Department of Thoracic Medicine, The Royal Brisbane and Women's Hospital, Brisbane, Australia.
Department of Thoracic Medicine, The Prince Charles Hospital, Brisbane, Australia.
Thorax. 2015 Feb;70(2):186-8. doi: 10.1136/thoraxjnl-2013-204914. Epub 2014 Mar 26.
Currently no tool exists to assess proceduralist skill at chest tube insertion. As inadequate doctor procedural competence has repeatedly been associated with adverse events, there is a need for a tool to assess procedural competence. This study aims to develop and examine the validity of a tool to assess competency at insertion of a chest tube, using either the Seldinger technique or blunt dissection. A 5-domain 100-point assessment tool was developed inline with British Thoracic Society guidelines and international consensus—the Chest Tube Insertion Competency Test (TUBE-iCOMPT). The instrument was used to assess chest tube insertion in mannequins and live patients. 29 participants (9 novices, 14 intermediate and 6 advanced) were tested by 2 blinded expert examiners on 2 occasions. The tool's validity was examined by demonstrating: (1) stratification of participants according to expected level of expertise (analysis of variance), and (2) test-retest and intertester reliability (intraclass correlation coefficient). The intraclass correlation coefficient of repeated scores for the Seldinger technique and blunt dissection, were 0.92 and 0.91, respectively, for test-retest results, and 0.98 and 0.95, respectively, for intertester results. Clear stratification of scores according to participant experience was seen (p<0.0001). There was no significant difference between scores obtained using mannequins or live patients. This study has validated the TUBE-iCOMPT, which could now be incorporated into chest tube insertion training programmes, providing a way to document acquisition of skill, guide individualised teaching, and assist with the assessment of the adequacy of clinician training.
目前尚无工具可用于评估胸腔引流管插入术专家的技能。由于医生操作技能不足与不良事件反复相关，因此需要一种工具来评估操作能力。本研究旨在开发并检验一种用于评估使用 Seldinger 技术或钝性解剖插入胸腔引流管能力的工具的有效性。根据英国胸科学会指南和国际共识，制定了一个 5 个领域 100 分的评估工具——胸腔引流管插入能力测试（TUBE-iCOMPT）。该工具用于在模拟人和真实患者中评估胸腔引流管插入。29 名参与者（9 名新手、14 名中级和 6 名高级）由 2 名盲法专家在 2 次测试中进行评估。通过证明以下几点来检验工具的有效性：（1）根据预期的专业水平对参与者进行分层（方差分析），以及（2）测试-重测和内-测试者可靠性（组内相关系数）。Seldinger 技术和钝性解剖的重复评分的组内相关系数分别为 0.92 和 0.91，用于测试-重测结果，分别为 0.98 和 0.95，用于内-测试者结果。根据参与者的经验，明显看到评分的分层（p<0.0001）。在使用模拟人和真实患者获得的分数之间没有显著差异。本研究验证了 TUBE-iCOMPT，现在可以将其纳入胸腔引流管插入培训计划中，提供一种记录技能获取、指导个体化教学和协助评估临床医生培训充分性的方法。
