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De Mol L, Lievens A, De Pauw N, Vanommeslaeghe H, Van Herzeele I, Van de Voorde P, Konge L, Desender L, Willaert W. Assessing Chest Tube Insertion Skills Using a Porcine Rib Model-A Validity Study. Simul Healthc 2023:01266021-990000000-00087. [PMID: 37782127 DOI: 10.1097/sih.0000000000000750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/03/2023]
Abstract
INTRODUCTION Assessments require sufficient validity evidence before their use. The Assessment for Competence in Chest Tube Insertion (ACTION) tool evaluates proficiency in chest tube insertion (CTI), combining a rating scale and an error checklist. The aim of this study was to collect validity evidence for the ACTION tool on a porcine rib model according to the Messick framework. METHODS A rib model, consisting of a porcine hemithorax that was placed in a wooden frame, was used as simulator. Participants were recruited from the departments of surgery, pulmonology, and emergency medicine. After familiarization with the rib model and the equipment, standardized instructions and clinical context were provided. They performed 2 CTIs while being scored with the ACTION tool. All performances were assessed live by 1 rater and by 3 blinded raters using video recordings. Generalizability-analysis was performed and mean scores and errors of both groups on the first performance were compared. A pass/fail score was established using the contrasting groups' method. RESULTS Nine novice and 8 experienced participants completed the study. Generalizability coefficients where high for the rating scale (0.92) and the error checklist (0.87). In the first CTI, novices scored lower than the experienced group (38.1/68 vs. 47.1/68, P = 0.042), but no difference was observed on the error checklist. A pass/fail score of 44/68 was established. CONCLUSION A solid validity argument for the ACTION tool's rating scale on a porcine rib model is presented, allowing formative and summative assessment of procedural skills during training before patient contact.
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Affiliation(s)
- Leander De Mol
- From the Department of Human Structure and Repair (L.D.M., A.L., N.D.P., I.V.H., L.D., W.W.), Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium; Department of Gastrointestinal Surgery (H.V., W.W.), Ghent University Hospital, Ghent, Belgium; Department of Thoracic and Vascular Surgery (I.V.H., L.D.), Ghent University Hospital, Ghent, Belgium; Department of Basic and Applied Medical Sciences (P.V.d.V.), Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium; Department of Emergency Medicine (P.V.d.V.), Ghent University Hospital, Ghent, Belgium; Faculty of Health and Medical Sciences, (L.K.) University of Copenhagen, Copenhagen, Denmark; and Copenhagen Academy for Medical Education and Simulation (CAMES) (L.K.), Copenhagen, Denmark
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Zante B. Impact of number of critical care procedural skill repetitions on supervision level and teaching style. PLoS One 2023; 18:e0280207. [PMID: 36689411 PMCID: PMC9870148 DOI: 10.1371/journal.pone.0280207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 12/22/2022] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND During critical care procedural skills training (e.g., in intubation and pericardiocentesis) the appropriate supervision level is important to ensure correct use of techniques and guarantee patient safety. The appropriate teaching style should be selected to address residents' learning behavior and foster their competence. The aim of this study was to explore the number of repetitions for given skills needed to achieve a specified supervision level and a specific teaching style. METHODS This cross-sectional multicenter survey obtained data from residents and faculty of three multidisciplinary intensive care units (ICU) in Switzerland. Using a 4-point Likert scale, participants were asked to indicate the number of repetitions required to achieve the specified supervision level and teaching style. RESULTS Among 91 physicians, the response rate was 64% (n = 59). Their median estimations of the numbers of skill repetitions needed to achieve the final fourth level of supervision and final fourth stage of teaching style were as follows: arterial catheter insertion: supervision level 32, teaching style 17.5; peritoneal paracentesis: supervision level 27, teaching style 17; central venous catheter insertion: supervision level 38, teaching style 28; lumbar puncture: supervision level 38, teaching style 21; endotracheal intubation: supervision level 100, teaching style 45; chest drain insertion: supervision level 27, teaching style 21.5; temporary pacemaker placement: supervision level 50, teaching style 19.5; percutaneous tracheostomy: supervision level 50, teaching style 29; pericardiocentesis: supervision level 50, teaching style 35. Comparison of repetitions between supervision level and teaching style revealed no difference at the first and second levels, except for endotracheal intubation at level 2 (p = 0.03). Differences were observed at the third and fourth levels of supervision level and teaching style (p≤0.04). CONCLUSIONS It appears that the supervision level and teaching style applied by faculty should change according to both the number of repetitions and the difficulty of critical care procedural skills.
