It is said that experience is the best teacher. And no one wants an amateur sewing up a lacerated finger or removing an infected toenail. So how do physician assistants get to be old hands – or at least competent professionals – at these common office procedures even before completing their degree?
For Wingate University students, Taylor Fischer may just have the model solution.
An Air Force veteran with a decade of PA experience, Fischer began teaching a course called Medical Procedures at Wingate’s Hendersonville campus two years ago and found himself struggling to get across precise techniques, especially when students had no way to practice them. “There are some procedures that are very difficult to teach – incision and draining of an abscess and any kind of toenail procedure,” Fischer says.
About the same time he attended the National Conference for PA Educators and saw companies marketing “task trainers” – models of body parts for students to practice on.
“Some of these models were $200 or $300 and were single-use,” Fischer says. “So, if you want to teach your students how to open up an abscess, it might cost $5,000 or $6,000, and then you have to spend that much all over again. That’s when I started thinking about how I could make them.”
Fischer has since developed low-cost, reusable prosthetic models that he hopes will help PA students at Wingate and across the nation learn to master common procedures without busting their departments’ budgets. It was a perfect way to marry his creative, artsy side with the science of teaching medical procedures.
“I paint. I know how to throw on a pottery wheel. I can weave,” Fischer says. “My high school art teacher was shocked when I told her I was not going to design school.”
He began researching how prosthetics are made and casting around for a fairly simple “human tissue” recipe – one with ingredients that were easily accessible. He had some pretty rigid parameters, so it took a lot of trial and error.
“I had to figure out one that had the consistency of human tissue; it had to be durable but also have the ability to give,” Fischer says. “I played around with some different recipes and mold techniques. I tried plaster and various silicone products.”
Now, he uses a soft quick-set silicone to make a negative, and then a combination of water, gelatin, glycerin and eye shadow poured into the mold to produce lifelike forefeet, hands and fingers for less than $1.50 each. Fischer has even gotten his preschool son in on the act, when he can persuade him to sit still long enough to shape a mold around his hand or foot.
A big perk of Fischer’s models is that they can be melted down and the material can be used up to seven more times. “Our reusable model can be made for pennies compared to $200 for something not reusable,” Fischer says.
By October he and fellow assistant professor Nicole Drake, who also serves as clinical coordinator for the Wingate program, were back at the National Conference for PA Educators, this time in Anaheim, California, making a presentation about the new model-making technique and displaying a row of “fingers” on wooden sticks. The enthusiastic response they received got Fischer thinking even bigger about how the models could help PA students across the nation, but only if he could prove their effectiveness.
“I can make a model of a forefoot and teach a student to remove a toenail, but anytime you have a task trainer, the purpose is to make sure it prepares the student later on,” Fischer says. “I think they will, but how you get data to show that is the tricky part.”
With a $2,000 grant from the Wingate Board of Visitors, he began making plans to create more models, expand their usage in the classroom and collect and analyze data.
“By proving that these models can be utilized to develop correct procedural technique and, through their realistic appearance, improve student confidence to perform procedures on real patients, we will have effectively caused a paradigm shift in simulation education,” Fischer told the Board via his grant application. “Top quality, inexpensive, and reusable task trainers will not only be available to our students, they will be within reach of PA programs and medical schools across the country.”
To study the effectiveness of teaching with his models, Fischer teamed up with educators from Yale University and the College of St. Scholastica, who began making models with his procedure in February to use in classes beginning in late June.
Fischer says he couldn’t have come this far with the idea without lots of support from Wingate co-workers.
“Andrew Hutchison, our IT guy, has helped me immensely with filming the process and creating instructional videos,” he says. “He's also assisted in brainstorming novel uses.”
Fischer says he will continue to collect and analyze data until December 2020, when the current student cohort will graduate. He and his research partners hope to show that the models increase not only students’ competency but also their confidence levels. If that’s the case, they can share the model-making techniques far and wide.
“I would love to get to a place where other institutions were using these things on a regular basis,” Fischer says. “I love teaching; I love showing the next generation how to be a PA.”