Background The West Midlands Deanery is running a training module in Chest Drain insertion for all CMT trainees using Simulation training in a Porcine–Resin Model. Between Feb 2009 and Feb 2010, 176 trainees have completed the training module. Universal feedback (95%) was good. Our concerns were that analogous to driving, experience on the road is necessary to produce a competent trainee. We present this study evaluating two cohorts of trainees derived from the original pool after 6 months of their simulation training.
Methods One cohort consisted of 12 CMT Trainees who were paired with a trainer who is a Consultant or SpR in Respiratory Medicine. The trainees were selected depending on the availability of trainer rather than their enthusiasm to participate. The other cohort of 18 trainees was randomly selected from the general pool, which was originally advised to seek experience in their trust during routine work. Both cohorts were asked about their confidence in chest drain insertion as well as number of procedures they have done in the last 6 months. In the supervised cohort, we have analysed the DOPS score and plotted the learning curve for chest drain insertion.
Results On average the trainees in the mentored group have done 10.5 procedures in the last 6 months while trainees from the general cohort have done only 2.2 procedures. Disappointingly universal feed back from the general cohort was that they quickly lost the confidence and skill. They have pointed out number of reasons; the prominent ones are lack of opportunity, radiologists taking the routine work, lack of supervision. It took about five procedures for trainees in the mentored group to get up to satisfactory level in the DOPS score and after seven procedures there was a definite plateau in the learning curve.
Conclusion Simulation training imparts confidence and familiarisation with the seldinger chest drain insertion but at least five to seven further supervised insertions on patients is required to do the procedure with out direct supervision. This needs further work on a larger group which is on going. What is clear is that close mentoring is essential to master the skill and Consultant time must be set aside formally to sustain the training programmes.
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