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Simulation-Based Breast Biopsy Training Using a Low-Cost Gelatin-Based Breast Model in Rwanda

  • Surgery in Low and Middle Income Countries
  • Published:
World Journal of Surgery Aims and scope Submit manuscript

Abstract

Background

An interdisciplinary team of healthcare providers and simulation specialists adopted and modified a protocol for the creation of a low-cost, gelatin-based breast model for teaching ultrasound-guided breast biopsy and assessed first-time user experience.

Methods

An interdisciplinary team of healthcare providers and simulation specialists adopted and modified a protocol for the creation of a low-cost, gelatin-based breast model for teaching ultrasound-guided breast biopsy for approximately $4.40 USD. Components include medical-grade gelatin, Jell-O™, water, olives, and surgical gloves. The model was used to train two cohorts comprising 30 students total during their junior surgical clerkship. The learners’ experience and perceptions on the first Kirkpatrick level were evaluated using pre- and post-training surveys.

Results

Response rate was 93.3% (n = 28). Only three students had previously completed an ultrasound-guided breast biopsy, and none had prior exposure to simulation-based breast biopsy training. Learners that were confident in performing biopsies under minimal supervision rose from 4 to 75% following the session. All students indicated the session increased their knowledge, and 71% agreed that the model was an anatomically accurate and appropriate substitute to a real human breast.

Conclusions

The use of a low-cost gelatin-based breast model was able to increase student confidence and knowledge in performing ultrasound-guided breast biopsies. This innovative simulation model provides a cost-effective and more accessible means of simulation-based training especially for low- and middle-income settings.

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Acknowledgements

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Funding

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

Author information

Authors and Affiliations

  1. Program in Global Surgery and Social Change, Harvard Medical School, 641 Huntington Avenue, Boston, MA, 02115, USA

    Matthew T. Hey, Barnabas T. Alayande, Callum Forbes, Radzi Hamzah, Robert Riviello & Geoffrey A. Anderson

  2. Center for Equity in Global Surgery, University of Global Health Equity, Kigali Heights, Plot 772, KG 7 Avenue, 5Th Floor, P.O. Box 6955, Kigali, Rwanda

    Matthew T. Hey, Ornella Masimbi, Natnael Shimelash, Barnabas T. Alayande, Callum Forbes, Jonas Twizeyimana, Robert Riviello, Abebe Bekele & Geoffrey A. Anderson

  3. Simulation and Skills Center, University of Global Health Equity, Kigali Heights, Plot 772, KG 7 Avenue, 5Th Floor, P.O. Box 6955, Kigali, Rwanda

    Ornella Masimbi, Natnael Shimelash & Jonas Twizeyimana

  4. University of Global Health Equity, Kigali Heights, Plot 772, KG 7 Avenue, 5Th Floor, P.O. Box 6955, Kigali, Rwanda

    Othniel Nimbabazi

  5. Global Health Corps, New York City, NY, 10001, USA

    Othniel Nimbabazi

  6. Ministry of Health, Kicukiro, KN 3 RD, P.O Box 84, Kigali, Rwanda

    Othniel Nimbabazi

  7. STRATUS Center for Medical Simulation, Brigham and Women’s Hospital, 10 Vining Street, Boston, MA, 02115, USA

    Persephone Giannarikas & Andrew Eyre

  8. Division of Trauma, Burn, and Surgical Critical Care, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA, 02115, USA

    Robert Riviello & Geoffrey A. Anderson

Authors
  1. Matthew T. Hey
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  2. Ornella Masimbi
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  3. Natnael Shimelash
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  4. Barnabas T. Alayande
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  5. Callum Forbes
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  6. Jonas Twizeyimana
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  7. Othniel Nimbabazi
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  8. Persephone Giannarikas
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  9. Radzi Hamzah
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  10. Andrew Eyre
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  11. Robert Riviello
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  12. Abebe Bekele
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  13. Geoffrey A. Anderson
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Corresponding author

Correspondence to Geoffrey A. Anderson.

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The authors declare that they have no conflicts of interest.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Human and animal rights

This study was approved by the institutional review boards of both the University of Global Health Equity and Mass General Brigham.

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Appendices

Appendix 1: Pre-survey questions

Low-Cost Gelatin-Based Breast Model for Teaching Simulation-Based Breast Biopsy (Pre-Survey).

Name:

Email:

What sex were you assigned at birth?

  1. 1.

    Male

  2. 2.

    Female

  3. 3.

    Intersex

Have you ever completed or participated in an ultrasound-guided core needle breast biopsy?

  1. 1.

    Yes

  2. 2.

    No

Have you ever completed or participated in an open surgical breast biopsy?

  1. 1.

    Yes

  2. 2.

    No

Have you ever completed or participated in a simulation session teaching breast biopsy?

  1. 1.

    Yes

  2. 2.

    No

For this next section, respond to the statement in accordance with how much you agree or disagree.

I can confidently describe the appropriate steps to successfully complete a core needle breast biopsy.

  1. 1.

    Strongly Agree

  2. 2.

    Agree

  3. 3.

    Neutral

  4. 4.

    Disagree

  5. 5.

