Abstract
Hypothesis Percutaneous tube thoracostomy (PTT) is a common procedure with complication rates reported as high as 30%. Because we cannot confidently ‘assume’ that all new interns joining our program can safely insert a chest tube, our institution has recently introduced a simulation-based chest tube workshop in an effort to enhance residents’ clinical skills and the safety of our patients. Methods Thirty-four surgical interns (11 categorical, 18 preliminary and five urology) were tested during July of their internship year for safe chest tube insertion using a validated seven-section checklist (10 points maximum score): correct insertion site, prep if available, 2-3 cm transverse incision, blunt dissection, parietal pleura puncture, finger in first and placement with clamped proximal end. One point was given for each step if done so correctly. All 34 interns were then retested in January of their intern year. A survey was then sent out in which we asked residents whether they had placed a chest tube on a real patient between the two tests, their level of confidence before and after six months of clinical training and the workshop, and what they did to familiarize themselves with the insertion technique. Results Overall performance inserting chest tubes improved (mean scores: July= 7 SD=2.3, January= 9 SD 1.4; p<0.05). Individually 21 interns improved, 2 scores dropped, and 11 scored the same. Seven interns scored a perfect ‘10’ in July whereas 24 interns scored a 10 in January. Five interns scored a 3 or less in July; none scored <7 in January. 13 residents said they had not inserted any chest tubes on real patients, 8 inserted 1, 2 inserted 2, 4 inserted 3 and 1 inserted >5. Confidence levels between July and January increased by an average of 2 points across the 30 trainees who filled out the survey. Table 1 Conclusion Our data suggest that a chest tube workshop and 6 months of clinical surgical training improved resident skills during chest tube insertion. Preliminary clinical data suggest fewer complications are occurring from chest tube insertion in our patients. Disclosures None
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