Resuscitative Thoracotomy Trainer: Setting the Bar for Competency

Introduction: Resuscitative thoracotomy (RT) is a high stakes yet low frequency procedure performed in the emergency room by trauma surgeons. The aim of this study was to establish the bar of competency using this novel simulator. Methods: Surgical trainees PGY 3-5 underwent pre-procedural training prior to performing the simulated procedure. Each trainee was video recorded while performing the procedure. Videos were de-identified prior to being assessed by reviewers asynchronously. The previously published assessment was used to evaluate the videos of trainees performing the procedure. Three reviewers reviewed each video independently. Correlation between key steps and general/global skills was analyzed and Cronbach alpha score was calculated. Results: Fifteen residents completed the pre-procedural training and the procedure. All videos were included. The mean score for the key steps and general skills, respectively, was 3.09 (0.74 SD) and 2.67 (0.74). The mean global score was 2.43 (SD 0.78). The correlation between key steps and global score was 0.86 and between general skills and global score was 0.92. The Cronbach alpha was 0.90. A global score of 3.0 was deemed to be an appropriate bar for competency. Conclusion: A score of three or higher correlated with what the experts deemed to be competent on the RT trainer using the previously published assessment tool. The RT trainer and the assessment tool are effective means to assess the basic level of competency of surgical residents.