Prepared, Not Perfect: A Teaching Intervention to Improve Resident Doctors’ Confidence in Chest Drain Management

Background Intercostal chest drains (ICDs) are essential in managing pleural pathology, yet many resident doctors begin surgical placements without adequate preparation to manage them safely. National audits and educational literature continue to highlight this gap in procedural confidence and training. Methods This prospective quality improvement project evaluated the impact of a structured, resident-led teaching session on chest drain management. Eighteen newly rotating resident doctors in general surgery completed pre- and post-session questionnaires assessing confidence across 10 domains, including indications, contraindications, anatomy, equipment, technique, and ward-based troubleshooting. The session was delivered via a single, slide-based teaching module designed for scalability and ease of repetition. Results were analyzed using the Wilcoxon signed-rank test. Results Statistically significant improvements were observed in every domain (p < 0.001). Median confidence scores (5-point Likert scale) increased across all domains, with median shifts ranging from +1 to +3 points. The largest gains were seen in identifying indications for ICD insertion (confidence rose from 52% to 95%; median shift +3; effect size r = 0.88) and anatomical knowledge (43% to 90%; median shift +2; r = 0.85). Even in domains with smaller proportional increases, such as equipment familiarity (37% to 40%; median shift +1; r = 0.45) and drain adjustment (6% to 52%; median shift +1; r = 0.52), the effect sizes indicated meaningful practical improvements in confidence. More modest gains were seen in procedural skills such as drain adjustment and equipment familiarity, suggesting a need for additional practical reinforcement. A spider plot visually demonstrated consistent post-intervention improvement. Conclusions A single, focused teaching intervention significantly improved resident doctors' confidence in managing ICDs. Given its low-cost, low-resource design, this model is ideally suited for integration into surgical induction across NHS trusts. While theoretical gains were substantial, future iterations should incorporate simulation or supervised practice to strengthen procedural competence and retention.