title: Phantom model and scoring system to assess ability in ultrasound-guided chest drain positioning.
abstract: BACKGROUND
  Chest tube positioning is an invasive procedure associated with potentially serious injuries. In the last few years, we have been running a project directed at developing a practical simulator of a surgical procedure taught on our medical training program. The phantom model reconstructs the pleural anatomy, visible by lung ultrasound, used for the assessed performance of the Seldinger technique. The aim of the present study was to investigate the validity of this simulation technology for assessing residents in anesthesia and intensive care medicine; specifically, their skill in positioning a US-guided chest tube drain was tested using the simulator device. The second aim of the paper was to evaluate the learning curve of our residents over their 5-year study course and validate the phantom scoring system.
  
  
  METHODS
  This was a prospective, single-blinded observational study. Participants were recruited from residents in anesthesia and intensive care medicine and divided into two groups: 'Novice' and 'Expert,' based on the course year attended (years 1, 2, and 3 vs. years 4 and 5, respectively). We asked them to position a chest tube drain in a phantom model, guided by ultrasound, to drain a simulated pleural effusion. Each subject performed two tests that simulated pleural effusions of 4 and 2 cm, respectively. Every step of the maneuver was constantly monitored and the performance scored by the investigators. We then performed a Spearman correlation analysis to evaluate the effect of experience level on the performance of the two groups of residents.
  
  
  RESULTS
  Thirty-one residents were included in this study: 20 in the Novice group and 11 in the Expert group. The mean performance rating score was 0.75 ± 4.38 for the Novice Group and 5.91 ± 3.75 for the Expert group (p = 0.0026). The Spearman correlation analysis examining the relationship between year of residency and performance rating score confirmed a positive correlation (r = 0.58, p = 0.0006). Post-test trend analysis revealed a statistically significant linear trend for skill growth across time, i.e., course year (p = 0.0022).
  
  
  CONCLUSIONS
  Our simulated procedure using a phantom model of lung anatomy can accurately and reliably be used to assess the skill levels of operators in their ability to drain pleural effusion.
authors.affiliation: Anesthesia and Intensive Care Medicine-Department of Medical and Biological Sciences, University of Udine, P.le S. M. della Misericordia 15, 33100, Udine, Italy. vetrugno.luigi@aoud.sanita.fvg.it.
authors.forename: Luigi
authors.initials: L
authors.lastname: Vetrugno
authors.affiliation: Department of Emergency Medicine, San Luigi Gonzaga University Hospital, Turin, Italy. gio.volpicelli@tin.it.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Volpicelli
authors.affiliation: Anesthesia and Intensive Care Medicine-Department of Medical and Biological Sciences, University of Udine, P.le S. M. della Misericordia 15, 33100, Udine, Italy. barbariol.federico@gmail.com.
authors.forename: Federico
authors.initials: F
authors.lastname: Barbariol
authors.affiliation: Anesthesia and Intensive Care Medicine-Department of Medical and Biological Sciences, University of Udine, P.le S. M. della Misericordia 15, 33100, Udine, Italy. ilaria.toretti@gmail.com.
authors.forename: Ilaria
authors.initials: I
authors.lastname: Toretti
authors.affiliation: Anesthesia and Intensive Care Medicine-Department of Medical and Biological Sciences, University of Udine, P.le S. M. della Misericordia 15, 33100, Udine, Italy. livia.pompei@uniud.it.
authors.forename: Livia
authors.initials: L
authors.lastname: Pompei
authors.affiliation: Anesthesia and Intensive Care Medicine IV, Pisa University Hospital, Pisa, Italy. francescoforfori@gmail.com.
authors.forename: Francesco
authors.initials: F
authors.lastname: Forfori
authors.affiliation: Anesthesia and Intensive Care Medicine-Department of Medical and Biological Sciences, University of Udine, P.le S. M. della Misericordia 15, 33100, Udine, Italy. giorgio.dellarocca@uniud.it.
authors.forename: Giorgio
authors.initials: G
authors.lastname: Della Rocca
keywords: Chest drainage; Chest tube; Learning; Simulation technology; Simulator; Training