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Affiliation(s)
- Bjoern Zante
- Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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Nayahangan LJ, Svendsen MBS, Bodtger U, Rahman N, Maskell N, Sidhu JS, Lawaetz J, Clementsen PF, Konge L. Assessment of competence in local anaesthetic thoracoscopy: development and validity investigation of a new assessment tool. J Thorac Dis 2021; 13:3998-4007. [PMID: 34422330 PMCID: PMC8339737 DOI: 10.21037/jtd-20-3560] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 02/24/2021] [Indexed: 12/03/2022]
Abstract
Background The aims of the study were to develop an assessment tool in local anaesthetic thoracoscopy (LAT), investigate validity evidence, and establish a pass/fail standard. Methods Validity evidence for the assessment tool was gathered using the unified Messick framework. The tool was developed by five experts in respiratory medicine and medical education. Doctors with varying experience performed two consecutive procedures in a standardized, simulation-based setting using a newly developed thorax/lung silicone model. Performances were video-recorded and assessed by four expert raters using the new tool. Contrasting groups’ method was used to set a pass/fail standard. Results Nine novices and 8 experienced participants were included, generating 34 recorded performances and 136 expert assessments. The tool had a high internal consistency (Cronbach’s alpha =0.94) and high inter-rater reliability (Cronbach’s alpha =0.91). The total item score significantly correlated with the global score (rs=0.86, P<0.001). Participants’ first performance correlated to second performance (test-retest reliability) with a Pearson’s r of 0.93, P<0.001. Generalisability (G) study showed a G-coefficient of 0.92 and decision (D) study estimated that one performance assessed by two raters or four performances assessed by one rater are needed to reach an acceptable reliability, i.e., G-coefficient >0.80. The tool was able to discriminate between the two groups in both performances: experienced mean score =30.8±4.2; novice mean score =15.8±2.3, P<0.001. Pass/fail standard was set at 22 points. Conclusions The newly developed assessment tool showed solid evidence of validity and can be used to ensure competence in LAT.
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Affiliation(s)
- Leizl Joy Nayahangan
- Copenhagen Academy for Medical Education and Simulation, Centre for HR and Education, The Capital Region of Denmark, Copenhagen, Denmark
| | - Morten Bo Søndergaard Svendsen
- Copenhagen Academy for Medical Education and Simulation, Centre for HR and Education, The Capital Region of Denmark, Copenhagen, Denmark
| | - Uffe Bodtger
- Department of Internal and Respiratory Medicine, Zealand University Hospital, Roskilde, Denmark.,Department of Respiratory Medicine, Næstved Hospital, Næstved, Denmark
| | - Najib Rahman
- Nuffield Department of Medicine, Oxford Respiratory Trials Unit, University of Oxford, Oxford, UK
| | - Nick Maskell
- Academic Respiratory Unit, School of Clinical Sciences, University of Bristol, Bristol, UK
| | | | - Jonathan Lawaetz
- Copenhagen Academy for Medical Education and Simulation, Centre for HR and Education, The Capital Region of Denmark, Copenhagen, Denmark.,Department of Vascular Surgery, Rigshospitalet, Copenhagen, Denmark
| | - Paul Frost Clementsen
- Copenhagen Academy for Medical Education and Simulation, Centre for HR and Education, The Capital Region of Denmark, Copenhagen, Denmark.,Department of Internal and Respiratory Medicine, Zealand University Hospital, Roskilde, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Lars Konge
- Copenhagen Academy for Medical Education and Simulation, Centre for HR and Education, The Capital Region of Denmark, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Souleymane M, Rajendram R, Mahmood N, Ghazi AMT, Kharal YMS, Hussain A. A survey demonstrating that the procedural experience of residents in internal medicine, critical care and emergency medicine is poor: training in ultrasound is required to rectify this. Ultrasound J 2021; 13:20. [PMID: 33847823 PMCID: PMC8044269 DOI: 10.1186/s13089-021-00221-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 03/25/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Training in procedural skills is often suboptimal. The aim of this study was to quantify the needs of residents in internal medicine (IM), critical care (CC), and emergency medicine (EM) for instruction in ultrasound-guided procedures. METHODS All IM, EM and CC residents (n = 200) at King Abdulaziz Medical City, Riyadh, Saudi Arabia, were invited to participate in a questionnaire-based survey to identify skill and experience gaps. The contribution of procedural skills to patient care (i.e. applicability) and proficiency in the sterile technique required to perform ultrasound-guided procedures were rated on Likert scales. Data on training, accreditation, and experience with and without ultrasound were collected. RESULTS The overall response rate was 72% (IM 91%, CC 100%, EM 40%). Although the sample reported that procedural skills were very applicable, 19% (IM n = 25, EM n = 2) had not performed any procedures. However, five residents were accredited in point-of-care ultrasound, 61% of the sample had performed ultrasound-guided procedures and 65% had used landmark techniques. Whilst more internists had performed procedures using landmark techniques, CC and EM residents had performed more ultrasound-guided procedures. Whilst CC residents had not missed any opportunities to perform procedures because supervisors were less available, EM (6) and IM (89) residents had. Whilst skill gaps were only identified in the IM residency programme, experience gaps were present in all three residency programmes. The IM residency programme had larger experience gaps than the CC and EM programmes for all procedural skills. DISCUSSION Residents in IM, CC and EM perceive that ultrasound-guided procedures are relevant to their practice. However, the IM residents performed fewer procedures than CC residents and EM residents at least partly because internists also lack skills in ultrasound. Training in ultrasound-guided procedures may reduce the use of landmark techniques and improve patient safety. Residents in IM, CC and EM therefore require training in ultrasound-guided procedures.
