Intercostal chest drain insertion by general physicians: attitudes, experience and implications for training, service and patient safety

Abstract

Given the disparity between clinical reality and what is expected of the physician-in-training, it is unclear whether ICD insertion can remain a core procedural skill for general physicians. Consideration should be given to how healthcare providers and training programmes might address issues relating to clinical experience and knowledge given the implications for patient safety and service provision.

The impact of simulation-based mastery learning, booster session timing and clinical exposure on confidence in intercostal drain insertion: a survey of internal medicine trainees in Scotland

“…It is possible that the majority of our participants had not reached a “threshold” number of drain insertions which would maintain their confidence [ 44 ]. Studies exploring competence have suggested that the number of ICD insertions needed to gain and subsequently maintain competence may be between five and ten per year [ 3 , 44 ]. The trend within this dataset would suggest that approximately 4–6 may be the threshold to ameliorate confidence decay between sessions.…”

“…2 Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde, Glasgow, UK. 3 Medical Education, NHS Lanarkshire, Bothwell, UK. 4 NHS Education for Scotland, Glasgow, UK.…”

“…ICD insertion can have significant adverse outcomes including iatrogenic pneumo/haemothorax, infection, organ puncture and, rarely, death [1]. Previous studies have suggested that doctors in training are becoming less competent and less confident at inserting ICDs [2][3][4][5][6]. If these skills are taught but unused, they will decay over time [7].…”

Development and Maintenance of a Pleural Disease Service: Role of the “Pleurologist”

“…This may limit the proceduralists because many do not get training on thoracic US as demonstrated by a survey of 117 general physicians in England. 4 The survey found that 19% of higher specialty trainees and 0% of core medical trainees had formal qualifications in thoracic US, 29 and 26% had informal training, and 48 and 68%, respectively, did not have training and did not expect to have access to any training.…”

Malignant Pleural Effusions: Management Options

“…The approximate incidence of MPE across the combined population of the United Kingdom and United States is thought to be in the region of 300,000 per year, with the United Kingdom's incidence accounting for more than 40,000 of those cases alone. 1,7 As a result, malignant pleural disease represents a significant and increasing burden on health care resources. The management may be complex and varied, with multiple options available.…”