Why is it important to have this training standard?
This is the second BTS training standard – the first covered thoracic ultrasound.
BTS has a strong track record in supporting safe, high-quality, evidence-based practice in the diagnosis and management of pleural disease and this document is a fantastic addition to our suite of resources.
Patient safety is at the forefront of this document. We want to support all those who are performing pleural procedures to do so safely, operating within their skillset.
We know that training in pleural procedures is embedded in various curricula, but this is the first framework that sets out an agreed standard to guide learners through completing their training. In particular we hope this will be valuable for the wider multiprofessional team including specialist nurses who until now have had no specific framework for training in pleural procedures.
Who was involved in developing this document?
We had an incredible response from BTS members when we called for help to develop this document. Work fell under the remit of the BTS Education and Training Committee and our Task and Finish Group included pleural experts from across the workforce.
It was important we balanced the educational component we needed to cover, with ensuring we were focused on patient centred, safe care that has been of ongoing concern since the BTS Pleural Organisational Audit.
Our group was focused and diligent and we are very grateful for all their efforts to bring this document to publication.
We recognise how significant this document will be to our pleural community, and we were keen to bring colleagues along with us as the draft took shape.
We consulted widely during the development of the document and ensured there was an appropriate period of public consultation. We are proud of this document and want to make sure it adds real value to training.
Who will use this document?
The standards will be relevant to a wide range of learners across the UK, whether they are working in a specialist pleural unit, university hospital or district general hospital.
Pleural procedures have long been core to the skill set of respiratory physicians. Developments in the multi-professional team have expanded their relevance and increased the pool of colleagues who will be working to develop their skillsets and competencies. Therefore, while the respiratory community is the primary audience, we expect the training standards to be read by skilled colleagues from other specialties.
It is vital to note that the document will also support educational supervisors, or any practitioner with CiP 5 entrustment, as they guide learners through the levels of capability. Clarity for those making entrustment decisions is so important as we recognise they may not always be performing pleural procedures themselves.
What are the key elements of the training standard?
It is important to emphasise that this does not set out the specifics of how to do procedures – this is about describing how to train to do them. This is an important distinction.
We cover the key primary procedures, relevant to general respiratory medicine, internal and acute medicine / critical care:
- Diagnostic pleural aspiration
- Therapeutic pleural aspiration
- Seldinger intercostal drain insertion
As well as advanced procedures, those which would be delivered by specialist teams/services:
- Blunt dissection (“surgical”) intercostal drain insertion
- Indwelling pleural catheter insertion
- Indwelling pleural catheter removal
- Local anaesthetic (“medical”) thoracoscopy
- Ultrasound guided pleural biopsy
One of the first tasks was to agree precise wording that is relevant to the individual levels of capability that apply to all pleural procedures, and so we have made an important distinction between Level 3 (entrusted to act with indirect supervision) and Level 4 (unsupervised practice) by recognition that key to independent practice is the ability to decide on the appropriateness of any intervention in the first place. We hope trainers and learners recognised that Level 3 entrustment, as we have described is still a high bar to achieve in procedural capability.
We want this document to emphasise that decision making must be patient centred. This is often a dynamic process, and we recognise the importance of local arrangements and solutions.
Training curricula have rightly pivoted to consider skills-based learning with demonstration of capability that an individual is entrusted to perform, rather than simply basing “sign off” decisions on the number of procedures performed. We support this shift – it is important that learners have a holistic understanding of the nuances of how these procedures can vary and move through the levels of capability based on reflective practice with multiple episodes of observed feedback.
Assessment of procedural skills should be made using the existing DOPS tool on e-portfolio. We recognise that some leaners will take different routes with some learning procedures in parallel while others may take a more linear route.
How do you think this publication will impact training?
We have responded to a need for greater clarity for all learners and their supervisors. We have the support of the Respiratory SAC and would be keen to continue to engage with colleagues from other relevant specialties.