Simulation-Based Mastery Learning Course for Tube Thoracostomy.

INTRODUCTION

Tube thoracostomy is a relatively infrequent, high-risk procedure that is a required competency for emergency medicine residents. Simulation-based mastery learning is the gold standard for procedure training and has been used to successfully train residents in high-risk procedures.

METHODS

We developed a simulation-based mastery learning course for tube thoracostomy for PGY 2 emergency medicine residents. The course included (1) precourse work, (2) baseline assessment using a modified version of the TUBE-iCOMPT checklist, (3) anatomy/radiology review, (4) deliberate practice to master individual aspects of the procedure, and (5) final assessment. If a minimum passing score was not achieved, additional coaching and deliberate practice occurred until the learner was able to achieve a minimum passing score.

RESULTS

After piloting the course with a cohort of seven PGY 2 emergency medicine residents, we successfully trained 24 additional PGY 2 residents in the subsequent two classes. Combining all three cohorts ( = 31), there was a statistically significant increase in learners' modified TUBE-iCOMPT scores (pretest = 61.2, = 10.0; posttest = 75.5, = 2.9; < .001). Learners' confidence in their ability to correctly place a chest tube increased, rated on a 10-point Likert scale (1 = , 10 = ; precourse = 5.6, = 1.8; postcourse = 8.3, = 1.1; < .001).

DISCUSSION

This simulation-based course was well received by learners. Our assessment demonstrated that learners improved directly observed procedural skills in simulation and confidence in tube thoracostomy placement.