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• W4387249727 abstract "SESSION TITLE: Education, Research, and Quality Improvement Posters 9 SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/11/2023 12:00 pm - 12:45 pm PURPOSE: Simulation-based mastery learning (SBML) is effective for teaching trainees tube thoracostomy with TUBE-iCOMPT being a validated tool for measuring this skill. Recent evidence shows non-inferiority and improved patient experience with percutaneous placement of pigtail catheters for hemothorax drainage. Our surgery residents expressed lower confidence in percutaneous insertion compared to blunt dissection. To address this, we used the Modified Anghoff method to assess the seldinger component of the TUBE-iCOMPT checklist and created a minimum passing criteria (MPC). METHODS: Attending physicians from critical care medicine, trauma, and cardiothoracic surgery acted as experts for the Modified Anghoff system to create the MPC for the seldinger portion of the TUBE-iCOPMT checklist. This score was used to measure performance and skill acquisition of surgical residents. SBML was used to ensure that every resident achieved competency. Results of the pre- and post-test were used to assess the efficacy of training and utility of the seldinger component of the TUBE-iCOMPT checklist. Residents were informed that participation and/or not meeting the MPC did not exclude them from performing the procedure under guidance of an experienced provider. Faculty were not notified of the results of training to mitigate potential bias. RESULTS: MPC was set to be 11/13 with 3 critical actions (aspirates pleural space; skin incision for dilation; confirms pleural placement post procedure) from the TUBE-iCOMPT checklist. Results from the pre-test showed 11/22 residents achieved MPC. PGY level-specific pass rates were: PGY1 (0/7), PGY2 (2/4), PGY3 (2/3), PGY4 (3/3), PGY5 (4/4). Upon post-test, every learner was able to achieve MPC in accordance with mastery learning theory. One checklist item (“notes depth of chest wall with introducer needle”) was deemed the least important non-critical action. An unexpected finding was that multiple learners fully inserted the chest tube with the over wire-obturator still in place. Removal of the obturator was not part of the checklist but represents potential harm. CONCLUSIONS: SBML is effective for teaching percutaneous chest tube placement and successfully trained learners to achieve procedural competence. The TUBE-iCOMPT checklist was given a MPC of 11/13 for the seldinger portion. There was suggestion of potential adjustments to the checklist based on the results (removal of “notes depth of chest wall with introducer needle” and modifying “dilators not passed >1cm past pleura” to also include obturator). Further studies with these modifications may improve the utility of the checklist. CLINICAL IMPLICATIONS: With recent evidence supporting non-inferiority of percutaneous placement of pigtail catheters for treatment of acute hemothorax, there is a role for competency-based training for residents. Our results demonstrate SBML to be effective in teaching this procedure. We propose changes to the existing TUBE-iCOMPT to better assess procedural competency, potentially improving utility of this training at other institutions. DISCLOSURES: Consultant relationship with Acumed Please note: 4/2019-current Added 03/28/2023 by William DeVoe, source=Web Response, value=Consulting fee No relevant relationships by Luke Simmons No relevant relationships by Allen Yi" @default.
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• W4387249727 date "2023-10-01" @default.
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• W4387249727 title "PERCUTANEOUS CHEST TUBE PLACEMENT: SIMULATION-BASED MASTERY LEARNING FOR GENERAL SURGERY RESIDENTS" @default.
• W4387249727 doi "https://doi.org/10.1016/j.chest.2023.07.2458" @default.
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