Chest
Volume 144, Issue 3, September 2013, Pages 930-934
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Original Research
Pulmonary Procedures
A New Instrument to Assess Physician Skill at Thoracic Ultrasound, Including Pleural Effusion Markup

https://doi.org/10.1378/chest.12-2728Get rights and content

Background

To reduce complications and increase success, thoracic ultrasound is recommended to guide all chest drainage procedures. Despite this, no tools currently exist to assess proceduralist training or competence. This study aims to validate an instrument to assess physician skill at performing thoracic ultrasound, including effusion markup, and examine its validity.

Methods

We developed an 11-domain, 100-point assessment sheet in line with British Thoracic Society guidelines: the Ultrasound-Guided Thoracentesis Skills and Tasks Assessment Test (UGSTAT). The test was used to assess 22 participants (eight novices, seven intermediates, seven advanced) on two occasions while performing thoracic ultrasound on a pleural effusion phantom. Each test was scored by two blinded expert examiners. Validity was examined by assessing the ability of the test to stratify participants according to expected skill level (analysis of variance) and demonstrating test-retest and intertester reproducibility by comparison of repeated scores (mean difference [95% CI] and paired t test) and the intraclass correlation coefficient.

Results

Mean scores for the novice, intermediate, and advanced groups were 49.3, 73.0, and 91.5 respectively, which were all significantly different (P < .0001). There were no significant differences between repeated scores.

Conclusions

Procedural training on mannequins prior to unsupervised performance on patients is rapidly becoming the standard in medical education. This study has validated the UGSTAT, which can now be used to determine the adequacy of thoracic ultrasound training prior to clinical practice. It is likely that its role could be extended to live patients, providing a way to document ongoing procedural competence.

Section snippets

Test Development

The UGSTAT tests skill level up to the point of skin markup at the best site for pleural needle insertion but does not include real-time imaging, such as is used for small, complex effusions. It consists of 11 assessment domains that cover knowledge of ultrasound knobology, recognition of ultrasound images that illustrate common pleural effusion appearances, the ability to perform a thoracic ultrasound and mark an appropriate site for drainage of a pleural effusion, and a global rating scale

Results

Twenty-two participants were tested, including eight in the novice group, seven in the intermediate group, and seven in the advanced group. In the advanced group, the median number of ultrasound cases on real patients prior to assessment was 200 (range, 30-200). For the intermediate group, the median time from having the instructional course to first assessment was 3 weeks (range, 2-26 weeks). The time taken to administer the test was between 6 and 14 min. Preliminary testing demonstrated good

Discussion

This study has introduced and validated a new tool for the assessment of physician-performed thoracic ultrasound, including markup for pleural effusions. The test gives results that are reliable and accurately reflect the skill level of those being assessed. In a time when ultrasound is becoming integral to the practice of the pulmonologist, this tool could be used to determine the adequacy of physician thoracic ultrasound training prior to clinical practice or to provide a way to document

Conclusions

Procedural training on mannequins prior to unsupervised performance on patients is rapidly becoming the standard in medical education. This study validates the UGSTAT, which can now be used to determine the adequacy of thoracic ultrasound training prior to clinical practice. It is likely that its role could be extended to live patients, providing a way to document ongoing procedural competence.

Acknowledgments

Author contributions: Dr Salamonsen had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Dr Salamonsen: contributed to the study formulation, data collection, and writing of the manuscript.

Mr McGrath: contributed to the scoring of ultrasound performances with the UGSTAT and review of the manuscript.

Dr Steiler: contributed to the scoring of ultrasound performances with the UGSTAT and review of the manuscript.

References (19)

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Funding/Support: Dr Salamonsen received research scholarships from The University of Queensland and the Royal Brisbane and Women's Hospital Foundation.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.

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