Table 1 Objective structured assessment of the technical skills score for chest tube insertion
Correct identification of incision location | 1 Poor The chosen dissection plane deviates tremendously from the suggested site | 2 | 3 Sufficient The chosen dissection plane deviates slightly from the suggested site | 4 | 5 Excellent 4th/5th intercostal space; mid/anterior axillary line |
Correct plane of dissection subcutaneously | 1 Poor Both distance or execution of tunneling lack accuracy | 2 | 3 Sufficient Either distance or execution of tunneling lack accuracy | 4 | 5 Excellent Both distance and execution of tunneling are accurate |
Blunt dissection on top side of rib | 1 Poor Flawed dissection; not carried out on top side of rib | 2 | 3 Sufficient Solid dissection carried out with minor errors | 4 | 5 Excellent Confident cut through the subcutaneous layers and intercostal muscles |
Scissors/clamp guarded with other hand during dissection and pulled out without closing the instrument | 1 Poor Hazardous handling that might affect the patient | 2 | 3 Sufficient Improvable handling | 4 | 5 Excellent Confident handling of the used instruments |
Digital exploration of pleural cavity on chest wall to rule out adhesions | 1 Poor No digital exploration | 2 | 3 Sufficient Finger inserted in pleural cavity | 4 | 5 Excellent Digital exploration in 360° with turning of the wrist rules out adhesions |
Drain guarded with hand while being inserted | 1 Poor Hazardous handling that might affect the patient | 2 | 3 Sufficient Improvable handling | 4 | 5 Excellent Confident handling of the used instruments |
Drain inserted into pleural cavity | 1 Poor Tube advancement is carried out poorly | 2 | 3 Sufficient Tube advancement is carried out with minor errors | 4 | 5 Excellent Forceps unclamped in time and tube manually advanced. |
Estimate made of drain length | 1 Poor Estimate deviates tremendously from rater’s opinion | 2 | 3 Sufficient Estimate deviates slightly from rater’s opinion | 4 | 5 Excellent Optimal estimate stated |
Economy of time and motion | 1 Poor Many unnecessary/disorganized movements | 2 | 3 Sufficient Organized time/motion, some unnecessary movement | 4 | 5 Excellent Maximum economy of movement and efficiency |
Amount of help/assistance needed from tutor | 1 Poor Task could not be carried out without extensive assistance | 2 | 3 Sufficient Trainee only raises important questions in order to maximize performance | 4 | 5 Excellent Almost no assistance needed; task is carried out confidently |