Article Text

Audit, research and guideline update
A new instrument to assess physician skill at chest tube insertion: the TUBE-iCOMPT
  1. Matthew R Salamonsen1,
  2. Farzad Bashirzadeh1,
  3. Alexander J Ritchie2,
  4. Helen E Ward3,
  5. David I K Fielding1
  1. 1Department of Thoracic Medicine, The Royal Brisbane and Women's Hospital, Brisbane, Australia
  2. 2Department of Thoracic Medicine, The Prince Charles Hospital, Brisbane, Australia
  3. 3Safety and Quality Unit, The Prince Charles Hospital, Brisbane, Australia
  1. Correspondence to Dr Matthew Salamonsen, Department of Thoracic Medicine, The Royal Brisbane and Women's Hospital, Herston 4029 Australia; mattsalamonsen{at}


Currently no tool exists to assess proceduralist skill at chest tube insertion. As inadequate doctor procedural competence has repeatedly been associated with adverse events, there is a need for a tool to assess procedural competence.

This study aims to develop and examine the validity of a tool to assess competency at insertion of a chest tube, using either the Seldinger technique or blunt dissection.

A 5-domain 100-point assessment tool was developed inline with British Thoracic Society guidelines and international consensus—the Chest Tube Insertion Competency Test (TUBE-iCOMPT). The instrument was used to assess chest tube insertion in mannequins and live patients. 29 participants (9 novices, 14 intermediate and 6 advanced) were tested by 2 blinded expert examiners on 2 occasions. The tool's validity was examined by demonstrating: (1) stratification of participants according to expected level of expertise (analysis of variance), and (2) test-retest and intertester reliability (intraclass correlation coefficient). The intraclass correlation coefficient of repeated scores for the Seldinger technique and blunt dissection, were 0.92 and 0.91, respectively, for test-retest results, and 0.98 and 0.95, respectively, for intertester results. Clear stratification of scores according to participant experience was seen (p<0.0001). There was no significant difference between scores obtained using mannequins or live patients. This study has validated the TUBE-iCOMPT, which could now be incorporated into chest tube insertion training programmes, providing a way to document acquisition of skill, guide individualised teaching, and assist with the assessment of the adequacy of clinician training.

  • Pleural Disease

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