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Identifying pitfalls in chest tube insertion: improving teaching and performance.

James S Davis1, George D Garcia, Jassin M Jouria

  • 1Leonard M. Miller School of Medicine, Department of Surgery, University of Miami, Miami, Florida 33101, USA.

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|April 27, 2013
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Novice practitioners often incorrectly perform critical steps during chest tube thoracostomies, such as finger sweeps and pleural entry. A mobile-learning module improved performance of some skills for novices, potentially easing the learning curve for this common surgical procedure.

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Area of Science:

  • Medical Education
  • Surgical Skills Training
  • Thoracic Surgery

Background:

  • Chest tube thoracostomies are frequently performed surgical procedures.
  • The learning process and skill acquisition for chest tube insertion are not well understood.
  • Objective evaluation of procedural competency is crucial for patient safety.

Purpose of the Study:

  • To evaluate the frequency of correctly performed tasks during chest tube insertion.
  • To assess the impact of a mobile-learning module on procedural skill acquisition.
  • To identify specific steps in chest tube thoracostomy that pose challenges for trainees.

Main Methods:

  • A prospective study involving 128 participants (medical students, residents, surgical team members) categorized as novice or expert.
  • Development and utilization of a mobile-learning module with multimedia guidance and a 14-item skills checklist.
  • Participants performed chest tube insertion on a TraumaMan simulator, with performance rated by a trained clinician.

Main Results:

  • Novices most frequently struggled with finger sweeps (33%), avoiding the neurovascular bundle (35%), and controlled pleural puncture (39%).
  • The mobile-learning module group showed significant improvement in performing finger sweeps (42%) and clamping the distal chest tube (42%) compared to the control group.
  • Experts also showed deficits in finger sweeps (70%) and avoiding the neurovascular bundle (75%), with no significant improvement from the module.

Conclusions:

  • Key procedural steps like avoiding the neurovascular bundle, controlled pleural entry, and finger sweeps are frequently performed incorrectly by novices.
  • Targeted instruction focusing on these challenging steps can aid educators in optimizing the training of chest tube thoracostomy.
  • Mobile-learning interventions show promise in enhancing specific procedural skills for surgical trainees.