ICU Trainees Report Sparse Chest Drain Experience and Low Confidence, Survey Finds

Junior doctors working in Australian intensive care units perform pleural procedures only rarely, and most say they would welcome simulation-based training to close the gap, according to a mixed methods study published in BMC Medical Education. The research, led by Lillian Fitzpatrick and colleagues, surveyed and interviewed intensive care trainees across four public intensive care units in New South Wales and found that nearly half had not inserted a chest drain of any kind in the previous twelve months. Pleural procedures, which include draining fluid or air from the space around the lungs, are core skills for intensive care doctors, but the study’s authors note they can be associated with serious complications.

The investigators used a prospective, multi-centre, convergent parallel mixed methods design, combining a twenty-one question survey with concurrent semi-structured interviews. Four intensive care units took part, two metropolitan and two regional, together providing public intensive care services to approximately 1.2 million people in New South Wales. All doctors at postgraduate year three and above working in these units were invited to participate, while consultants were excluded, giving a total of seventy eligible doctors.

Forty of the seventy invited doctors completed the survey, a response rate of fifty-seven percent, and the majority of respondents were relatively senior trainees, with twenty-six of the forty at postgraduate year five or above. From this pool, the researchers used purposive sampling to select eight respondents spanning a range of seniority for in-depth interviews, allowing them to explore not just how much experience trainees reported but why opportunities to gain that experience varied so widely. The numbers on formal training were striking.

Fewer than half of respondents, nineteen of forty, reported ever receiving formal training in pleural interventions, and only fourteen of forty, or thirty-five percent, had received formal training in thoracic ultrasound. Experience with actual procedures was similarly sparse. In the twelve months before the survey, nineteen of forty respondents had not performed a chest drain of any type, and among those who had, only three had completed more than five insertions in that period.

Career-long totals told a comparable story. Thirteen of forty respondents, thirty-two and a half percent, had never performed a Seldinger chest drain, and a further fifteen had performed five or fewer in their entire careers. Half of all respondents had never carried out a blunt-dissection chest drain at any point in their careers.

Against this backdrop of limited hands-on experience, only fifteen of forty respondents, thirty-seven and a half percent, felt confident to independently insert a chest drain. Despite the low confidence, trainees showed a clear appetite for structured skills development. Almost all respondents, thirty-eight of forty or ninety-five percent, said they would benefit from simulation-based training in pleural procedures.

The interview component of the study added texture to these survey findings by identifying the factors that increase or decrease opportunities to perform pleural procedures. The researchers organised these factors into four subthemes: patient factors, operator factors, situational factors and organisational factors. Because the study was qualitative in this component, it describes how trainees experienced these barriers and enablers rather than measuring their effect on outcomes.

The authors conclude that the study demonstrates low levels of self-reported procedure volume and self-perceived confidence among intensive care junior doctors, and that the qualitative findings highlight both barriers and opportunities for enhancing training. Because the data are self-reported and drawn from a single Australian state, the findings describe the experience of these trainees rather than establishing how training is delivered elsewhere.

Even so, the combination of low procedure counts, limited formal training and low confidence across a predominantly senior group of trainees provides a concrete evidence base for future work on training in this area. With nearly half of trainees going a full year without inserting a chest drain and almost all asking for simulation-based instruction, the study offers a quantitative and qualitative picture of where the training gap lies.

Subject of Research: Self-reported pleural procedural experience, training and confidence among intensive care trainees in New South Wales, Australia

Article Title: A mixed methods evaluation of pleural procedural experience and training in intensive care trainees

Article References: Fitzpatrick, L., Pickering, C. E., Kerr, K., Thodur Madapusi, V., Rashid, A., Guilhermino, M. C., Brieva, J., Grainge, C., Rahman, N. M., & George, V. (2026). A mixed methods evaluation of pleural procedural experience and training in intensive care trainees. BMC Medical Education. https://doi.org/10.1186/s12909-026-10206-w

Image Credits: AI Generated

DOI: 10.1186/s12909-026-10206-w

Keywords: intensive care, pleural procedures, chest drain, thoracic ultrasound, medical education, simulation training, trainee confidence, mixed methods, New South Wales, procedural skills, mixed, methods