basic knowledge is the result of didactic work and classroom sessions and gives the learner an overall awareness of what a female pelvic exam entails. Within a four to six week period, the goals for a beginning learner should be clear: Learners are expected to learn the palpatory differences noted between an anterverted uterus, a retroverted uterus, a normal ovary and an ovarian mass. The number of times a given learner has to perform an exam to gain a general understanding of the steps of the exam will vary tremendously, so generally speaking, the best way to assess the learner’s proficiency with the exam is not based on the number of times the learner practices the exam. Instead, the instructor has the ability to objectively assess the performance of the given student by using the After Action Review capabilities. One key way to support the learning process is to provide supplemental materials for learners to reference when using the ExamSIM in the Learning Mode (which is considered to be the “practice mode” for beginning learners). These materials might include visuals of the anatomy (anterior and sagital views) of the female pelvic anatomy and pictures describing how to use the speculum and other related exam instruments. By supplementing the learning environment around the simulator, instructors can promote self-learning and discovery.
5.2
Adjunct Implementation For several decades, the use of Gynecological Teaching Associates (GTAs) has been a cornerstone for educating learners in the area of female pelvic exams. By incorporating trained teaching associates who recognize proper technical skills, students gain a new level of confidence in their ability to perform the examination. This direct, hands-on approach provides a realistic learning environment and the necessary feedback students need when learning to perform the exam properly. However, the limitations of this approach include cost, availability for multiple examinations, and the demonstration of pathological findings. While using GTAs continues to be an effective means to develop better interpersonal skills, there is no truly significant way to observe or measure the student’s cognitive abilities or psychomotor skills during the examination. But by adding the ExamSIM to the curriculum, it is possible to increase the effectiveness of the GTAs and provide an objective means to determine the skill level and skill acquisition of the learner. Starting a learning module by providing ample practice and assessment time on the ExamSIM better prepares learners for a more appropriate and sensitive interaction with the GTAs, and gives the instructor the means to assess where the learner needs support. This combined effort provides a better overall learning experience for the learner. Suggested Implementation To increase the effectiveness of GTAs, it may be beneficial to allow learners to spend time using the ExamSIM in both learning modules, i.e., the Learning Mode and Assessment Mode. (NOTE: For more detail regarding the set up and use of both of these ExamSIM learning modes, please refer to the section entitled Learning Modules found in the System Usage section of this User Guide.) By allowing learners to practice bimanual pelvic exams with meaningful feedback regarding palpation pressure, internal anatomy orientation and various pathologies, the learner will be better prepared to examine a real patient. The instructor can make the ExamSIM available to students for independent practice time, or set up groups of two to three students to use the simulator and explore their own exam skill level.
5.3
After learners have ample practice time, the instructor can record the session to evaluate the learner’s exam results and highlight specific areas that need improvement. By evaluating the learner’s performance in a blind examination — when the Computer Workstation is turned so that only the instructor can monitor the feedback – the instructor can determine if the learner is ready to begin interaction with a GTA. This helps make the learner more confident and the GTA more comfortable. Independent Study Modules It is easy to set up independent study modules for advanced learners who want to hone and perfect their examination skills. If you have a lab environment, providing access to the simulator should be fairly easy. To best support independent study when using the ExamSIM, we suggest that only learners who have been exposed to the use of the simulator during monitored sessions are permitted to use it in this mode. It is important that independent learners understand the Cautions & Warnings and all system usage details to ensure that the ExamSIM is not misused or damaged during a learning session. Some of the key benefits of independent learning modules include the student’s ability to take all the time he or she needs to practice the exam. By using the feedback on the Computer Workstation, the learner begins to comprehend the subtle differences in purposeful touch and excessive touch along with palpation techniques that are more effective when performing the bimanual pelvic exam. If you plan to support independent study modules, it is a good idea to require that your students save their recorded sessions for your review at a later date. This will help you maintain an objective record of the learner’s progress and development over time. It is a good idea to keep the Quick Start Chart, near the ExamSIM workstation. This will help support independent learners in the use and care of the simulator system.
5.4
Other Assessment Alternatives ª To assess learners with regard to the full spectrum of clinical procedures, it may be helpful to set up what is called an Objective Structured Clinical Examination (OSCE) station. This OSCE station can be used as a final examination of sorts, which provides instructors with quality data and assessment information to objectively evaluate a student’s performance and understanding of the bimanual female pelvic exam. When using multiple ExamSIM units, each OSCE station is set up with a different Internal Anatomy Component and a patient history file is provided that is specific to each station. Learners must go to each station, read the patient file and perform specific exam requirements. This mode helps instructors assess the learner’s ability to assimilate patient history and perform the exam appropriately.
