The CITT Kit: Deskilling Contraceptive Implantation and Removal Procedures

To decrease the number of incorrectly inserted and removed subdermal in-arm contraceptive implants in developing countries, we have generated a training tool that aims to effectively teach lower-level health care providers to successfully insert and remove the contraceptive implants. The Contraceptive Implant Training Tool Kit has improved on three main aspects of training: biofidelity of the tissue layers of the arm model, human factors emphasis, and removal training. Biofidelity was improved in two ways. First, the standards of care lack a fat layer that accurately simulates the fat layer of the arm; this is a problem because inserting the implant into the fat layer is the biggest reason implants are ineffective once inserted into the body. Having silicone layers to model muscle, fat, and skin (instead of cotton, latex, etc as used by the SOC) will allow the health care provider a training experience much closer to that of a real patient. Second, we have made the training tool wearable so that in addition to being used as a stand-alone trainer, like the SOC, it can also be worn by another student who is pretending to be a patient which is standard training protocol. The ability to wear the trainer allows for more biofidelic training because actual biomarkers, such as the elbow, can be used to train providers on proper implant placement. Wearability also emphasizes human factors in the training and prepares students for patients that move, as many do during the procedures. Finally, all other SOC lack any removal-specific training, which is widely accepted to be the more difficult of the two procedures associated with this form of contraception, whereas the CITT Kit contains a portion of the trainer that will train students in the difficulties of the removal procedure.