Shefrin Allan Evan, Khazei Afshin, Hung Geoffrey Robert, Odendal Lisa Teres, Cheng Adam
1Division of Pediatric Emergency Medicine,Children's Hospital of Eastern Ontario,University of Ottawa,Ottawa,ON.
2Division of Emergency Medicine,Vancouver General Hospital,University of British Columbia,Vancouver,BC.
CJEM. 2015 Mar;17(2):140-7. doi: 10.2310/8000.2014.141406.
Pediatric emergency medicine (PEM) physicians receive little opportunity to practice and perform chest tube insertion. We sought to develop and validate a scoring tool to assess chest tube insertion competency and identify areas where training is required for PEM physicians.
We developed a 40-point, 20-item (scored 0, 1, or 2) assessment tool entitled the Tool for Assessing Chest Tube Insertion Competency (TACTIC) and studied how PEM physicians and fellows scored when inserting a chest tube into a pork rib model. Participants were scored at baseline and compared to themselves after receiving targeted training using Web-based animations and presentations followed by expert instruction and practice on chest tube insertion task trainers. All insertions were video recorded and reviewed by two blinded reviewers. Eight common videos were reviewed to assess interrater reliability.
The TACTIC demonstrated good interrater reliability with an r 2 =0.86. Our cohort demonstrated a significant improvement in TACTIC scores by taking part in targeted training (precourse TACTIC=65%, 95% CI 54-76 v. postcourse TACTIC=84%, 95% CI 80-88), highlighting the construct validity of the TACTIC. Individual participants increased their TACTIC scores by an average of 17%.
The TACTIC demonstrates good interrater reliability, content validity, and construct validity in assessing a PEM practitioner's skill inserting chest tubes in a simulated setting.
儿科急诊医学（PEM）医生很少有机会练习和进行胸腔闭式引流管置入操作。我们试图开发并验证一种评分工具，以评估胸腔闭式引流管置入能力，并确定PEM医生需要培训的领域。
我们开发了一种名为“胸腔闭式引流管置入能力评估工具（TACTIC）”的40分、20项（每项评分0、1或2）评估工具，并研究了PEM医生和住院医师在将胸腔闭式引流管插入猪肋骨模型时的得分情况。参与者在基线时进行评分，并在接受基于网络的动画和演示文稿的针对性培训后，再由专家指导并在胸腔闭式引流管置入任务训练器上进行练习，之后与他们自己之前的评分进行比较。所有操作均进行视频记录，并由两名不知情的评审人员进行评审。评审了八个常见视频以评估评分者间的可靠性。
TACTIC显示出良好的评分者间可靠性，r² = 0.86。我们的研究队列通过参与针对性培训，TACTIC评分有显著提高（课程前TACTIC = 65%，95%置信区间54 - 76 vs课程后TACTIC = 84%，95%置信区间80 - 88），突出了TACTIC的结构效度。个体参与者的TACTIC评分平均提高了17%。
TACTIC在评估PEM从业者在模拟环境中插入胸腔闭式引流管的技能时，显示出良好的评分者间可靠性、内容效度和结构效度。