ª
Another assessment method that may prove useful is the Immediate Post Training Assessment mode. In this mode, learners are divided into manageable sized groups and then sent into the classroom for a brief lecture. The lecture will cover key learning points and pertinent information designed to isolate specific learning objectives. Once the lecture is complete, the learners are asked to perform an exam on the ExamSIM and follow up with an evaluation of their clinical findings. Specific objectives such as the size, shape, position and consistency of the organs being palpated and other pathological findings are recorded and then reviewed by the instructor with the students for immediate feedback.
ª
The ExamSIM provides a realistic representation of the female pelvis, but that is only one part of the overall exam process. Understanding the anatomy without taking into consideration the sensitive nature of the exam itself does not provide learners with a complete understanding of how a bimanual examination should be performed. Adding the human element is an essential component to the learning process and should not be minimized. We already discussed the use of GTAs, but when GTAs are not available, it is still possible, using the ExamSIM, to add the human factor into your learning modules. With a little bit of set up and a volunteer, you can create a realistic exam setting for your learners.
5.5
Start by setting up the ExamSIM on the end of an examination table. Brief your volunteer student with all the specifics they need to know regarding the Internal Anatomy Component you are using, along with symptoms and other such information they can feed to the learner during the exam. Have the volunteer sit behind the ExamSIM on the table and drape a cloth over the volunteer and the ExamSIM. Allow the learner to enter the exam area and begin the exam by interacting with your volunteer. Encourage the learner to ask key questions before he or she actually begins the exam. Incorporate a detailed patient history and other information including blood pressure and vital statistics that help the learner begin to consider all of the various health factors of their “patient.” Follow up this learning session with immediate feedback recorded in the After Action Review (AAR) and from notes taken during the interaction with the patient. This learning module will help orient the learner to the variables of patient interaction and help balance the experience with verifiable and objective exam data.
5.6
Care/Maintenance Simple care and maintenance steps help to ensure your ExamSIM system stays in good working condition. We recommend that you follow these steps and do a thorough check of your various components each time you use your simulator. The Pelvic Assembly ª After each use, ensure that the abdominal skin covering is clean and free from dirt or markings. The abdominal skin is machine-washable using a gentle setting and a mild detergent. Allow the fabric to air dry completely before reattaching the skin to the pelvic assembly.
ª
It is best to always wear non-sterile exam gloves when handling the abdominal skin as oils from your hands can cause the material to discolor and influence the texture.
ª
To store the Pelvic Assembly, it is best to cover the unit with a drape and store in an area where it cannot be bumped or damaged.
ª
It is not necessary to remove the Internal Anatomy Components or Removable Abdominal Wall when storing the Pelvic Assembly at the end of a session.
ª
Disconnect the Computer Workstation from the Pelvic Assembly and store in a safe and secure place.
The Ancillary Equipment ª Be sure to store all of the Internal Anatomy Components not in use in a safe place to ensure that the sensors are not damaged.
ª
Be sure to store the Fat Pad in a safe place.
ª
Keep your Helix Connectors kit and Silicone Oil in a safe place.
6.1
The Computer Component ª Make sure that you keep the Pelvic ExamSIM software up to date. METI sends out software upgrades directly to our users. Included with these upgrades are the installation instructions. Keeping your software current will help you maintain the full range of functionality.
ª
Do not install other software on your ExamSIM Computer Workstation. METI does not support any applications other than the application that pertains to the use of the METI Pelvic ExamSIM.
ª
When storing the Computer Workstation, make sure to include the USB cable and the power adapter. It is best to store the computer component in a secure location to prevent theft.
6.2
Troubleshooting Steps When the ExamSIM is configured properly, each time a user performs a bimanual pelvic exam, the palpations should register on the Main User Interface Window (displayed on the Computer Workstation). The following indicators register activity at the site of each palpation:
1. 2. 3.
An indicator light on the Pelvic Image will illuminate with either a red or green dot. The Pressure Indicator Bars will indicate the range of pressure for each given palpation site. The Exam Checklist will note each palpated site.
If any one of the seven internal sensors within the Internal Anatomy Component is damaged in any way, there will be an absence of this data on the Main User Interface Window. If you notice that the Pelvic Image, Pressure Indicator Bars and the Exam Checklist are not registering your palpation, use the following troubleshooting steps to determine if the sensor(s) within the given Internal Anatomy Component are not functioning properly:
1. 2.
