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Original Research: Pulmonary Procedures |

A New Instrument to Assess Physician Skill at Thoracic Ultrasound, Including Pleural Effusion MarkupAssessment of Physician Thoracic Ultrasound

Matthew Salamonsen, MBBS; David McGrath, MScApp; Geoff Steiler, MBBS; Robert Ware, PhD; Henri Colt, MD, FCCP; David Fielding, MBBS
Author and Funding Information

From the Department of Thoracic Medicine (Drs Salamonsen and Fielding) and Department of Medical Imaging (Mr McGrath and Dr Steiler), Royal Brisbane and Women’s Hospital, Brisbane, QLD, Australia; School of Population Health (Dr Ware), The University of Queensland, Brisbane, QLD, Australia; and the Division of Pulmonary and Critical Care Medicine (Dr Colt), University of California Irvine Medical Center, Orange, CA.

Correspondence to: Matthew Salamonsen, MBBS, Department of Thoracic Medicine, Royal Brisbane and Women’s Hospital, Butterfield St, Herston, QLD 4029 Australia; e-mail: mattsalamonsen@gmail.com


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.


Chest. 2013;144(3):930-934. doi:10.1378/chest.12-2728
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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.

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