A Systematic Review of Live Animal Use as a Simulation Modality ("Live Tissue Training") in the Emergency Management of Trauma

INTRODUCTION: Live anaesthetized animals are used as simulation models to teach techniques in the emergency management of trauma. We aimed to explore how "live tissue training" (LTT) is designed, delivered and evalu-ated in order to better understand and characterize aspects of educational merit.METHODS: A systematic review was performed using PRISMA guidance. A combined approach, involving a 3 -stage modified narrative synthesis process and reflexive thematic analysis was used to identify key concepts across the published literature.FINDINGS: Qualitative synthesis of 48 selected articles suggests that LTT is mainly used to teach military and civilian physicians and military medical technicians. The procedures trained vary with the learner population, from simple pre-hospital trauma tasks to advanced oper-ative surgical skills. Many courses use a combination of didactic and practical training, with an animal model used to train practical application of knowledge and pro-cedural skills. Descriptions of the learning interventions are limited, and explicit use of educational theory or pedagogic frameworks were absent within the litera-ture. Four themes were identified regarding aspects of LTT that are valued by learners: "recreating the experi-ence," relating to fidelity and realism; "tick tock" "dynamics of hemorrhage", encompassing the impact of bleeding and urgent pressure to act; "emotional impact" of conducting the training, and "self-efficacy: I believe I can do it."CONCLUSION: Thematic analysis of published litera-ture suggests that there may be educational benefit in the use of live tissue models due to time criticality and bleeding, which creates a real-life event. LTT also invokes an emotional response, and learners experi-ence an increase in self-efficacy from participation. We consider that these aspects and associated pedagogy should be addressed when researching and developing alternative simulation modalities, in order to intelli-gently replace, reduce and refine the use of animals in training practitioners in the emergency management of trauma. ( J Surg Ed 80:1320-1339. Crown Copyright & COPY; 2023 Published by Elsevier Inc. on behalf of Association of Program Directors in Surgery. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/))