3. 4.
Start by checking the signal box on the back of the simulator to make sure that all of the signal leads are properly connected. If the leads are properly connected and you are still not getting feedback on the monitor at any one of the seven palpation sites, remove the abdominal wall and reconfirm the positioning of the Internal Anatomy Component. Make sure that you verify that the attachment sites are configured appropriately for the uteri chosen. Reattach the abdominal wall and re-test. (NOTE: If you are using the Retroverted uterus, ensure that the colon is not cramped by the uterus. This can give you faulty sensor readings.) Check for abnormal calibrations by applying pressure in each of the seven palpation areas and confirm the indicator bars have a full range of pressure. If the system still fails to register palpation activity at any one of the seven sites, you may have a damaged sensor.
Damaged Sensors If you have damaged sensors in any of your Internal Anatomy Components, please contact METI Customer Support toll-free at 866-462-7920.
6.3
INDEX ITEMS Cautions and Warnings Personal Safety: Electrical, 0.1
Signal Box, 1.5, 2.3, 2.5, 2.7-8, 2.12, 2.15, 4.2, 4.4, 4.5, 4.23, 6.3 Signal Leads, 2.3, 4.23, 6.3
Mannequin, 0.1
Signal Pigtail, 2.3-2.5, 2.15, 4.4, 4.5
Computer Component, 0.1
Silicone Oil, 0.2, 1.2, 1.3, 1.8, 4.30
System Safety:
Simulator Electronics, 1.5, 1.7, 2.3, 2.7, 2.15, 4.2, 4.5
Electrical, 0.2
Standard Equipment, 1.2
Mannequin, 0.2
Shut Down, 2.11, 2.13-14
Computer Component, 0.3
USB Data Cable, 1.5, 2.7, 2.11, 2.14, 4.5, 4.12 Work Area, 0.1-0.3, 2.1, 2.12
Equipment Components Abdominal Skin Covering, 0.2, 1.2, 1.4, 1.8, 2.2, 2.6, 2.15,
Software Terminology
4.2, 4.3, 4.23, 6.1
After Action Review, 3.3, 4.11, 4.18-19, 4.21, 4.24, 4.26,
Abdominal Wall, 1.2, 1.4, 2.2, 2.5, 2.12, 2.15, 4.2, 4.3,
4.27, 4.29-31, 4.33, 5.2, 5.6
4.23, 6.1, 6.3
Assessment Mode, 1.8, 3.3, 4.7, 4.15, 4.16, 4.27,
AC Plug Adapter Kit, 0.1, 0.2, 2.7
4.29, 4.30, 5.3
Breakdown — Lab Environment, 2.10
Blind Exam Mode, 4.29, 4.30
Breakdown — Non Lab Environment, 2.13
Configuration, 4.7, 4.10, 4.22, 4.23, 4.25, 4.31
Cleaning Considerations, 2.15, 6.1
Data Migration, 4.26
Computer Workstation, 1.1, 1.2, 1.5, 1.7, 1.8, 2.1, 2.7, 2.8,
Dialog Box, 4.8, 4.10-12, 4.17, 4.24, 4.25, 4.30, 4.31
2.10, 2.12, 2.13, 2.15, 4.2-4.8, 4.12, 4.17, 4.23, 4.25, 4.26,
Edit, 4.9
4.27, 6.1, 6.2
Exam Checklist, 4.7, 4.12, 4.16, 4.23, 4.28, 4.30, 6.3
ExamSIM Software, 1.3, 1.9, 2.1, 2.8, 2.10, 4.1, 4.6, 4.7,
Exit, 2.10, 2.13, 4.9, 4.12
4.10, 4.14, 4.23, 6.2
Graphical Comparison, 4.21-22, 4.24, 4.31-32
Fat Pad, 1.2, 1.5, 2.6, 2.15, 6.1
Help, 4.10
Helix Connectors Kit, 1.2, 1.8, 6.1
Immediate Post Training Assessment, 5.5
Instrumented Internal Anatomy Spares Kit, 1.3, 1.9
Independent Study Modules, 5.4
Internal Anatomy Components, 1.1, 1.2, 1.5-1.9, 2.2-2.5,
Learning Mode, 1.7, 3.2, 4.7, 4.16, 4.27-29, 5.2, 5.3
2.4, 2.12, 2.15, 4.4, 4.5, 4.10, 4.23, 4.30, 4.31, 5.6, 6.1, 6.3
Main User Interface Window, 2.9, 2.10, 4.7, 4.9, 4.11-13,
Clinical Uterus with Normal Anatomy, 1.2, 1.6,
4.15, 4.23, 4.28-31, 6.3
4.3-4, 4.10
Open Report, 4.9, 4.11, 4.31
Clinical Uterus with Ovarian Cyst, 1.2, 1.6, 2.2, 4.3-4
