Thoracic ultrasound (TUS) training: Regional survey of respiratory specialty trainees (RST) from West Midlands Deanery (WMD), UK

Abstract

Background: The burden of pleural diseases is growing and so is the need for TUS guided pleural procedures, commonly performed by RST. RST in UK follow Royal College of Radiology (RCR) guidelines for TUS training, requiring them to be level 1 signed off before attempting unsupervised pleural procedures. Evidence suggests that RCR guidelines can be hard to follow. Aim: We aimed to study the TUS training organization for RST in WMD, UK. Methods: An online survey was sent to RST in hospitals across WMD. Data was collected on TUS training structure, supervision and exposure to TUS guided pleural procedures. Results: 40 RST completed the survey from 14 hospitals across WMD. 30 RST (75%) were TUS level 1 competent. 22 RST (55%) were not able to meet RCR requirements for level 1 competency. 29 RST (72%) had performed unsupervised pleural procedures before level 1 sign off. 19 RST (47%) did not have access to a named consultant to help with difficult procedures. 32 RST (80%) had a pleural lead in their hospital but only 22 (55%) had access to organized education and training of pleural skills. 20 RST (50%) did not have a clear management pathway for emergency pleural procedures. Non-respiratory trainees performed pleural procedures in 8/14 hospitals, and their competence level was not known. Conclusion: There is significant room for improvement in TUS training and supervision of RST performing pleural procedures. Every hospital must have a pleural lead to ensure training of TUS/pleural skills and establish out of hours pathway for pleural diseases management. RCR recommendations can be quite confusing and need replacing by specific pleural diseases guidelines.