Bone Marrow Biopsy Simulation Training for Fellows

Cyrus Khan, MD, and Ghulam Rehman Mohyuddin
Published: Friday, Jan 18, 2013
A bone marrow aspirate and biopsy is the single most common procedure that hematologists and oncologists carry out day in and day out throughout their career. Therefore, it is also the most common procedure that fellows in hematology/oncology training programs have to learn and then perform during their training. It is very important for fellows to become proficient and confident in doing this procedure independently and safely. In order to achieve this level of competence, they must learn not only the necessary steps but also master the correct technique.

Typically, in most training programs, new fellows learn how to do a bone marrow biopsy from either their senior fellows or attending physicians. They will usually observe a few procedures first and then learn to carry them out on patients under supervision. This training process is often unstructured, and there is no way to monitor the fellow’s progress or proficiency.

Table. The evaluation criteria for observation of new fellows performing bone marrow biopsy procedures

Patient Care
‘Time Out’ performed
Anatomic landmarks identified
Aseptic technique maintained
Adequate local anesthesia used
Appropriate technique
Medical Knowledge
Understands indications
Understands what specimens are needed, ie, cytogenetics, flocytometry
Communication/Interpersonal skills
Explains the indication for the procedure
Explains what the patient will experience
Explains the potential risks; consent properly obtained
Uses clear, understandable terms
Accepts instruction and suggestions
Respects patient privacy and dignity
Uses respectful language
Courteous to nursing and allied health staff
Practice-Based Learning
Reviews final results of the test
Systems-Based Practice
Understands logistics of setting up a bone marrow biopsy
Understands logistics of specimen handling, transportation to lab
Moreover, different fellows and attending physicians have different procedural techniques and skills, as well as teaching ability. This combination leads to a haphazard method of learning for the new fellows in training.

At our institution, we recognized this deficiency and devised a plan to address it. We have recently developed a program for new fellows that allows them to learn the correct indications, contraindications, and technique for doing a bone marrow aspirate and biopsy. They can then demonstrate their learning by simulating it on a mannequin or patient actor. In order to help others who may want to set up a similar program, we will describe how we structured it.

Program Setup

The first step is to identify a space where the program will be run. At our institution, and at many academic centers, a simulation center is available. Such centers provide examination rooms, conference rooms, audiovisual equipment, medical instruments, monitors, and mannequins.

The next step is scheduling. It is important to arrange a suitable time when all of the new fellows will be free for 3 hours for the training program. Cross-coverage must be arranged if needed.

To run the program, you need to have the following equipment available: a bone marrow biopsy kit, an examination room, an anatomical model of the pelvis, and audiovisual equipment. We also employed the services of a patient actor for demonstration purposes.

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