Operating System, 4.6
Clinical Uterus with Fibroid, 1.2, 1.6, 4.3-4
Pelvic Image, 4.7, 4.12, 6.3
Clinical Retroverted Uterus, 1.2, 1.6, 2.4, 4.3-4, 4.23,
Pre-Use Test, 4.23, 4.27, 4.29
4.28, 4.30, 5.2, 6.3
Pressure Indicator Bars, 4.7, 4.13, 4.14, 6.3
Internal Anatomy Spares Kit, 1.9
Printing, 4.24, 4.25
Internal Pelvic Cavity, 1.2, 1.4, 1.5, 1.7, 4.2
Purposeful Touch/Excessive Touch, 4.12-14, 4.20, 4.22, 5.4
International Users, 0.1, 0.2
Recording, 2.10, 2.13, 4.7, 4.8, 4.12, 4.15, 4.16, 5.4
Learning Cards, 1.2, 1.8
Review, 4.18, 4.30
Optional Equipment, 1.3
Start Button, 4.8, 4.26
Pelvic Assembly, 1.2, 1.4, 1.7, 1.8, 1.9, 2.1, 2.4-7, 2.12,
Status Box, 4.7
2.15, 4.2, 4.4-7, 4.12, 6.1
Threshold Indicator Sliders, 4.14
Power Supply, 2.7
User Interface Window, 4.6
Rubber Latex, 0.1
View Exam Mode, 4.29, 4.30
Sensor Pressure Bars, 1.7, 4.23 Sensors, 1.7, 2.3, 2.4, 2.9, 4.4, 4.12, 4.15, 4.20, 4.22, 6.1, 6.3
7.1
What’sInside
Use the following Inventory Checklist to ensure that you have all of the METI Pelvic ExamSIM™ system components. For a complete explanation of all of the Pelvic ExamSIM system components, please refer to the Equipment Overview section of the enclosed User Guide.
Box One: The Female Pelvic Assembly & Ancillary Components 1. One Female Pelvic Assembly* 2. One USB Data Cable 3. One Power Cord 4. One Fat Pad 5. One Silicone Oil 6. One Helix Connectors Kit
3
10
1
11
*Pelvic Assembly is shipped pre-installed with the Clinical Uterus with Normal Anatomy.
6 4
Box Two: 7. Clinical Uterus with Ovarian Cyst
5
9
Box Three: 8. Clinical Uterus with Fibroid
8
Box Four: 9. Clinical Retroverted Uterus
7
2
IMPORTANT: ª
LATEX CAUTION: The METI Pelvic ExamSIM contains natural rubber latex, which may cause allergic reactions. Users with latex allergies need to take necessary precautions.
ª
It is important that you keep all of your original METI Pelvic ExamSIM shipping materials including the boxes. All warranty and repair items must be return shipped to METI in the original packaging.
12. One User Guide (not shown) that includes:
ª
•Four Learning Cards •Warranty Information •License Agreement
Refer to the complete Cautions & Warnings section of the enclosed User Guide for specific safety considerations. DO NOT install other software.
ª
Please refer to the Set Up/Breakdown section of the enclosed User Guide for complete system configuration details.
Box Five: The Computer Workstation (laptop) 10. One Laptop Computer** 11. One Electrical Cable **The laptop computer comes preconfigured with the Pelvic ExamSIM software. DO NOT INSTALL OTHER SOFTWARE ON THE COMPUTER WORKSTATION.
(NOTE TO INTERNATIONAL USERS: Two AC Adaptor Kits are included.
SetUpQuickChart
Pre-UseTest
First Step
Second Step
Set Pelvic Assembly and Computer Workstation on sturdy work surface.
Connect the USB Data Cable from the Pelvic Assembly to the Computer Workstation.
Third Step
Fourth Step
Plug in the Power Cord for the Pelvic Assembly and plug the other end into your wall outlet.
Plug in the Power Cord for the Computer Workstation and plug the other end into your wall outlet.
Fifth Step
Sixth Step
Flip the Power Switch located on the signal box to the On position.
