Techniques of training in the management of tension pneumothorax: bridging the gap between confidence and competence.

BACKGROUND: Thoracocentesis is a simple procedure with high potential to be life-saving, but is associated with complications if performed incorrectly. The aim of this study was to determine both the ability and confidence of practitioners who would be expected deal with a tension pneumothorax both in and out of hospital. If any shortfall was identified between theoretical and practical knowledge the goal was to develop techniques to overcome that shortfall.

METHODS: A total of 51 consenting medical practitioners were recruited to participate in a prospective single-subject crossover applied behavioural analysis study. The primary outcome was the change in accuracy of identification of the correct site for needle thoracocentesis on an anatomical diagram and by verbal description. This was compared before and after the introduction of brief and frequent "life-saving practical skills" training sessions. Participants' confidence was also assessed pre and post intervention.

RESULTS: There was a disparity pre-intervention between confidence (79.4% felt able to perform the procedure without assistance) and competence (85.2% of these incorrectly identified the anatomical site). Following intervention, the in-practice correct identification of the site increased from 15.7% to 52.9%. The disparity between confidence and competence still existed by was reduced.

CONCLUSIONS: The learning and re-learning of this skill should occur regularly through both theoretical and practical teaching to ensure the adequate ability of practitioners and reduce the danger associated with false confidence.