The TACTIC: development and validation of the Tool for Assessing Chest Tube Insertion Competency.
OBJECTIVE
Pediatric emergency medicine (PEM) physicians receive little opportunity to practice and perform chest tube insertion. We sought to develop and validate a scoring tool to assess chest tube insertion competency and identify areas where training is required for PEM physicians.


METHODS
We developed a 40-point, 20-item (scored 0, 1, or 2) assessment tool entitled the Tool for Assessing Chest Tube Insertion Competency (TACTIC) and studied how PEM physicians and fellows scored when inserting a chest tube into a pork rib model. Participants were scored at baseline and compared to themselves after receiving targeted training using Web-based animations and presentations followed by expert instruction and practice on chest tube insertion task trainers. All insertions were video recorded and reviewed by two blinded reviewers. Eight common videos were reviewed to assess interrater reliability.


RESULTS
The TACTIC demonstrated good interrater reliability with an r 2 =0.86. Our cohort demonstrated a significant improvement in TACTIC scores by taking part in targeted training (precourse TACTIC=65%, 95% CI 54-76 v. postcourse TACTIC=84%, 95% CI 80-88), highlighting the construct validity of the TACTIC. Individual participants increased their TACTIC scores by an average of 17%.


CONCLUSIONS
The TACTIC demonstrates good interrater reliability, content validity, and construct validity in assessing a PEM practitioner's skill inserting chest tubes in a simulated setting.
1Division of Pediatric Emergency Medicine,Children's Hospital of Eastern Ontario,University of Ottawa,Ottawa,ON.
Allan Evan
AE
Shefrin
2Division of Emergency Medicine,Vancouver General Hospital,University of British Columbia,Vancouver,BC.
Afshin
A
Khazei
3Canadian Medical Protective Association,Ottawa,ON.
Geoffrey Robert
GR
Hung
4Division of Pediatric Emergency Medicine,Alberta Children's Hospital,Calgary,AB.
Lisa Teres
LT
Odendal
5KidSIM-Aspire Simulation Research Program,Section of Emergency Medicine,Alberta Children's Hospital,University of Calgary,Calgary,AB.
Adam
A
Cheng
D000818:Animals; D015505:Chest Tubes; D002648:Child; D002983:Clinical Competence; D004501:Education, Medical / Q000379:methods*; D006801:Humans; D007396:Internship and Residency / Q000379:methods*; D010372:Pediatrics / Q000193:education*; D010820:Physicians / Q000592:standards*; D015203:Reproducibility of Results; D013552:Swine; D014741:Video Recording