Pleural procedure confidence and competence in postgraduate UK medical trainees

Introduction: In the UK on completing Core Medical Training (CMT), independence is required for drains for pneumothorax and desirable in effusions. Following a National Patient Safety Agency report in 2009, guidelines were implemented in hospitals to reduce intercostal chest drain (ICD) complications for effusions by formalising training. Rates of adverse events have reduced however has this reduced procedural exposure for CMT doctors? Method: We evaluated general medical trainees including those who had passed CMT (ST3+) with a survey. The survey had 10 questions evaluating stage of training, experience and trainee confidence in pleural procedures. Results: Responders were CMTs (68%), ST3+ (21%), and other medical doctors (11%). CMTs reported no regular bedside teaching, 22% had none or just observation. ST3+ had more teaching but half more than 12 months ago. 8% of CMTs had done >4 aspirations and 0 had done > 4 chest drains. ST3+ had done more procedures but only 1 >10. Confidence was highest in CMTs for procedure indications (Medium= 7/10) then using equipment (Medium= 6/10) and then managing complications and carrying out pleural procedures (Medium=5/10). ST3+ were more confident in all areas. Conclusion: CMT & ST3+ doctors have minimal exposure and teaching in pleural procedures with literature showing there has been a significant reduction in ICD insertions by CMTs. As a result we see low confidence in the practical aspects of the procedure. Trainees are at risk of not obtaining their competency requirements which poses the question should procedural training and curriculum objectives be reviewed.