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The TACTIC: development and validation of the Tool for Assessing Chest Tube Insertion Competency

Published online by Cambridge University Press:  01 April 2015

Allan Evan Shefrin ,
Afshin Khazei ,
Geoffrey Robert Hung ,
Lisa Teres Odendal  and
Adam Cheng
Allan Evan Shefrin*
Affiliation:
Division of Pediatric Emergency Medicine, Children’s Hospital of Eastern Ontario, University of Ottawa, Ottawa, ON
Afshin Khazei
Affiliation:
Division of Emergency Medicine, Vancouver General Hospital, University of British Columbia, Vancouver, BC
Geoffrey Robert Hung
Affiliation:
Canadian Medical Protective Association, Ottawa, ON
Lisa Teres Odendal
Affiliation:
Division of Pediatric Emergency Medicine, Alberta Children’s Hospital, Calgary, AB
Adam Cheng
Affiliation:
KidSIM-Aspire Simulation Research Program, Section of Emergency Medicine, Alberta Children’s Hospital, University of Calgary, Calgary, AB
*
Correspondence to: Dr. Allan Evan Shefrin, 401 Smyth Road, Ottawa, ON K1H 8L1; ashefrin@cheo.on.ca

Abstract

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Objectives: Pediatric emergency medicine (PEM) physicians receive little opportunity to practice and perform chest tube insertion. We sought to develop and validate a scoring tool to assess chest tube insertion competency and identify areas where training is required for PEM physicians.

Methods: We developed a 40-point, 20-item (scored 0, 1, or 2) assessment tool entitled the Tool for Assessing Chest Tube Insertion Competency (TACTIC) and studied how PEM physicians and fellows scored when inserting a chest tube into a pork rib model. Participants were scored at baseline and compared to themselves after receiving targeted training using Web-based animations and presentations followed by expert instruction and practice on chest tube insertion task trainers. All insertions were video recorded and reviewed by two blinded reviewers. Eight common videos were reviewed to assess interrater reliability.

Results: The TACTIC demonstrated good interrater reliability with an r2=0.86. Our cohort demonstrated a significant improvement in TACTIC scores by taking part in targeted training (precourse TACTIC=65%, 95% CI 54–76 v. postcourse TACTIC=84%, 95% CI 80–88), highlighting the construct validity of the TACTIC. Individual participants increased their TACTIC scores by an average of 17%.

Conclusions: The TACTIC demonstrates good interrater reliability, content validity, and construct validity in assessing a PEM practitioner’s skill inserting chest tubes in a simulated setting.

Résumé

Objectifs: Les médecins en médecine d’urgence pédiatrique (MUP) ne procèdent pas souvent à la pose de drains thoraciques. Aussi avons-nous cherché à élaborer et à valider un instrument de notation visant à évaluer la compétence relative à la pose de drains thoraciques, et à cerner les points faibles qui nécessiteraient une formation chez les médecins en MUP.

Méthode: Nous avons élaboré un instrument d’évaluation portant sur 20 tâches et noté sur 40 points (0, 1, 2), appelé Tool for Assessing Chest Drain Insertion Competency (TACTIC), et avons étudié les résultats de médecins et de stagiaires en MUP relativement à la pose de drains thoraciques dans un modèle porcin de gril thoracique. Les participants ont été évalués au départ, puis comparés à euxmêmes après une formation ciblée, comportant des animations et des pré sentations sur le Web, un enseignement thé orique donné par des spé cialistes et la pratique de la pose de drains thoraciques sur des simulateurs passifs («task trainers»). Toutes les poses de drain ont été enregistrées sur vidéo, puis examinées par deux examinateurs tenus dans l’ignorance des faits. Huit vidéos courantes ont été revues aux fins d’évaluation de la fiabilité interévaluateurs.

Résultats: L’instrument TACTIC a obtenu de bons résultats au regard de la fiabilité interé valuateurs: ρ2=0.86. De son côté , la cohorte a connu une amélioration sensible des résultats, selon la grille TACTIC (avant le cours: 65%; IC à 95%: 54–76; après le cours: 84%, IC à 95%: 80–88), après avoir suivi une formation ciblée, ce qui confirme la validité de construction de l’instrument TACTIC. La note de chacun des participants, selon la grille TACTIC, a augmenté en moyenne de 17%.

Conclusions: Les résultats de l’étude ont démontré que l’instrument TACTIC possé dait une bonne fiabilité interévaluateurs, une validité de contenu et une validité de construction, dans l’évaluation de la compétence de praticiens en MUP, relative à la pose de drains thoraciques, en simulation.

Type
Original Research
Information
Canadian Journal of Emergency Medicine , Volume 17 , Issue 2 , March 2015 , pp. 140 - 147
Copyright
Copyright © Canadian Association of Emergency Physicians 2015 

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