P78 The role of the general medical registrar in performing out-of-hours pleural procedures: a UK national survey of trainee and trainer perspectives

Abstract

<h3>Introduction</h3> Pleural procedural competencies are part of the UK general internal medicine (GIM) curriculum, with a widespread expectation that GIM registrars should be able to perform these procedures out-of-hours (OOH) if required. GIM registrar exposure to pleural procedures has declined, with procedures increasingly done by specialists in-hours. Pleural interventions risk significant harm. We explored GIM registrars’ perceived competence and confidence in performing OOH pleural procedures, from the perspective of both GIM registrars and respiratory consultants. <h3>Methods</h3> An anonymised survey was distributed to non-respiratory GIM registrars and respiratory consultants across the UK. <h3>Results</h3> We received responses from 389 registrars (representing all training grades and 14 specialties) and 93 consultants (including 12 with training programme director experience). Only 37% of registrars reported being ‘signed-off’ as independent in inserting a chest drain for pneumothorax. 69% had not done a pleural procedure for at least a year. Regarding perceived confidence for OOH chest drain insertion for pneumothorax, 42% of registrars reported no confidence to perform the procedure even if directly supervised, with only 11% feeling confident to do it unsupervised. Respiratory consultants were asked to rate the pleural procedural competence of an average non-respiratory GIM registrar, 88% felt they would require supervision and only 4% felt they could perform the procedure unsupervised. 56% of respiratory consultants felt that pleural competencies in the internal medicine curriculum should be changed or removed. Common themes in the free text included anxiety surrounding pleural procedures, patient safety concerns, insufficient available training opportunities to maintain competency and differing opinions on the changing role of the medical registrar and who should be expected to perform OOH pleural procedures. <h3>Conclusions</h3> Our findings suggest that the majority of UK non-respiratory GIM registrars lack both competence and confidence to independently perform OOH pleural procedures, according to both trainees and trainers. This raises concerns for patient safety and service delivery, highlighting the urgent need to review GIM training, curriculum, and OOH pleural procedural provisions.