Development of a comprehensive Percutaneous Dilatational Tracheostomy process model for procedural training: a Delphi?based experts consensus

Abstract

Background
Deconstructing a complex procedure improves skills learning, but no model has covered all relevant Percutaneous Dilatational Tracheostomy (PDT) procedural aspects. Moreover, the heterogeneity of techniques described may hinder trainees’ competency acquisition. Our objective was to develop a PDT model for procedural training that includes a comprehensive step?by?step design.

Methods
Procedural descriptions were retrieved after a structured search in medical databases. Activities were extracted and the adherence to McKinley’s dimensions of procedural competence was analyzed. We developed a comprehensive PDT model, which was further validated through a Delphi?based consensus of Spanish?speaking international experts.

Results
The 14 descriptions retrieved for analysis presented a median [interquartile range] of 18 [11?22] steps, covering 3 [2?4] of McKinley’s dimensions. The Delphi panel’s first model included all McKinley’s dimensions, and was answered by 25 experts from 9 countries, ending in the second round. The final model included 59 activities divided into 6 stages (51 from the initial model and 8 proposed by experts) and performed by two operators (bronchoscopy and tracheostomy).

Conclusions
We have presented a PDT model that includes necessary competence dimensions to be considered complete. The model was validated by an experts’ consensus, allowing to improve procedural training to promote safer patient care.