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Affiliation(s)
- Mamdouh Souleymane
- Department of Medicine, King Abdulaziz Medical City, King Abdullah International Medical Research Center, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia
| | - Rajkumar Rajendram
- Department of Medicine, King Abdulaziz Medical City, King Abdullah International Medical Research Center, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia.
- College of Medicine, King Saud Bin Abdulaziz University of Health Sciences, Riyadh, Saudi Arabia.
| | - Naveed Mahmood
- Department of Medicine, King Abdulaziz Medical City, King Abdullah International Medical Research Center, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia
- College of Medicine, King Saud Bin Abdulaziz University of Health Sciences, Riyadh, Saudi Arabia
| | - Amro M T Ghazi
- Department of Intensive Care, King Abdulaziz Medical City, King Abdullah International Medical Research Center, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia
| | | | - Arif Hussain
- Department of Cardiac Sciences, King Abdulaziz Medical City, King Abdullah International Medical Research Center, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia
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Pietersen PI, Jørgensen R, Graumann O, Konge L, Skaarup SH, Lawaetz Schultz HH, Laursen CB. Training Thoracic Ultrasound Skills: A Randomized Controlled Trial of Simulation-Based Training versus Training on Healthy Volunteers. Respiration 2021; 100:34-43. [PMID: 33454705 DOI: 10.1159/000509298] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 06/10/2020] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION As ultrasound becomes more accessible, the use of point-of-care ultrasound examinations performed by clinicians has increased. Sufficient theoretical and practical skills are prerequisites to integrate thoracic ultrasound into a clinical setting and to use it as supplement in the clinical decision-making. Recommendations on how to educate and train clinicians for these ultrasound examinations are debated, and simulation-based training may improve clinical performance. OBJECTIVES The aim of this study was to explore the effect of simulation-based training in thoracic ultrasound compared to training on healthy volunteers. METHOD A total of 66 physicians with no previous experience in thoracic ultrasound completed a training program and assessment of competences from November 2018 to May 2019. After a theoretical session in ultrasound physics, sonoanatomy, and thoracic ultrasound, the physicians were randomized into one of three groups for practical training: (1) simulation-based training, (2) training on a healthy volunteer, or (3) no training (control group). Primary outcome was difference in the clinical performance score after the training period. RESULTS Using a multiple comparison, ANOVA with Bonferroni correction for multiplicity, there was no statistical significant difference between the two trained groups' performance score: 45.1 points versus 41.9 points (minimum 17 points, maximum 68 points; p = 0.38). The simulation-based training group scored significantly higher than the control group without hands-on training, 36.7 points (p = 0.009). CONCLUSIONS The use of simulation-based training in thoracic ultrasound does not improve the clinical performance score compared to conventional training on healthy volunteers. As focused, thoracic ultrasound is a relatively uncomplicated practical procedure when taught; focus should mainly be on the theoretical part and the supervised clinical training in a curriculum. However, simulation can be used instead or as an add-on to training on simulated patients.
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Affiliation(s)
- Pia Iben Pietersen
- Department of Respiratory Medicine, Odense University Hospital, Odense, Denmark, .,Regional Center for Technical Simulation, Odense University Hospital, Odense, Denmark, .,Institute for Clinical Research, University of Southern Denmark, Odense, Denmark, .,OPEN, Odense Patient data Explorative Network, Odense University Hospital, Odense, Denmark,
| | - Rasmus Jørgensen
- Department of Respiratory Medicine, Odense University Hospital, Odense, Denmark.,Regional Center for Technical Simulation, Odense University Hospital, Odense, Denmark
| | - Ole Graumann
- Institute for Clinical Research, University of Southern Denmark, Odense, Denmark.,Department of Radiology, Odense University Hospital, Odense, Denmark
| | - Lars Konge
- Copenhagen Academy for Medical Education and Simulation, Capital Region of Denmark, Copenhagen, Denmark
| | - Søren Helbo Skaarup
- Department of Respiratory Medicine, Aarhus University Hospital, Aarhus, Denmark.,MidtSim, Aarhus University Hospital, Aarhus, Denmark
| | - Hans Henrik Lawaetz Schultz
- Copenhagen Academy for Medical Education and Simulation, Capital Region of Denmark, Copenhagen, Denmark.,Department of Cardiothoracic Surgery, Unit of Lung transplantation, Rigshospitalet Glostrup, Glostrup, Denmark
| | - Christian B Laursen
- Department of Respiratory Medicine, Odense University Hospital, Odense, Denmark.,Institute for Clinical Research, University of Southern Denmark, Odense, Denmark
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