    Strongly Disagree

I can confidently describe the indications to perform a core needle breast biopsy.

  1. 1.

    Strongly Agree

  2. 2.

    Agree

  3. 3.

    Neutral

  4. 4.

    Disagree

  5. 5.

    Strongly Disagree

I can confidently describe the contraindications to performing a core needle breast biopsy.

  1. 1.

    Strongly Agree

  2. 2.

    Agree

  3. 3.

    Neutral

  4. 4.

    Disagree

  5. 5.

    Strongly Disagree

I can confidently perform a core needle breast biopsy with minimal assistance.

  1. 1.

    Strongly Agree

  2. 2.

    Agree

  3. 3.

    Neutral

  4. 4.

    Disagree

  5. 5.

    Strongly Disagree

The use of simulation is an appropriate way to teach the skill of core needle breast biopsy.

  1. 1.

    Strongly Agree

  2. 2.

    Agree

  3. 3.

    Neutral

  4. 4.

    Disagree

  5. 5.

    Strongly Disagree

I agree to participate in this study for research purposes.

  1. 1.

    Yes

  2. 2.

    No

Appendix 2: Post-survey questions

Low-Cost Gelatin-Based Breast Model for Teaching Simulation-Based Breast Biopsy (Post-Survey).

Name:

Email:

I attended the breast biopsy surgical simulation session and used the low-cost gelatin-based breast model.

  1. 1.

    Yes

  2. 2.

    No

For this next section, respond to the statement in accordance with how much you agree or disagree.

I can confidently describe the appropriate steps to successfully complete a core needle breast biopsy.

  1. 1.

    Strongly Agree

  2. 2.

    Agree

  3. 3.

    Neutral

  4. 4.

    Disagree

  5. 5.

    Strongly Disagree

I can confidently describe the indications to perform a core needle breast biopsy.

  1. 1.

    Strongly Agree

  2. 2.

    Agree

  3. 3.

    Neutral

  4. 4.

    Disagree

  5. 5.

    Strongly Disagree

I can confidently describe the contraindications to performing a core needle breast biopsy.

  1. 1.

    Strongly Agree

  2. 2.

    Agree

  3. 3.

    Neutral

  4. 4.

    Disagree

  5. 5.

    Strongly Disagree

I can confidently perform a core needle breast biopsy with minimal assistance.

  1. 1.

    Strongly Agree

  2. 2.

    Agree

  3. 3.

    Neutral

  4. 4.

    Disagree

  5. 5.

    Strongly Disagree

The use of simulation is an appropriate way to teach the skill of core needle breast biopsy.

  1. 1.

    Strongly Agree

  2. 2.

    Agree

  3. 3.

    Neutral

  4. 4.

    Disagree

  5. 5.

    Strongly Disagree

The low-cost gelatin-based breast model was an anatomically accurate and appropriate substitute to a real human breast. (ONLY ANSWER IF YOU HAVE EXAMINED A REAL HUMAN BREAST).

  1. 1.

    Strongly Agree

  2. 2.

    Agree

  3. 3.

    Neutral

  4. 4.

    Disagree

  5. 5.

    Strongly Disagree

The low-cost gelatin-based breast model accurately simulated the consistency of a real human breast. (ONLY ANSWER IF YOU HAVE EXAMINED A REAL HUMAN BREAST).

  1. 1.

    Strongly Agree

  2. 2.

    Agree

  3. 3.

    Neutral

  4. 4.

    Disagree

  5. 5.

    Strongly Disagree

The low-cost gelatin-based breast model accurately simulated the consistency of the breast simulator used to teach the clinical breast exam.

  1. 1.

    Strongly Agree

  2. 2.

    Agree

  3. 3.

    Neutral

  4. 4.

    Disagree

  5. 5.

    Strongly Disagree

The low-cost gelatin-based breast model significantly contributed to increasing my knowledge of how to perform a core needle breast biopsy.

  1. 1.

    Strongly Agree

  2. 2.

    Agree

  3. 3.

    Neutral

  4. 4.

    Disagree

  5. 5.

    Strongly Disagree

Using the low-cost gelatin-based breast model was an appropriate substitute to simulate core needle breast biopsy for teaching using simulation.

  1. 1.

    Strongly Agree

  2. 2.

    Agree

  3. 3.

    Neutral

  4. 4.

    Disagree

  5. 5.

    Strongly Disagree

Using the low-cost gelatin-based breast model will help expand learning opportunities to students and trainees who do not have access to traditional high-cost breast models.

  1. 1.

    Strongly Agree

  2. 2.

    Agree

  3. 3.

    Neutral

  4. 4.

    Disagree

  5. 5.

    Strongly Disagree

What comments would you offer to improve the low-cost gelatin-based breast model?

What, if any, major concerns do you have with the low-cost gelatin-based breast model?

I agree to participate in this research study.

  1. 1.

    Yes

  2. 2.

    No

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Hey, M.T., Masimbi, O., Shimelash, N. et al. Simulation-Based Breast Biopsy Training Using a Low-Cost Gelatin-Based Breast Model in Rwanda. World J Surg 47, 2169–2177 (2023). https://doi.org/10.1007/s00268-023-07038-w

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