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Ensuring basic competency in chest tube insertion using a simulated scenario: an international validation study
  1. Peter Hertz1,2,
  2. Katrine Jensen1,2,
  3. Saleh N Abudaff3,
  4. Michael Strøm1,4,
  5. Yousif Subhi1,
  6. Hani Lababidi3 and
  7. Lars Konge1
  1. 1 Copenhagen Academy for Medical Education and Simulation (CAMES), University of Copenhagen and the Capital Region of Denmark, Rigshospitalet, Copenhagen, Denmark
  2. 2 Department of Cardiothoracic Surgery, University Hospital of Copenhagen, Rigshospitalet, Copenhagen, Denmark
  3. 3 King Fahad Medical City, Riyadh, Saudi Arabia
  4. 4 Department of Vascular Surgery, University Hospital of Copenhagen, Rigshospitalet, Copenhagen, Denmark
  1. Correspondence to Dr Peter Hertz; hertz.peter{at}


Introduction Chest tube insertion can be associated with serious complications. A structured training programme is needed to minimise complications and enhance patient safety. Novices should pass a reliable test with solid evidence of validity before performing the procedure supervised on patients. The aim of this study was to establish a credible pass/fail standard.

Methods We used an established assessment tool the Chest Tube Insertion Competency Test (TUBE-iCOMPT). Validity evidence was explored according to Messick’s five sources of validity. Two methods were used to establish a credible pass/fail standard. Contrasting groups’ method: 34 doctors (23 novices and 11 experienced surgeons) performed the procedure twice and all procedures were video recorded, edited, blinded and rated by two independent, international raters. Modified Angoff method: seven thoracic surgeons individually determined the scores that defined the pass/fail criteria. The data was gathered in Copenhagen, Denmark and Riyadh, Saudi Arabia.

Results Internal consistency reliability was calculated as Cronbach’s alpha to 0.94. The generalisability coefficient with two raters and two procedures was 0.91. Mean scores were 50.7 (SD±13.2) and 74.7 (SD±4.8) for novices and experienced surgeons, respectively (p<0.001). The pass/fail score of 62 points resulted in zero false negatives and only three false positives.

Discussion We have gathered valuable additional validity evidence for the assessment tool TUBE-iCOMPT including establishment of a credible pass/fail score. The TUBE-iCOMPT can now be integrated in mastery learning programmes to ensure competency before independent practice.

  • assessment
  • validity
  • chest tube
  • simulation
  • education

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  • Contributors LK contributed to the development of the statistical analysis plan. HL implemented the data collection in Riyadh. YS was repsonsible for the video data management and statistical analysis. MS contributed to the data collection. SNA and KJ are expert raters. PH was responsible for the data collection, drafted and revised the paper and is the guarantor. LK and PH analysed the data. LK, HL and PH contributed to the design and idea of the study. HL, YS, MS, SNA and KJ contributed to the critical revision of the draft paper.

  • Funding The two medical education centres covered equipment and travel costs.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval Danish Ethical Committee (journal no. 150019066) and Saudi Arabia IRB (reg. IRB00008644 and FWA00018774).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data are available.

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