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Background: Chest tube insertions (CTI) have a high complication rate, warranting a dedicated Simulation-Based Mastery Learning (SBML) curriculum to acquire technical skills. This randomized controlled trial compares residents' skills in CTI after completing a SBML curriculum with those enrolled in a traditional residency program., Methods: Junior residents were baseline tested on cognitive and technical skills (Thiel bodies) before randomization into an intervention and control group. The former deliberately trained CTI on a porcine rib model until passing a predefined pass/fail score and were then summatively tested on Thiel bodies. The latter had no additional training opportunities and was evaluated 3 months later., Results: Seventeen residents were recruited and randomized. Following the per-protocol principle, a significant interaction effect for Group × Procedure (F(1,14) = 6.2, p = 0.026) was observed. Between baseline and summative assessment, both the control group (28.0 ± 8.2 vs. 43.6 ± 8.1, p < 0.001) and the intervention group (33.2 ± 7.7 vs. 57.6 ± 5.7, p < 0.001) significantly increased their scores. The intervention group outperformed the control group at summative assessment (43.6 ± 8.1 vs. 57.6 ± 5.7, p < 0.001). All participants in the intervention group and one resident in the control group achieved the pass/fail score., Conclusion: This SBML curriculum enabled quicker and superior skill acquisition. Skills trained on a porcine model are transferred to the highly realistic Thiel bodies and reach expert level, potentially increasing resident skill in clinical practice., (© 2024 International Society of Surgery/Société Internationale de Chirurgie (ISS/SIC).)

Introduction: Assessments require sufficient validity evidence before their use. The Assessment for Competence in Chest Tube Insertion (ACTION) tool evaluates proficiency in chest tube insertion (CTI), combining a rating scale and an error checklist. The aim of this study was to collect validity evidence for the ACTION tool on a porcine rib model according to the Messick framework., Methods: A rib model, consisting of a porcine hemithorax that was placed in a wooden frame, was used as simulator. Participants were recruited from the departments of surgery, pulmonology, and emergency medicine. After familiarization with the rib model and the equipment, standardized instructions and clinical context were provided. They performed 2 CTIs while being scored with the ACTION tool. All performances were assessed live by 1 rater and by 3 blinded raters using video recordings. Generalizability-analysis was performed and mean scores and errors of both groups on the first performance were compared. A pass/fail score was established using the contrasting groups' method., Results: Nine novice and 8 experienced participants completed the study. Generalizability coefficients where high for the rating scale (0.92) and the error checklist (0.87). In the first CTI, novices scored lower than the experienced group (38.1/68 vs. 47.1/68, P = 0.042), but no difference was observed on the error checklist. A pass/fail score of 44/68 was established., Conclusion: A solid validity argument for the ACTION tool's rating scale on a porcine rib model is presented, allowing formative and summative assessment of procedural skills during training before patient contact., Competing Interests: The authors declare no conflict of interest., (Copyright © 2023 Society for Simulation in Healthcare.)