Evaluation of an Emergency‐procedure Teaching Laboratory for the Development of Proficiency in Tube Thoracostomy

Abstract

Objective: Emergency-procedure laboratories are not a standardized part of the curriculum for emergency medicine residency programs. The authors evaluated the efficacy of an emergency-procedure laboratory to teach medical students and residents the performance of tube thoracostomy.Methods: A prospective repeated-measures study of tube thoracostomy placement training was performed in an animal-laboratory setting. Participants were six first-postgraduate-year emergency medicine residents and six fourth-year medical students. Each participant was given a written pretest on tube thoracostomies followed by lectures on tube thoracostomy, venous cutdown, peritoneal lavage, and surgical airway. The procedure laboratory, using an anesthetized canine model (20-25 kg), was then conducted. Tube thoracostomies were timed from skin incision to passage of the tube into the thoracic cavity with subsequent tube fogging. Four attempts per participant were documented. Eighteen days later, an identical procedure laboratory was conducted for the same students including a written posttest identical to the pretest. Results:The written test scores improved for every participant (p < 0.0001). Mean times for procedures completion improved from 121 sec to 39 sec (p = O< .001) during the first session and improved from 58 sec to 28 sec (p = 0.005) during the second session. Retention of skills was indicated by significant shortening of the time to completion from the first attempt of the first session to that of the second session (121 sec to 58 sec, p = 0.002). Conclusions:This procedure laboratory, which emphasized skill repetition, led to improvement in procedural speed and retention of tube thoracostomy skills over time. This approach to teaching clinical procedures should be considered for emergency medicine residency programs and for continuing medical education courses that emphasize acquisition of clinical procedural skills.

Developing Technical Expertise in Emergency Medicine—The Role of Simulation in Procedural Skill Acquisition

“…Traditionally, the training of chest tube placement has been accomplished using either animal or cadaver models 47,48 . Using a canine lab to train EM residents and fourth‐year medical students, Homan et al 49 found that repetition increased procedural speed and improved retention of skills. Chapman et al 50 demonstrated that paper and computer modeling of open thoracotomy did not increase procedural accuracy.…”

Learning and Retention Rates after Training in Posterior Epistaxis Management

“…Agreement with the checklist and performance standard among an expert panel of physicians, consistent performance scores between 1‐week pretraining tests and same‐day pretraining tests, and improvement in posttraining performance measures all provide construct validity 19 to the assessment methodology. Concurrent validity (correlation with other assessment measures for the procedure) 20 and discriminant validity (ability to produce results that are different from another validated test) 21 were not measured because no other published assessment methods for this procedure are available for comparison.…”

Validation of a novel resin-porcine thorax model for chest drain insertion training

“…Some have used animal cadavers and rib cages, live dogs, mannequins and human cadavers; some of these are expensive and not practical in every skills lab. [12][13][14][15] Interestingly, very few have been rigorously tested for their validity in training as well as assessment. This article describes a model which is practical and affordable, using porcine ribs mounted on a resin cast of a human thorax.…”