Education, Research, and Quality Improvement: Education, Research, and Quality Improvement |

Feasibility and Utility of Competency-Based Testing Using Video Recording of Pulmonary/Critical Care Fellows in Performance of Thoracentesis FREE TO VIEW

Luis Quintero, DO; Sean Dhar, MD; Henry Mayo, BS; Paul Mayo, MD; Effie Singas, MD
Author and Funding Information

Northwell Health, New Hyde Park, NY

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;150(4_S):609A. doi:10.1016/j.chest.2016.08.701
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SESSION TITLE: Education, Research, and Quality Improvement

SESSION TYPE: Original Investigation Poster Discussion

PRESENTED ON: Monday, October 24, 2016 at 12:00 PM - 01:30 PM

PURPOSE: Competence in thoracentesis is a required part of training for pulmonary/critical care (PCCM) fellows. Traditional methods of determining procedural competence are generally based on numerical requirement or subjective faculty opinion. We developed an objective method for competency based testing of thoracentesis using video recording during patient thoracentesis. Our literature review indicates this is the first example of video based scoring of a PCCM procedure to test for competency.

METHODS: 11 PCCM fellows performed a thoracentesis with video recording of the procedure using a camera (GoPro) attached to their forehead with headgear. Recording started with patient identification and safety check and ended with check for pneumothorax using ultrasonography. Video recordings were reviewed by two separate observers, one PCCM attending and one medical student, using a standardized checklist designed to capture 30 scorable elements of the procedure. The scoring tool was developed in iterative fashion by a working group of PCCM fellows and attendings. The fellow was judged to be competent only if they achieved a perfect score on the checklist. All patients gave consent for video recording of the procedure. A supervisory attending was present during the procedure but was not involved with scoring of the video record.

RESULTS: Eleven fellows performed a thoracentesis with video recording. All fellows reported that the camera did not hinder their performance of the procedure. 10/11 (90.9%) fellows achieved a perfect score. In one case, the recording was terminated prematurely at the time of catheter removal before the check for post procedure pneumothorax. One fellow neglected to check for pneumothorax pre- and post-procedure. This fellow was allowed to review the video and on a subsequent attempt achieved a perfect score. Inter-observer variability was 0%.

CONCLUSIONS: Video recording with a standardize checklist of thoracentesis is feasible and offers an accurate, low cost, and useful means of competency based testing for thoracentesis performed by PCCM fellows. It avoids problems inherent to determination of competence based on numerical requirements and subjective judgment of faculty who also are trainers.

CLINICAL IMPLICATIONS: Video recording with a standardize checklist can be utilized as a training tool to improve fellow performance in any procedural skill. Further studies are needed to see if the same results can be applied to high risk procedures such as intubations, central line placement, and tracheotomy. If so, video recording would be a superior and perferred method for assessing competency.

DISCLOSURE: The following authors have nothing to disclose: Luis Quintero, Sean Dhar, Henry Mayo, Paul Mayo, Effie Singas

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