Identifying pitfalls in chest tube insertion: Improving teaching and performance

James S. Davis, George Garcia, Jassin M. Jouria, Mary M. Wyckoff, Salman Alsafran, Jill M. Graygo, Kelly F. Withum, Carl I Schulman

Research output: Contribution to journalArticle

7 Citations (Scopus)

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 languageEnglish
Pages (from-to)334-339
Number of pages6
JournalJournal of Surgical Education
Volume70
Issue number3
DOIs
StatePublished - May 1 2013

Fingerprint

Chest Tubes
Teaching
Fingers
video
expert
performance
Thoracostomy
Group
Checklist
Control Groups
military
resident
Multimedia
Learning Curve
Suction
Tertiary Healthcare
Medical Students
Punctures
Constriction
didactics

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 journalArticle

Davis, James S. ; Garcia, George ; Jouria, Jassin M. ; Wyckoff, Mary M. ; Alsafran, Salman ; Graygo, Jill M. ; Withum, Kelly F. ; Schulman, Carl I. / Identifying pitfalls in chest tube insertion : Improving teaching and performance. In: Journal of Surgical Education. 2013 ; Vol. 70, No. 3. pp. 334-339.
@article{a4448f327b9b4bac864879aec072b280,
title = "Identifying pitfalls in chest tube insertion: Improving teaching and performance",
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.",
keywords = "chest tube, instruction, procedure, simulation, surgical educa- tion, thoracostomies",
author = "Davis, {James S.} and George Garcia and Jouria, {Jassin M.} and Wyckoff, {Mary M.} and Salman Alsafran and Graygo, {Jill M.} and Withum, {Kelly F.} and Schulman, {Carl I}",
year = "2013",
month = "5",
day = "1",
doi = "10.1016/j.jsurg.2012.12.005",
language = "English",
volume = "70",
pages = "334--339",
journal = "Journal of Surgical Education",
issn = "1931-7204",
publisher = "Elsevier Inc.",
number = "3",

}

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 -