Rehearsal to Premiere: Transfer of Chest Tube Insertion Skills From Simulation to the Clinical Context.

BACKGROUND

Simulation-based mastery learning (SBML) can establish procedural competence in a standardized environment, but how learners subsequently transfer these skills in clinical practice is less understood. This study explored the transfer of chest tube insertion skills from simulation to clinical practice and contextual factors influencing this process.

METHODS

In this mixed-methods study, novice trainees completed an SBML curriculum in chest tube insertion using the Seldinger technique and were assessed using an Objective Structured Assessment of Technical Skills (OSATS). Their first clinical chest tube insertion was subsequently observed, with procedural participation documented and OSATS items assessed for components performed. Field notes captured contextual factors surrounding each encounter. Clinical performance was analyzed descriptively and field notes thematically.

RESULTS

Thirty-five trainees completed the simulation curriculum and 24 were evaluated clinically. Nine (37%) observed, 13 (54%) actively participated, and 2 (8%) completed the procedure independently. Despite all learners achieving mastery in simulation, clinical participation varied considerably. Contextual factors included patient acuity and urgency, learner confidence, supervisor judgment, parental presence, clinical team support, and application of skills from related procedures.

CONCLUSIONS

Mastery in a standardized simulation environment provides an important foundation for procedural learning but does not fully capture how skills are transferred in clinical practice. Learner, supervisor, patient, family, and environmental factors influenced opportunities to perform and adapt simulation-acquired skills. These findings highlight the complexity of transfer and the need for simulation designs that build on technical mastery by preparing learners to adapt across variable clinical contexts.