Turn on the Computer Workstation as shown.
1 2 3
Set the software to the appropriate Internal Anatomy Component configuration by selecting Configurations from the menu bar. Select the appropriate setting. Perform a standard bimanual pelvic exam. Make sure to monitor the Computer Workstation to ensure that the pressure indicator bars are registering your palpations and that the Exam Checklist is accounting each touch for the specific palpation locations.
4
If all of the pressure indicators are working and the checklist is complete, the system is ready for your learning session. If not, proceed to steps 5-7.
5
If you notice that the pressure indicator bars and the checklist field are not registering your palpations, check the signal box on the back of the simulator to make sure that all of the signal leads are properly connected.
6 Final Step The METI Pelvic ExamSIM software will automatically launch, displaying the Main User Interface Window.
7 For complete details on how to set up the METI Pelvic ExamSIM,please refer to the Set Up/Breakdown section of the User Guide.
Click the Reset button on the Main User Interface Window. This will recalibrate the sensors and reset the assessment fields on the monitor.
If the leads are properly connected and you still are not getting feedback on the display at any of the seven palpation sites, remove the abdominal wall and reconfirm the positioning of the Internal Anatomy Component. Make sure that you verify that the attach ment sites are configured appropriately for the uteri chosen. Reattach the abdominal skin covering and abdominal wall and re-test. If the system still fails to register palpation activity at any of the seven sites, you may have a damaged sensor. Check for abnormal calibrations by applying pressure in each of the seven palpation areas and confirm the indicator bars have a full range of pressure. If your pressure bars are not indicating a full range, contact METI Customer Service toll-free at 866-462-7920.
Patient Histor y
D i a g n o s i s / Im p r e s s i o n
Te a c h i n g P o i n t s
Set-up
Sara M. is a 20-year-old female who
Diagnosis / Impression
Teaching Points
Pelvic ExamSIM Set-Up and
visits the student outpatient clinic
Normal exam.
1. Normal pelvic exam.
Clinical Supplies Needed
2. Identify patient at risk for STD
seeking birth control pills. She states
and recommend appropriate
she had first-time intercourse with
Normal Internal Anatomy Component
follow-up care.
boyfriend two weeks ago. Did not use
Treatment
condom or spermicide. Denies any
Screen for STD's (e.g., chlamydia).
3. Screen for STD's.
Flexible light source
eight days ago.
Recommend pap smear.
4. Examiner utilizes appropriate
Vaginal speculum (Pederson only)
Pregnancy test.
pelvic exam sequence. 5. Assess unwanted pregnancy risk [is she currently on her period
Exam Challenges
or has she missed her period
None — normal pelvic exam with
since her interaction with her
patient in no apparent distress.
boyfriend].
Clinical Findings Normal exam. No inflammatory findings. Cervix round and closed.
Silicone oil Non-sterile exam gloves
Learni ng Objectives
Normal Exam
R e f e re n c e s
References: APGO: Medical Student Educational
1. Student will demonstrate the ability to
9. Describe the gross anatomy of the pelvis and
Objectives, 7th edition. Association of
perform a complete pelvic examination.
pelvic viscera, including arterial blood supply,
Professors of Gynecology and Obstetrics,
[Objective 2, APGO, p. 3]
venous and lymphatic drainage, and neurologic
1997.
2. After completing the history and physical exam, the student will demonstrate the ability to form a diagnostic impression
innervation. [Gynecology Competencies, CCOG, p.82] 10. Demonstrate critical thinking and diagnostic skills
CCOG: Educational Objectives: Core Curriculum in Obstetrics and Gynecology, 7th
including differential diagnosis and
in clinical decision-making.
edition. Council on Resident Education in
develop a management plan.
[Guideline I, AWHONN, p. 2]
Obstetrics and Gynecology, 2002.
[Objective 4, APGO, p. 4] 3. Perform a complete and accurate medical history and physical exam. [Specific Competencies, CCOG, p.13] 4. Make an informed diagnosis. [Specific Competencies, CCOG, p.13] 5. Make evidence-based treatment decisions. [Specific Competencies, CCOG, p.13] 6. Prescribe medications in a rational, thoughtful and safe manner. [Specific Competencies, CCOG, p.13] 7. Safely and correctly perform the diagnostic and surgical procedures unique to the
11. Perform a comprehensive physical assessment. [Guideline I, AWHONN, p. 2] 12. Order, perform and interpret screening and
Education, 5th edition. Association of
[Guideline I, AWHONN, p. 2]
Women’s Health, Obstetric and Neonatal
13. Develop and analyze differential diagnoses on the basis of clinical and laboratory data. [Guideline I, AWHONN, p. 3] 14. Recommend diagnostic and therapeutic interventions with attention to safety, efficacy and cost-effectiveness. [Guideline I, AWHONN, p. 3] 15. Provide clinical management, including selected therapeutic procedures for women with
[Specific Competencies, CCOG, p.13]
gynecologic problems.
