{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,6]],"date-time":"2026-01-06T08:38:04Z","timestamp":1767688684323,"version":"3.48.0"},"reference-count":20,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2026,1,5]],"date-time":"2026-01-05T00:00:00Z","timestamp":1767571200000},"content-version":"unspecified","delay-in-days":4,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open Resp Res"],"accepted":{"date-parts":[[2025,12,21]]},"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>UK General Internal Medicine (GIM) registrars are traditionally expected to be able to perform pleural procedures out-of-hours (OOH) if required. Pleural exposure for GIM registrars has declined, with procedures increasingly performed by specialists in-hours. Pleural procedures can cause significant harm. We explored the role of the GIM registrar in performing OOH pleural procedures, with particular focus on competence and confidence.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>An anonymous survey was distributed to GIM registrars and respiratory consultants across the UK.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Responses were received from 391 non-respiratory GIM registrars and 93 respiratory consultants. 37% of registrars reported being \u2018signed-off\u2019 as independent in chest drain insertion 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% reported no confidence to perform the procedure even if directly supervised, with only 11% feeling confident to proceed unsupervised. Consultants rated the pleural competence of an average non-respiratory GIM registrar; only 4% felt they could perform the procedure unsupervised. 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 evolving role of the medical registrar and who should be expected to perform OOH pleural procedures.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The majority of UK GIM registrars are neither confident nor perceived by trainers as competent to independently perform OOH chest drain insertion. This has implications for patient safety and service delivery, informing broader discussions regarding GIM training, curriculum and the need to establish local OOH pleural pathways.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjresp-2025-003740","type":"journal-article","created":{"date-parts":[[2026,1,6]],"date-time":"2026-01-06T08:35:32Z","timestamp":1767688532000},"page":"e003740","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Role of the general medical registrar in performing out-of-hours pleural procedures: a UK national survey of trainee and trainer perspectives"],"prefix":"10.1136","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3475-9651","authenticated-orcid":false,"given":"Danyal","family":"Jajbhay","sequence":"first","affiliation":[{"name":"Department of Respiratory Medicine, Guy's and St Thomas\u2019 NHS Foundation Trust, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Avinash","family":"Aujayeb","sequence":"additional","affiliation":[{"name":"Department of Respiratory Medicine, Northumbria Healthcare NHS Foundation Trust, Newcastle, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Poppy","family":"Denniston","sequence":"additional","affiliation":[{"name":"Department of Respiratory Medicine, Guy's and St Thomas\u2019 NHS Foundation Trust, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mark","family":"Juniper","sequence":"additional","affiliation":[{"name":"National Confidential Enquiry into Patient Outcome and Death, London, UK"},{"name":"Great Western Hospitals NHS Foundation Trust, Swindon, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Janeth","family":"Liang","sequence":"additional","affiliation":[{"name":"Department of Respiratory Medicine, Guy's and St Thomas\u2019 NHS Foundation Trust, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hannah","family":"Shotton","sequence":"additional","affiliation":[{"name":"National Confidential Enquiry into Patient Outcome and Death, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Junyi","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Respiratory Medicine, Guy's and St Thomas\u2019 NHS Foundation Trust, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Owais","family":"Kadwani","sequence":"additional","affiliation":[{"name":"Department of Respiratory Medicine, Guy's and St Thomas\u2019 NHS Foundation Trust, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2026,1,5]]},"reference":[{"key":"2026010600352894000_13.1.e003740.1","doi-asserted-by":"crossref","unstructured":"Bodtger U , Hallifax RJ . Epidemiology: why is pleural disease becoming more common? In: Maskell NA , Laursen CB , Lee YCG , et al , eds. Pleural disease (ERS monograph). Sheffield: European Respiratory Society, 2020: 1\u201312. Available: https:\/\/doi.org\/10.1183\/2312508X.10022819","DOI":"10.1183\/2312508X.10022819"},{"key":"2026010600352894000_13.1.e003740.2","unstructured":"Joint Royal Colleges of Physicians Training Board . Internal medicine stage 2 training curriculum implementation. 2022. Available: https:\/\/www.thefederation.uk\/sites\/default\/files\/Internal%20Medicine%20stage%202%20curriculum%20DRAFT%20FINAL.pdf [Accessed 24 Jul 2025]."