A mixed methods evaluation of pleural procedural experience and training in intensive care trainees

Abstract Background Pleural procedures are key skills for Intensive Care Unit (ICU) doctors but can be associated with serious complications. We aimed to explore ICU junior doctors’ training, experience, and confidence in performing pleural procedures. Methods The study was a prospective, multi-centre, convergent parallel, mixed-method design, consisting of a survey of 21 questions with concurrent semi-structured interviews. The study involved four ICUs (two metropolitan and two regional) in New South Wales, Australia, which provide public intensive care services to 1.2 million Australians. All Postgraduate Year (PGY) 3 and above doctors working in these units were invited to participate (N= 70). Consultants were excluded. Results Of 70 doctors invited to participate, 40/70 (57%) completed the survey. 26/40 (65%) of survey respondents were PGY 5 or above. Purposive sampling was used to identify 8 (20%) of the survey respondents across a range of seniorities. They then underwent semi-structured interviews. Of the respondents, 19/40 (47.5%) had received formal training in pleural interventions, and 14/40 (35%) had received formal training in thoracic ultrasound. In the 12 months prior, 19/40 (47.5%) of respondents had not performed a chest drain of any type. Of those who had, 3/40 (7.5%) had completed more than 5. Across their careers 13/40 (32.5%) had not performed a Seldinger chest drain and 15/40 (37.5%) had performed five or less. Half of respondents had not performed a blunt dissected drain in their career. 15/40 (37.5%) of respondents felt that they were confident to independently insert a chest drain. Almost all (38/40, 95%) felt they would benefit from simulation-based training in this area. The interviews highlighted factors that increased or decreased opportunities for gaining experience in performing pleural procedures. These factors were categorised into subthemes: patient, operator, situational, and organisational. Conclusions This study demonstrates low levels of procedure volume, and confidence in ICU junior doctors. Qualitative findings highlight barriers and opportunities to enhance training.