genitalia, including arterial blood supply, venous and lymphatic drainage and neurologic innervation. [Gynecology Competencies, CCOG, p.82]
Practitioner: Guidelines for Practice and
diagnostic procedures and tests.
discipline of obstetrics and gynecology. 8. Describe the gross anatomy of the external
AWHONN: The Women’s Health Nurse
[Guideline I, AWHONN, p. 3]
Nurses and National Association of Nurse Practitioner’s in Women’s Health, 2002.
Patient Histor y
D i a g n o s i s / Im p r e s s i o n
Te a c h i n g P o i n t s
Set-up
Mary P. is a 32-year-old obese female
Diagnosis / Impression
Teaching Points
Pelvic ExamSIM Set-Up and
who
Benign ovarian tumor/cystic mass.
1. Examiner utilizes appropriate
Clinical Supplies Needed
presents
to
the
ED
with
pelvic exam sequence.
complaints of excessive nausea and
2. Note consistency and tenderness
vomitting for the past 48 hours. She states this is in conjunction with severe
Treatment
of ovarian mass. Attempt to
abdominal pain and "a feeling of
If smaller than 8 cm, reexamine in
estimate ovarian mass size.
fullness." She also complains of being
4-6 weeks. If greater than 8 cm and solid, laparotomy to remove.
Exam Challenges Obese abdomen. Complains of severe abdominal pain. Potential for abnormal exam findings.
Clinical Findings A mass on the right ovary. Cervix round and closed. Right lower quandrant pain.
3. Examiner assesses the need for further diagnostic studies
anorexic.
(e.g., ultrasound or CT).
Ovarian Cyst Internal Anatomy Fat pad Flexible light source Vaginal speculum (Pederson only) Silicone oil Non-sterile exam gloves
Learning Objectives
Ovarian Cyst
R e f e re n c e s
References: APGO: Medical Student Educational
1. Student will demonstrate the ability to perform
10. Describe the gross anatomy of the external
Objectives, 7th edition. Association of
a complete pelvic examination.
genitalia, including arterial blood supply,
Professors of Gynecology and Obstetrics,
[Objective 2, APGO, p. 3]
venous and lymphatic drainage and neurologic
1997.
2. After completing the history and physical exam, the student will demonstrate the ability to form
innervation. [Gynecology Competencies, CCOG, p.82]
CCOG: Educational Objectives: Core
a diagnostic impression including differential
11. Describe the gross anatomy of the pelvis and pelvic
diagnosis and develop a management plan.
viscera, including arterial blood supply, venous and
edition. Council on Resident Education in
[Objective 4, APGO, p. 4]
lymphatic drainage and neurologic innervation.
Obstetrics and Gynecology, 2002.
3. Student will be able to evaluate the patient with an adnexal mass. [Objective 59, APGO, p. 40] 4. The student will be able to describe the characteristics of benign neoplasms and their management. [Objective 59, APGO, p. 40] 5. Perform a complete and accurate medical history and physical exam. [Specific Competencies, CCOG, p.13] 6. Make an informed diagnosis. [Specific Competencies, CCOG, p.13] 7. Make evidence-based treatment decisions. [Specific Competencies, CCOG, p.13] 8. Prescribe medications in a rational, thoughtful and safe manner. [Specific Competencies, CCOG, p.13] 9. Safely and correctly perform the diagnostic
[Gynecology Competencies, CCOG, p.82] 12. Demonstrate critical thinking and diagnostic skills in
AWHONN: The Women’s Health Nurse
clinical decision-making.
Practitioner: Guidelines for Practice and
[Guideline I, AWHONN, p. 2]
Education, 5th edition. Association of
13. Perform a comprehensive physical assessment. [Guideline I, AWHONN, p. 2] 14. Order, perform and interpret screening and diagnostic procedures and tests. [Guideline I, AWHONN, p. 2] 15. Develop and analyze differential diagnoses on the basis of clinical and laboratory data. [Guideline I, AWHONN, p. 3] 16. Recommend diagnostic and therapeutic interventions with attention to safety, efficacy and cost-effectiveness. [Guideline I, AWHONN, p. 3] 17. Provide clinical management, including selected therapeutic procedures for women with gynecologic
and surgical procedures unique to the discipline
problems.
of obstetrics and gynecology.