},{"key":"2026010600352894000_13.1.e003740.3","doi-asserted-by":"crossref","DOI":"10.1136\/bmj.b4923","article-title":"Insertion of chest drains: summary of a safety report from the National Patient Safety Agency","volume":"339","author":"Lamont","year":"2009","journal-title":"BMJ"},{"key":"2026010600352894000_13.1.e003740.4","doi-asserted-by":"crossref","first-page":"ii61","DOI":"10.1136\/thx.2010.137026","article-title":"Pleural procedures and thoracic ultrasound: British Thoracic Society Pleural Disease Guideline 2010","volume":"65 Suppl 2","author":"Havelock","year":"2010","journal-title":"Thorax"},{"key":"2026010600352894000_13.1.e003740.5","doi-asserted-by":"crossref","DOI":"10.1136\/bmjresp-2018-000307","article-title":"Providing safe and effective pleural medicine services in the UK: an aspirational statement from UK pleural physicians","volume":"5","author":"Evison","year":"2018","journal-title":"BMJ Open Respir Res"},{"key":"2026010600352894000_13.1.e003740.6","unstructured":"Allen M . Respiratory medicine: GIRFT programme national specialty report (NHS England and NHS Improvement). 2021. Available: https:\/\/gettingitrightfirsttime.co.uk\/wp-content\/uploads\/2021\/11\/Respiratory-Medicine-Oct21L.pdf"},{"key":"2026010600352894000_13.1.e003740.7","doi-asserted-by":"publisher","DOI":"10.1136\/postgradmedj-2014-133155"},{"key":"2026010600352894000_13.1.e003740.8","doi-asserted-by":"crossref","first-page":"105","DOI":"10.12968\/hmed.2015.76.2.105","article-title":"Are we failing our trainees in providing opportunities to attain procedural confidence?","volume":"76","author":"Lagan","year":"2015","journal-title":"Br J Hosp Med"},{"key":"2026010600352894000_13.1.e003740.9","doi-asserted-by":"crossref","DOI":"10.1186\/s12909-023-04978-8","article-title":"Training, experience, and perceptions of chest tube insertion by higher speciality trainees: implications for training, patient safety, and service delivery","volume":"24","author":"Probyn","year":"2024","journal-title":"BMC Med Educ"},{"key":"2026010600352894000_13.1.e003740.10","unstructured":"Stanton A , Evison M . British thoracic society national pleural services organisational audit report 2021. British thoracic society reports, ISSN 2040-2023, Vol 13. 2022."},{"key":"2026010600352894000_13.1.e003740.11","doi-asserted-by":"crossref","DOI":"10.1136\/bmjresp-2024-002840","article-title":"Pleural procedural safety in the UK: is everyone\u2019s house in order? Reflections from the BTS National Pleural Service Organisational Audit and a national review of patient safety incidents","volume":"12","author":"Stanton","year":"2025","journal-title":"BMJ Open Respir Res"},{"key":"2026010600352894000_13.1.e003740.12","unstructured":"National confidential enquiry into patient outcome and death. Pleural Procedures; 2025. Available: https:\/\/www.ncepod.org.uk\/pleural.html [Accessed 14 Aug 2025]."},{"key":"2026010600352894000_13.1.e003740.13","doi-asserted-by":"publisher","DOI":"10.1191\/1478088706qp063oa"},{"key":"2026010600352894000_13.1.e003740.14","unstructured":"Joint Royal Colleges of Physicians Training Board . Respiratory medicine ARCP decision aid 2022. 2022. Available: https:\/\/www.thefederation.uk\/sites\/default\/files\/uploads\/Respiratory%20Medicine%202022%20ARCP%20Decision%20Aid.pdf [Accessed 21 Nov 2025]."},{"key":"2026010600352894000_13.1.e003740.15","doi-asserted-by":"crossref","first-page":"367","DOI":"10.1007\/s41030-023-00232-0","article-title":"Pneumothorax Trends from 2010-2020 from a Large-Volume Pleural Unit","volume":"9","author":"Hyman","year":"2023","journal-title":"Pulm Ther"},{"key":"2026010600352894000_13.1.e003740.16","doi-asserted-by":"publisher","DOI":"10.1136\/thorax-2023-220304"},{"key":"2026010600352894000_13.1.e003740.17","doi-asserted-by":"crossref","DOI":"10.1186\/s12909-022-03654-7","article-title":"The impact of simulation-based mastery learning, booster session timing and clinical exposure on confidence in intercostal drain insertion: a survey of internal medicine trainees in Scotland","volume":"22","author":"Kerins","year":"2022","journal-title":"BMC Med Educ"},{"key":"2026010600352894000_13.1.e003740.18","doi-asserted-by":"crossref","DOI":"10.1136\/bmjresp-2019-000552","article-title":"British Thoracic Society Training Standards for Thoracic Ultrasound (TUS)","volume":"7","author":"Stanton","year":"2020","journal-title":"BMJ Open Respir Res"},{"key":"2026010600352894000_13.1.e003740.19","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1186\/s13089-024-00363-8","article-title":"Canadian Internal Medicine Ultrasound (CIMUS) consensus statement: recommendations for mandatory ultrasound competencies for ultrasound-guided thoracentesis, paracentesis, and central venous catheterization","volume":"16","author":"Walsh","year":"2024","journal-title":"Ultrasound J"},{"key":"2026010600352894000_13.1.e003740.20","doi-asserted-by":"crossref","first-page":"400","DOI":"10.1177\/17511437251331849","article-title":"United Kingdom Intensive Care Medicine Trainees\u2019 Confidence, Training, and Practice in Pleural Procedures: A Nationwide Survey","volume":"26","author":"Sagar","year":"2025","journal-title":"J Intensive Care Soc"}],"container-title":["BMJ Open Respiratory Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjresp-2025-003740","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,6]],"date-time":"2026-01-06T08:35:36Z","timestamp":1767688536000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopenrespres.bmj.com\/lookup\/doi\/10.1136\/bmjresp-2025-003740"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1]]},"references-count":20,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,1,5]]},"published-print":{"date-parts":[[2026,1]]}},"alternative-id":["10.1136\/bmjresp-2025-003740"],"URL":"https:\/\/doi.org\/10.1136\/bmjresp-2025-003740","relation":{},"ISSN":["2052-4439"],"issn-type":[{"value":"2052-4439","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1]]}}}