Table 3. Objective structured assessment of technical skills tool for evaluation of chest tube insertion based on one created by Friedrich et al.

[16]

	1: Poor	2	3: Sufficient	4	5: Excellent
Correct identification of incision location	The chosen dissection plane is not near the suggested site		The chosen dissection plane deviates slightly from the suggested site		4th/5th intercostal space, mid/anterior axillary line
Incision on top side of rib	Dissection not performed on top side of rib		Dissection carried out with minor errors		A roughly 2-cm cut is performed on the top side of rib with a clean cut through subcutaneous layers, and intercostal muscle
Blunt dissection of subcutaneous plane	Distance or execution of tunneling lacking		Either distance or execution of tunneling lacking		Confident and accurate execution and distance of dissection into the pleural cavity
Clamp insertion and removal to open path for chest tube insertion	Poor handling of instruments that may cause avoidable harm to the patient. Multiple attempts.		Clamp expanded upon removal, handling could be improved. 1-2 attempts		Confident handling of clamp, smooth removal with clamp expanded to widen the tunnel on the first attempt
Digital exploration of tunnel and pleural cavity to ensure proper position and lack of adhesions between lung and pleural surface	No digital exploration		Finger inserted into pleural cavity, no digital exploration		Thorough digital exploration, with 360○ turn, ensure no adhesion of lung to pleural space or blood clots obstructing path
Chest tube insertion into pleural cavity	Hazardous handling of tube that might cause avoidable harm to the patient, no use of clamps   Poor tube advancement		Clamp closed on tip of chest tube and used to direct tube into position. Improvable handling, advancement carried out with minor errors		Confident handling with clamp closed on tip of chest tube and used to direct tube into position   Clamp removed at appropriate time for manual tube advancement
Tube length and position	Estimated drain length greatly deviates from recommended length, and/or chest tube inserted too far into pleural cavity causing avoidable discomfort		Estimate length or amount of chest tube inserted into pleural space deviates slightly from rater’s opinion		Optimal chest tube length and appropriate insertion into pleural space
Securing chest tube/ suturing	Unsure how to secure chest tube and had significant difficulty performing the anchoring suture or knot   Chest tube not secure by rater’s opinion		Room for improvement of suturing skills, but chest tube secure by rater’s opinion		Confident placement of anchoring suture, and securing of chest tube   Chest tube secure by rater’s opinion
Length of time required to complete procedure	Many unnecessary or disorganized movements and significant pauses or uncertainty		Some unnecessary movement or nervousness but with organized time and motions		Confident movements with maximum efficiency
Amount of help or assistance needed from tutor	Learner needed multiple demonstrations and much instruction from tutor		Learner was able to complete task follow demonstration with some help from the instructor, only raising important questions to maximize performance.		Learner was able to confidently complete task with almost no assistance from instructor following the initial demonstration
Teamwork between learner and assistant	Poor communication/ execution of team roles		Communication between team members could be improved, but otherwise appropriately carried out roles		Excellent communication between learner and assistant, both members carried out their roles well and in synchrony.
Total Score: __/55