We welcome these comments and agree that a training programme in tube thoracostomy is required. We would argue that the 7% complication rate encountered by surgical trainees remains unacceptable, especially as these trainees insert most tube thoracostomies for trauma. The training model within the Specialty Skills in Cardiothoracic Surgery would appear to be a good starting point for the safe and effective insertion of tube thoracostomies and, ideally, this training should be offered to all trainees likely to be involved with chest trauma.