Journal of Education and Teaching in Emergency Medicine

Audience: This task trainer was designed to instruct emergency medicine (EM) residents and faculty at all levels of training. 

Introduction: Priapism management is time-sensitive, and the clinical opportunities to perform dorsal penile nerve block and corporal aspiration are seldom practiced. Despite knowledge of the importance of prompt recognition and management of priapism, many emergency physicians may not actually perform the recommended procedures to manage it for a variety of reasons.¹ Due to the sensitive nature of the condition, physicians are eager to learn about and practice these intimate maneuvers in the safe setting of simulation; however, there is not a commercial task trainer available.²Some low-fidelity creations have been published as solutions, but they are less realistic and time consuming to make, limiting feasibility and usability.^3-7 One published creation inspired this task trainer, but the main structure is no longer available to be purchased, underscoring the need for a model that can be reproduced and recreated by the educator with flexible starting materials.³ Others are more time-consuming to make and require specific simulation equipment⁴ or may not be easily reused.^{5, 6} Other published low-fidelity creations are less anatomically accurate, limiting the fidelity of practice regarding the most intimate aspects of the procedure.^{7, 8}

Educational Objectives: By the end of this educational session, participants should be able to: 1) identify indications, contraindications, and potential complications of priapism management, 2) gather appropriate supplies and describe relevant landmarks, anatomy, and patient positioning for management of priapism, 3) demonstrate a dorsal penile nerve block, aspiration of corpus cavernosum, and intracavernosal phenylephrine administration to treat priapism, and 4) develop an approach to manage common pitfalls of priapism care.

Educational Methods: We developed a more realistic and replicable priapism task trainer using materials readily accessible in a simulation lab. Emergency medicine faculty and simulation center staff collaborated to create a task trainer constructed from silicone and internal tubing, using the mold of a phallic-shaped candle (see attachment). This model was then used in a 30-minute training session, which included ten minutes of interactive discussion reviewing the steps of dorsal penile block and priapism management with PowerPoint images as a visual aid. Next, learners performed the procedure from start to finish with faculty guidance, followed by an opportunity to ask questions. The training session was open to EM residents, pediatric emergency medicine (PEM) fellows, EM community physicians, and EM academic faculty.

Research Methods: This study was approved as exempt status by the Indiana University Institutional Review Board. Following the educational session, participants completed a voluntary survey evaluating the task trainer’s realism, its usefulness as a teaching tool, and their change in confidence in performing priapism management. 

Results: The mixed group included 14 EM residents, five PEM fellows, four EM community physicians, and four EM academic physicians. Of 27 participants who used the task trainer, the majority (92.6%) of survey respondents agreed or strongly agreed that the task trainer was realistic.  Learners reported increased confidence in knowledge of the procedural steps and increased confidence in potentially performing the procedure in the clinical setting (Table 1). Most participants would recommend the training to a provider of a similar level of training. 

Discussion: Overall, the educational content was effective since learners reported an increase in knowledge of the steps of the procedure in addition to improved confidence to perform the procedure safely and successfully in the clinical environment. While many learners had never performed this procedure before in the clinical setting, the majority would recommend this training to a colleague of the same level of training. While the need for training in this procedure is clear,^1-2 the options for available task trainers have remained limited. There is no commercial priapism task trainer, and published creations have varied strengths and weaknesses in balancing fidelity, cost-effectiveness, reproducibility, and reusability.^3-7 The main takeaway from this training is that a realistic, durable, and low-cost task trainer can be developed to effectively teach how to treat a rare and sensitive procedure.

Topics: Priapism, penile nerve block, dorsal nerve block, urology, aspiration, decompression.