[Guideline I, AWHONN, p. 3]
[Specific Competencies, CCOG, p.13]
Curriculum in Obstetrics and Gynecology, 7th
Women’s Health, Obstetric and Neonatal Nurses and National Association of Nurse Practitioner’s in Women’s Health, 2002.
Patient Histor y
Diagnosis / Impression
Te a c h i n g P o i n t s
Set-up
Lorraine A. is a 40-year-old patient
Diagnosis / Impression
Teaching Points
Pelvic ExamSIM Set-Up and
known to your practice who presents
Normal exam.
1. Examiner utilizes appropriate
Clinical Supplies Needed
pelvic exam sequence.
for her annual gynecologic exam. She has
no
subjective
or
findings.
2. Note retroverted uterine fundus
objective Treatment None.
3. Proper use of recto-vaginal exam technique when indicated.
Exam Challenges Retroverted uterine fundus.
Retroverted Uterus Internal Anatomy
upon exam. Flexible light source Vaginal speculum (Pederson only) Silicone oil Non-sterile exam gloves
Clinical Findings Retroverted uterine fundus. Cervix round and closed.
Learning Objectives
Retroverted Uterus
R e f e re n c e s
References: APGO: Medical Student Educational
1. Student will demonstrate the ability to perform a complete pelvic examination. [Objective 2, APGO, p. 3] 2. After completing the history and physical exam, the student will demonstrate the ability to form a diagnostic impression including differential diagnosis and develop a management plan. [Objective 4, APGO, p. 4] 3. Perform a complete and accurate medical history
10. Demonstrate critical thinking and diagnostic skills in clinical decision-making [Guideline I, AWHONN, p. 2] 11. Perform a comprehensive physical assessment. [Guideline I, AWHONN, p. 2] 12. Order, perform and interpret screening & diagnostic procedures & tests.
basis of clinical and laboratory data.
[Specific Competencies, CCOG, p.13]
[Guideline I, AWHONN, p. 3]
[Specific Competencies, CCOG, p.13] 5. Make evidence-based treatment decisions. [Specific Competencies, CCOG, p.13] 6. Prescribe medications in a rational, thoughtful
14. Recommend diagnostic & therapeutic interventions
[Specific Competencies, CCOG, p.13] genitalia, including arterial blood supply, venous and lymphatic drainage and neurologic innervation. [Gynecology Competencies, CCOG, p.82] 9. Describe the gross anatomy of the pelvis and pelvic viscera, including arterial blood supply, venous and lymphatic drainage and neurologic innervation. [Gynecology Competencies, CCOG, p.82]
Practitioner: Guidelines for Practice and Education, 5th edition. Association of Women’s Health, Obstetric and Neonatal Nurses and National Association of Nurse
[Guideline I, AWHONN, p. 3] 15. Provide clinical management, including selected
[Specific Competencies, CCOG, p.13]
8. Describe the gross anatomy of the external
AWHONN: The Women’s Health Nurse
Practitioner’s in Women’s Health, 2002.
therapeutic procedures for women with gynecologic
of obstetrics and gynecology.
edition. Council on Resident Education in Obstetrics & Gynecology, 2002.
with attention to safety, efficacy & cost-
problems.
surgical procedures unique to the discipline
Curriculum in Obstetrics & Gynecology, 7th
effectiveness.
and safe manner. 7. Safely and correctly perform the diagnostic and
CCOG: Educational Objectives: Core
[Guideline I, AWHONN, p. 2] 13. Develop & analyze differential diagnoses on the
and physical exam. 4. Make an informed diagnosis.
Objectives, 7th edition. Association of Professors of Gynecology & Obstetrics, 1997.
[Guideline I, AWHONN, p. 3]
Patient Histor y
Diagnosis / Impression
Te a c h i n g P o i n t s
Set-up
Suzanne M. is a 38-year-old patient
Diagnosis / Impression
Teaching Points
Pelvic ExamSIM Set-Up and
who presents for complaints of feeling
Uterine leiomyoma.
1. Examiner utilizes appropriate
Clinical Supplies Needed
pelvic exam sequence.
fatigued and tired "all the time." She
2. Note consistency and tenderness
states that her menstrual period is 3 days longer than usual with increased
Diagnostic Studies Indicated
of uterine fundus. Attempt to
bleeding for the past 9 months. She
CBC
estimate uterine fibroid size.
states her new husband and her would
Vaginal and Abdominal Ultrasound
like to start a family.
