PTH-136 Drain training: increasing CMT confidence and competence in abdominal paracentesis

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Abstract

Introduction

Core Medical Trainees (CMTs) often find limited planned opportunities to practice abdominal paracentesis, a skill required for completion of Annual Review of Competence Progression (ARCP) and for medical registrar roles. This limited experience reduces procedural confidence. We aimed to provide CMTs at the Royal Free Hospital (RFH) with training and supervised opportunities to practice ascitic drain insertion with a view to increasing confidence and obtaining competencies for ARCP.

Methods

An abdominal paracentesis teaching programme was introduced from October 2016 to July 2017. An online ‘Survey Monkey’ questionnaire assessed CMTs pre-existing experience in therapeutic procedures including ascitic drain insertion, their confidence performing procedures and availability of opportunities to practice with appropriate supervision. An online ‘Doodle’ poll offered CMTs weekly ‘drop in’ slots to attend the RFH Planned Investigation and Treatment Unit where patients attended for elective paracentesis. CMTs were given one-to-one teaching on ascitic drain insertion technique, including the use of bedside ultrasound to identify appropriate insertion sites. The CMTs were then supervised inserting ascitic drains on consenting, elective patients by an experienced clinician and signed off for Direct Observation of Procedural Skills (DOPS) assessments. A Whatsapp group allowed informal feedback and slot swaps amongst the CMTs. An online survey at the end of the programme sought feedback on how valuable the trainees had found it in improving procedural confidence and obtaining required DOPS. No complications were reported by supervisors during supervised drain insertion.

Conclusion

The introduction of a bespoke CMT paracentesis training programme at RFH helped trainees safely gain experience and confidence in ascitic drain insertion. The weekly opportunities throughout the year ensured all CMTs received the requisite number of DOPS assessments from experienced supervisors. Confidence performing the procedure increased significantly. However, following the programme, 36% of CMTs still lacked confidence performing paracentesis independently. Future programs should explore additional opportunities for simulation and real patient practice to further improve this. This model can be replicated in any Trusts with elective ascitic drain services, improving ARCP outcomes and increasing procedural confidence for CMTs progressing to medical registrar roles nationally.

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