Introduction Nasogastric tube (NGT) insertion for enteral feeding is common practise, but is associated with the risk of tube misplacement or malposition in both the immediate and subsequent time points.1 Between 2005 to 2010, 21 deaths and 79 other cases of harm have been reported on the updated National Patient Safety Agency (NPSA) Alert (2011), “Reducing harm caused by nasogastric feeding tubes”. In 45% of cases, misinterpretation of the chest X-ray was directly responsible for the harm inflicted.
The General Medical Council’s (GMC) guidance for undergraduate education, “Tomorrow’s Doctors (2009)” does not specify NGT placement as a core competency for a graduate or Foundation Trainee.2
The purpose of this survey was to ascertain the number of medical schools in the United Kingdom (UK) which provide specific teaching on NGT placement and correct identification of tube position (using either pH method or clinical interpretation of a plain chest X-ray film). Furthermore, the authors sought to identify whether these medical schools included formative or summative assessment of the respective methods.
Methods All 30 GMC recognised Medical Schools within the UK were invited to participate by means of a standardised survey proforma. This proforma was emailed to relevant staff members who were either responsible for course development or were personnel within the clinical skills faculty.
Results To date, there has been a 57% (17/30) response rate (Table 1).
Of the 10 medical schools that provide formal teaching on NGT insertion, 8 of them required formative assessment for both the practical technique and the interpretation of correct tube position.
Of the 7 medical schools that do not to provide formal teaching of NGT insertion, 6 of them stated that this was due to the GMC’s “Tomorrow’s Doctors” guidance not including NGT placement as a mandatory proficiency for a graduate.
Conclusion This survey found that 59% (10/17) of the participating UK medical schools provide formal teaching on NGT placement and correct identification of tube position. There is variable emphasis on NGT procedure proficiency in undergraduate medical education. Given the risks highlighted by the 2011 NPSA report, we would suggest that NGT placement instruction and training should be facilitated at the undergraduate level.
Disclosure of Interest None Declared
National Patient Safety Alert (PSA 002): Reducing the harm caused by misplaced nasogastric feeding tubes in adults, children and infants; Mar 2011. URL: http://www.nrls.npsa.nhs.uk/alerts/?entryid45 = 129640
General Medical Council (GMC) Tomorrow’s Doctors 2009; URL: http://www .gmc-uk.org/TomorrowsDoctors_2009.pdf_39260971.pdf
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