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Simulation-based training enhances APP preparedness in ischemic priapism management: Results from an inaugural regional course
Andrew Kehm, BS1, Ilene Staff, PhD2, Tara McLaughlin Proto, PhD3, Brenden Race, BS4, Thomas Nowicki, MD4, Jared Bieniek, MD3.
1Frank Netter School of Medicine, Quinnipiac University, North Haven, CT, USA, 2Research Department, Hartford HealthCare, Hartford, CT, USA, 3Tallwood Urology & Kidney Institute, Hartford HealthCare, Hartford, CT, USA, 4Center for Education, Simulation, and Innovation, Hartford HealthCare, Hartford, CT, USA.
BACKGROUND: Advanced practice providers (APPs) are increasingly involved in frontline evaluation and management of time-sensitive urologic emergencies, including ischemic priapism (IP). Such skills are particularly relevant for APPs treating erectile dysfunction (ED). We evaluated the impact of a high-fidelity priapism simulation course delivered at an inaugural regional APP training program.
METHODS: The course included both didactics and supervised hands-on training using a high-fidelity ballistics gel task trainer to simulate corporal aspiration (CA) and intracavernosal injection (ICI) (Figure 1). Trainees completed pre- and post-training surveys rating comfort managing priapism, confidence with individual skills, and expected impact on clinical practice using 1-5 point Likert scales. We evaluated the proportion of APPs demonstrating improvements in these domains from pre- to post-training.
RESULTS: Complete data were available for 25/36 (69%) APPs completing the training. Years in practice ranged from 0.5 to 40 (median 5; the vast majority in urology). Seven (28%) covered inpatient urology. Twenty-two (88%) prescribe ED therapies; 15 (60%) prescribe ICI while 12 (48%) teach ICI. Only 5 (20%) reported office availability of phenylephrine to reverse IP. Prior IP procedural experience was limited (mean 0.7 aspirations over last year). None had prior IP simulation exposure. After training, comfort with IP management improved in 23 (92%) of participants. CA and ICI comfort increased in 22 (88%) and 15 (60%), respectively. Moderate/major improvement in knowledge/skills was reported in 22 (88%), and 12 (48%) reported moderate/major impact on clinical practice. All would recommend the training to a colleague.
CONCLUSIONS: This high-fidelity priapism simulation improved APP self-reported comfort and perceived clinical readiness, particularly for IP aspiration. Similar approaches may help address experience gaps for APPs managing infrequent urologic emergencies.
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