Chest Tube Insertion Among Surgical and Nonsurgical Trainees: How Skilled Are Our Residents? J Surg Res 2020 Mar;247:344-349
Date
11/26/2019Pubmed ID
31761442DOI
10.1016/j.jss.2019.10.010Scopus ID
2-s2.0-85079456893 (requires institutional sign-in at Scopus site) 2 CitationsAbstract
BACKGROUND: Competency-based medical education has renewed focus on the attainment and evaluation of resident skill. Proper evaluation is crucial to inform educational interventions and identify residents in need of increased training and supervision. Currently, there is a paucity of studies rigorously evaluating resident chest tube insertion skill.
MATERIALS AND METHODS: Residents of all training levels before their intensive care unit rotation or currently rotating through the intensive care unit were invited to participate. Trainees inserted a thoracostomy tube on a high-fidelity simulator. Their performances were recorded and scored by blinded raters using the validated TUBE-iCOMPT rubric. Surgical and nonsurgical residents were compared.
RESULTS: Forty-nine residents participated; 30 from nonsurgical and 19 from surgical training programs. Overall, trainees were most deficient in the "preprocedural checks" and "patient positioning and local anesthetic" domains. Surgical trainees demonstrated higher chest tube insertion skill than their nonsurgical peers (median total score 88 [interquartile range, 74-90] versus 75 [interquartile range, 66-85], respectively, P = 0.01), particularly in the "patient positioning" and "blunt dissection" domains (P = 0.01 and P = 0.03, respectively). These differences were no longer significant when controlled for experience and Advanced Trauma Life Support certification.
CONCLUSIONS: Overall, surgical residents were more skilled than nonsurgical residents in tube thoracostomy placement. Relative skill deficits within the domains of chest tube insertion have also been identified among residents of different specialties. These areas can be targeted with educational interventions to improve resident performance, and ultimately, patient safety.
Author List
Kuper TM, Federman N, Sharieff S, Tejpar S, LeBlanc D, Murphy PB, Parry N, Leeper RAuthor
Patrick Murphy MD Assistant Professor in the Surgery department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
AdultChest Tubes
Clinical Competence
Competency-Based Education
Cross-Sectional Studies
Educational Measurement
Female
General Surgery
Humans
Internship and Residency
Male
Patient Positioning
Patient Safety
Thoracostomy
