Abstract
Objective: Chest tube thoracostomies are common surgical procedures, but little is known about how practitioners learn the skill. This study evaluates the frequency with which correctly performed tasks are executed by subjects during chest tube thoracostomies. Design: In this prospective study, we developed a mobile-learning module, containing stepwise multimedia guidance on chest tube insertion. Next, we developed and tested a 14-item checklist, modeled after key skills in the module. Participants, defined as novice (fewer than 10 chest tubes placed) or expert (10 or more placed), were assigned to either the video or control group. A trained clinician used the checklist to rate participants while they inserted a chest tube on a TraumaMan simulator. Setting: University of Miami, Miller School of Medicine, a tertiary care academic institution. Participants: Current medical students, residents, and the United States Army Forward Surgical Team members rotating through the institution. One hundred twenty-eight subjects entered and finished the study. Results: One hundred twenty-eight subjects enrolled in the study; 86 (67%) were residents or US Army Forward Surgical Team members, 66 (77%) were novices, and 20 (23%) were experts. Novices most frequently connected the tube to suction (91%), adequately dissected the soft tissue (82%), and scrubbed or anesthetized appropriately (80%). They least frequently completed full finger sweeps (33%), avoided the neurovascular bundle (35%), and performed a controlled pleural puncture (39%). Comparing the novice video group with the novice control group, the video group was more likely to correctly perform a finger sweep (42%, p<0.001) and clamp the distal end of the chest tube (42%, p<0.001). Of all the steps, experts least frequently completed full finger sweeps (70%) and avoided the neurovascular bundle (75%). Comparing the expert video group with the expert control group, the video group was more likely to correctly perform finger sweeps, the incision, and clamping the distal chest tube (20%, p = not significant). Conclusions: Avoiding the neurovascular bundle, controlled pleural entry, and finger sweeps are most often performed incorrectly among novices. This information can help instructors to emphasize key didactic steps, possibly easing trainees' learning curve.
| Original language | English |
|---|---|
| Pages (from-to) | 334-339 |
| Number of pages | 6 |
| Journal | Journal of Surgical Education |
| Volume | 70 |
| Issue number | 3 |
| DOIs | |
| State | Published - May 1 2013 |
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Keywords
- chest tube
- instruction
- procedure
- simulation
- surgical educa- tion
- thoracostomies
ASJC Scopus subject areas
- Surgery
- Education
Cite this
Identifying pitfalls in chest tube insertion : Improving teaching and performance. / Davis, James S.; Garcia, George; Jouria, Jassin M.; Wyckoff, Mary M.; Alsafran, Salman; Graygo, Jill M.; Withum, Kelly F.; Schulman, Carl I.
In: Journal of Surgical Education, Vol. 70, No. 3, 01.05.2013, p. 334-339.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Identifying pitfalls in chest tube insertion
T2 - Improving teaching and performance
AU - Davis, James S.
AU - Garcia, George
AU - Jouria, Jassin M.
AU - Wyckoff, Mary M.
AU - Alsafran, Salman
AU - Graygo, Jill M.
AU - Withum, Kelly F.
AU - Schulman, Carl I
PY - 2013/5/1
Y1 - 2013/5/1
N2 - Objective: Chest tube thoracostomies are common surgical procedures, but little is known about how practitioners learn the skill. This study evaluates the frequency with which correctly performed tasks are executed by subjects during chest tube thoracostomies. Design: In this prospective study, we developed a mobile-learning module, containing stepwise multimedia guidance on chest tube insertion. Next, we developed and tested a 14-item checklist, modeled after key skills in the module. Participants, defined as novice (fewer than 10 chest tubes placed) or expert (10 or more placed), were assigned to either the video or control group. A trained clinician used the checklist to rate participants while they inserted a chest tube on a TraumaMan simulator. Setting: University of Miami, Miller School of Medicine, a tertiary care academic institution. Participants: Current medical students, residents, and the United States Army Forward Surgical Team members rotating through the institution. One hundred twenty-eight subjects entered and finished the study. Results: One hundred twenty-eight subjects enrolled in the study; 86 (67%) were residents or US Army Forward Surgical Team members, 66 (77%) were novices, and 20 (23%) were experts. Novices most frequently connected the tube to suction (91%), adequately dissected the soft tissue (82%), and scrubbed or anesthetized appropriately (80%). They least frequently completed full finger sweeps (33%), avoided the neurovascular bundle (35%), and performed a controlled pleural puncture (39%). Comparing the novice video group with the novice control group, the video group was more likely to correctly perform a finger sweep (42%, p<0.001) and clamp the distal end of the chest tube (42%, p<0.001). Of all the steps, experts least frequently completed full finger sweeps (70%) and avoided the neurovascular bundle (75%). Comparing the expert video group with the expert control group, the video group was more likely to correctly perform finger sweeps, the incision, and clamping the distal chest tube (20%, p = not significant). Conclusions: Avoiding the neurovascular bundle, controlled pleural entry, and finger sweeps are most often performed incorrectly among novices. This information can help instructors to emphasize key didactic steps, possibly easing trainees' learning curve.
AB - Objective: Chest tube thoracostomies are common surgical procedures, but little is known about how practitioners learn the skill. This study evaluates the frequency with which correctly performed tasks are executed by subjects during chest tube thoracostomies. Design: In this prospective study, we developed a mobile-learning module, containing stepwise multimedia guidance on chest tube insertion. Next, we developed and tested a 14-item checklist, modeled after key skills in the module. Participants, defined as novice (fewer than 10 chest tubes placed) or expert (10 or more placed), were assigned to either the video or control group. A trained clinician used the checklist to rate participants while they inserted a chest tube on a TraumaMan simulator. Setting: University of Miami, Miller School of Medicine, a tertiary care academic institution. Participants: Current medical students, residents, and the United States Army Forward Surgical Team members rotating through the institution. One hundred twenty-eight subjects entered and finished the study. Results: One hundred twenty-eight subjects enrolled in the study; 86 (67%) were residents or US Army Forward Surgical Team members, 66 (77%) were novices, and 20 (23%) were experts. Novices most frequently connected the tube to suction (91%), adequately dissected the soft tissue (82%), and scrubbed or anesthetized appropriately (80%). They least frequently completed full finger sweeps (33%), avoided the neurovascular bundle (35%), and performed a controlled pleural puncture (39%). Comparing the novice video group with the novice control group, the video group was more likely to correctly perform a finger sweep (42%, p<0.001) and clamp the distal end of the chest tube (42%, p<0.001). Of all the steps, experts least frequently completed full finger sweeps (70%) and avoided the neurovascular bundle (75%). Comparing the expert video group with the expert control group, the video group was more likely to correctly perform finger sweeps, the incision, and clamping the distal chest tube (20%, p = not significant). Conclusions: Avoiding the neurovascular bundle, controlled pleural entry, and finger sweeps are most often performed incorrectly among novices. This information can help instructors to emphasize key didactic steps, possibly easing trainees' learning curve.
KW - chest tube
KW - instruction
KW - procedure
KW - simulation
KW - surgical educa- tion
KW - thoracostomies
UR - http://www.scopus.com/inward/record.url?scp=84876591331&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84876591331&partnerID=8YFLogxK
U2 - 10.1016/j.jsurg.2012.12.005
DO - 10.1016/j.jsurg.2012.12.005
M3 - Article
C2 - 23618442
AN - SCOPUS:84876591331
VL - 70
SP - 334
EP - 339
JO - Journal of Surgical Education
JF - Journal of Surgical Education
SN - 1931-7204
IS - 3
ER -