175 - A Novel Low-Cost Hair Apposition Task Trainer for Scalp Lacerations

Publication Number: 4172.175

Dana Chatila, University of Texas Southwestern Medical Center, Dallas, TX, United States; Purujit Chatterjee, University of Texas Southwestern Medical School, Dallas, TX, United States; Khawar Nawaz, University of Texas Southwestern Medical School, Dallas, Texas, TX, United States; Ngoc Van Horn, University of Texas-Southwestern Medical Center, Dallas, TX, United States; Emine Tunc, University of Texas Southwestern Medical School, Dallas, TX, United States

Background: Scalp lacerations are common pediatric injuries in emergency and primary care settings. Traditional closure methods include sutures and staples. Hair apposition technique (HAT) provides a suture-free closure method with less pain and anxiety. While procedural competence is emphasized in Accreditation Council for Graduate Medical Education (ACGME) standards and Entrustable Professional Activity (EPA) 9, formal training in pediatric procedures, including HAT, remains limited during pediatric residency.

Objective: To design and implement a low-cost, high-yield task trainer for teaching HAT to pediatric residents. We aimed to assess the impact of this simulation-based intervention on learners’ self-reported competence across four key domains: recognition of appropriate lacerations, material recall, procedural performance, and caregiver counseling.

Design/Methods: We developed a low-cost HAT task trainer using everyday materials, including a mannequin head, 11-blade scalpel, red nail polish, and glue. Using the scalpel, we created lacerations (3 to 8 cm), which we outlined with nail polish to represent active wounds. Incoming pediatric interns at the University of Texas Southwestern (UTSW) Medical Center participated in a training session that included instruction, demonstration, paired practice, and debrief. Participants completed a post-procedure rubric assessing recognition of suitable lacerations, recall of materials, performance of the procedure, and counseling of caregivers.

Results: A total of 40 pediatric interns completed the structured simulation and pre- and post-training assessments. 85% of learners had not heard, observed, or performed HAT prior to the session. We used a Wilcoxon signed-rank test to compare paired pre- and post-training scores with the sample size of 40 participants. Across all four domains, learners demonstrated statistically significant improvements in self-assessed competence following the training session (p <.0001 for all comparisons). Effect sizes (r), calculated as r = Z/‾√N where Z is the standard score approximation for the Wilcoxon test and N is the number of pairs, were 0.86 for each domain, indicating a very large impact of the intervention.

Conclusion(s): This activity introduces pediatric trainees to a practical, low-stress wound closure technique using a cost-effective simulation model. Aligned with Level 2 (Learning) of Kirkpatrick’s New World Learning Pyramid, this study highlights a significant gain in self-assessed confidence in HAT, which lays the foundation for future studies to evaluate behavior change in clinical settings and, ultimately, patient outcomes.

Step-by-Step Hair Apposition Technique (HAT) Simulation
IMG_7183.jpeg1- Locate and clean superficial linear laceration

Step-by-Step Hair Apposition Technique (HAT) Simulation
IMG_7189-2.jpeg2-Select hair strands from opposite sides of laceration.

Step-by-Step Hair Apposition Technique (HAT) Simulation
IMG_7193-2.jpeg3-Twist hair strands and apply glue to twisted junction.