title: A survey to medical residents on the performance of diagnostic and therapeutic thoracenteses: a training gap?
abstract: OBJECTIVE
  Pleural fluid aspiration is a routine procedure for pulmonologists and internists. Our aim was to evaluate technical and methodological aspects of diagnostic and therapeutic thoracenteses performed by last two-year residents of Pulmonology and Internal Medicine.
  
  
  METHODS
  An online 24-item questionnaire was sent to participants, and responses were evaluated according to the medical specialty.
  
  
  RESULTS
  The survey was completed by 139 (17.1%) residents (71 internists and 68 pulmonologists). 29.5% and 41% performed one or no diagnostic or therapeutic thoracenteses monthly, respectively. Only 44% used ultrasonography to guide pleural procedures. Less than half of respondents used local anesthesia for diagnostic aspirations. Contrary to current recommendations, 25% of residents employed intramuscular needles for therapeutic aspirations. More than 80% of residents routinely ordered pleural fluid cultures and cytological studies, regardless of the clinical suspicion. About 40% requested imaging studies after a diagnostic thoracentesis. Half or more of the respondents were unaware of pH measurement methodologies, culture type for mycobacteria, and performance of cell blocks. Pulmonologists were more experienced than internists, and also made use of ultrasonography more frequently.
  
  
  CONCLUSIONS
  This survey highlights gaps of knowledge and skills in conducting diagnostic and therapeutic thoracenteses.
authors.affiliation: Unidad de Medicina Pleural, Servicio de Medicina Interna, Hospital Universitario Arnau de Vilanova, Instituto de Investigación Biomédica de Lleida Fundación Dr. Pifarré, IRBLLEIDA, Lleida, España. Electronic address: jporcelp@yahoo.es.
authors.forename: J M
authors.initials: JM
authors.lastname: Porcel
authors.affiliation: Servicio de Neumología, Hospital Universitario y Politécnico La Fe, Valencia, España.
authors.forename: E
authors.initials: E
authors.lastname: Cases-Viedma
authors.affiliation: Unidad de Medicina Pleural, Servicio de Medicina Interna, Hospital Universitario Arnau de Vilanova, Instituto de Investigación Biomédica de Lleida Fundación Dr. Pifarré, IRBLLEIDA, Lleida, España.
authors.forename: S
authors.initials: S
authors.lastname: Bielsa
keywords: Derrame pleural; Líquido pleural; Pleural effusion; Pleural fluid; Thoracentesis; Toracocentesis