Exam Challenges
Depends on level of anemia & ultrasound findings. Myomectomy. Consider gonadotropin-releasing
Clinical Findings
hormone agonist (e.g., leuprolide).
Large subserous mass at the apex of
Iron supplement.
the fundus. Cervix round and closed.
Flexible light source Vaginal speculum (Pederson only) Silicone oil
Treatment Enlarged and hard uterus.
Uterine Fibroid Internal Anatomy
Non-sterile exam gloves
Learning Objectives
Uterine Fibroids
R e f e re n c e s
References: APGO: Medical Student Educational
1. Student will demonstrate the ability to perform a complete pelvic examination. [Objective 2, APGO, p. 3] 2. After completing the history and physical exam, the student will demonstrate the ability to form a diagnostic impression including differential diagnosis and develop a management plan. [Objective 4, APGO, p. 4] 3. Student will be able to evaluate and diagnose abnormal uterine bleeding. [Objective 49, APGO, p.33] 4. The student will be able to describe the methods to confirm the diagnosis of uterine leiomyomas and the indications for medical and surgical treatment. [Objective 57, APGO, p.39] 5. Perform a complete and accurate medical history and physical exam. [Specific Competencies, CCOG, p.13] 6. Make an informed diagnosis. [Specific Competencies, CCOG, p.13] 7. Make evidence-based treatment decisions. [Specific Competencies, CCOG, p.13] 8. Prescribe medications in a rational, thoughtful and safe manner. [Specific Competencies, CCOG, p.13] 9. Safely and correctly perform the diagnostic and surgical procedures unique to the discipline of obstetrics and gynecology. [Specific Competencies, CCOG, p.13] 10. Describe the gross anatomy of the external genitalia, including arterial blood supply, venous and lymphatic drainage and neurologic innervation. [Gynecology Competencies, CCOG, p.82] 11. Describe the gross anatomy of the pelvis and pelvic viscera, including arterial blood supply, venous and lymphatic drainage and neurologic innervation. [Gynecology Competencies, CCOG, p.82]
12. Describe the major causes of pelvic masses. [Gynecology Competencies, CCOG, p.88] 13. Elicit a pertinent history suggestive of a pelvic mass, such as: weight loss or weight gain, gastro-intestinal symptoms, menstrual abnormalities. [Gynecology Competencies, CCOG, p.88] 14. Perform a focused physical exam to confirm the diagnosis of a pelvic mass. [Gynecology Competencies, CCOG, p.88] 15. Perform tests such as endovaginal or abdominal ultrasonography to confirm the diagnosis of a pelvic mass. [Gynecology Competencies, CCOG, p.88] 16. Interpret the results of other tests to confirm the diagnosis mass. [Gynecology Competencies, CCOG, p.88] 17. Treat benign pelvic masses medically and surgically, considering such factors as patient age, general health, patient preference, desire for future childbearing, symptom complex. [Gynecology Competencies, CCOG, p.88] 18. Describe the appropriate follow-up for patients who have been treated for a benign pelvic mass. [Gynecology Competencies, CCOG, p.88] 19. Demonstrate critical thinking and diagnostic skills in clinical decision-making. [Guideline I, AWHONN, p. 2] 20. Perform a comprehensive physical assessment. [Guideline I, AWHONN, p. 2] 21. Order, perform and interpret screening and diagnostic procedures and tests. [Guideline I, AWHONN, p. 2] 22. Develop & analyze differential diagnoses on the basis of clinical and laboratory data. [Guideline I, AWHONN, p.3] 23. Recommend diagnostic and therapeutic interventions with attention to safety, efficacy and cost-effectiveness. [Guideline I, AWHONN, p. 3] 24. Provide clinical management, including selected therapeutic procedures for women with gynecologic problems. [Guideline I, AWHONN, p. 3]
Objectives, 7th edition. Association of Professors of Gynecology and Obstetrics, 1997. CCOG: Educational Objectives: Core Curriculum in Obstetrics and Gynecology, 7th edition. Council on Resident Education in Obstetrics and Gynecology, 2002. AWHONN: The Women’s Health Nurse Practitioner: Guidelines for Practice and Education, 5th edition. Association of Women’s Health, Obstetric and Neonatal Nurses and National Association of Nurse Practitioner’s in Women’s Health, 2002.
