-Chest drain insertion in inexperienced hands carries a significant morbidity and mortality. The royal colleges, recognising this, stipulated that chest drain insertion be included as one of the core competences for all core medical trainees. However, there is no formal training in chest drain insertion included in training programmes. Simulation training should, in theory, provide a safe and objective method to overcome the obstacles in chest drain insertion training. There have been a number of attempts to find the ideal simulator for chest drain insertion with varying success. This article describes a model which is practical and affordable in all clinical skills labs, using porcine ribs mounted on a resin cast of a human thorax, and the data about the validation of the porcine-thorax model for chest drain insertion presented.

though 26/71(37%) reported that it aided communication. Most learned their behaviour from senior colleagues (22/76), own observation (16/76) or medical school (27/76). The closest associations were for Pictures C (77/78 responses, 99%¼normal) and E (94/ 102,92%¼wheeze/rhonchi combined). Crosses were commonly interpreted as crepitations in Pictures B (89/101,88%¼fine and bibasal combined) and F (66/94, 70%¼coarse). Pleural effusion was most commonly linked to Pictures A (35/107, 33%) and D (75/98, 77%) though both of these had an additional eight and four interpretations respectively. Conclusion The majority of doctors use pictorial representation to record respiratory examination. Lack of standardisation leads to variation in annotation and potentially alternative interpretation by others. With the exception of Picture C, the use of pictures alone is unreliable. Reassuringly for patient safety, most doctors also write down their findings. Pictorial representation is most often informally learned and appears to be well established in UK medical practice.

required to establish whether this finding is generic across the UK and the underlying mechanisms driving this phenomenon.Abstract P81 Figure 1 Variation in monthly admissions of children with empyema and variation in mean monthly maximum temperature from