Performing a chest drain procedure with a safe technique is a core skill for a medical registrar and arguably the highest risk procedure they are expected to perform at junior level.
The competency level of a cohort of registrars who typically rotate every six months is often not known. Little regard is given to this when drawing up on call rotas and training needs are often missed. In this initiative we aimed to address these failings.
Methods By way of induction for the general medical registrars beginning a six month post in our hospitals we arranged a short verbal introduction to the group about local processes of how chest procedures within our hospital are performed eg. location of equipment in centralised packs, standardised equipment lists, check lists and use of bedside US and patient information/consent.
Over the first two weeks of the run we arranged “one on one” teaching with a Consultant chest physician who taught each registrar according to their needs on realistic mannequins. Three techniques taught: thoracocentesis with an 8 F drainage pack; a small bore 12 F seldinger drain and a surgical 28 F drain drain according to need. Teaching of 32 registrars was completed within a two week time frame in the space of four PA/clinic sessions. Competency was judged at the end of the session and electronic DOPS and feedback from the registrars was obtained. We encouraged further discussion with educational supervisors with regard to ongoing training requirements for individuals.
Results and evaluation Attendance was 31/32. 59% had 12 months or less experience as a registrar. 66% were able to perform thoracocentesis and 63% seldinger drain independently. Most others were competent enough to perform with a colleague supervising. Additionally 38% and 25% of registrars were deemed to be able to teach other thoracocentesis and seldinger drains respectively.
Learner feedback was extremely positive and self-rated confidence and safety improved from 5–7.6 and 5.2 to 7.7 out of 10 respectively. Responses highly valued the fact this was delivered by a Consultant and identified a need for further bedside chest US training.