Decay of Competence with Extended Research Absences During Residency Training: A Scoping Review

Abstract

A significant number of residents in postgraduate training programs pursue dedicated research training. Currently, no formal curricula exist to transition residents back into clinical roles following dedicated research leave. This scoping review aims to determine what literature exists on the challenges faced by trainees who interrupt their clinical training for extended periods of time for research leave. The Pubmed and Medline databases were searched for all study designs related to postgraduate trainees taking academic or research leave. A three-step selection process including title, abstract and full-article review was employed to identify articles that mentioned decay of knowledge, skill or competence. A narrative review of the literature was generated to present key themes identified within the studies. The search yielded 174 articles of which five investigated resident skill decay during research leave. The five studies included for analysis were cohort studies that used general surgery residents’ self-perception and faculty members’ perception of residents’ skill decay as a measure. Residents and faculty perceived decay of residents’ technical skills, leadership skills and knowledge following dedicated research leave. The greatest decay perceived was in technical skills, specifically with more complex tasks and longer periods of non-use. This review identified that residents and faculty perceive a decay of resident skills following dedicated research training. To provide the necessary support to limit this potential decay, as well as to assist in the transition back into clinical training, the needs of and challenges faced by research residents and postgraduate programs must be better understood.

Evidence for recency of practice standards for regulated health practitioners in Australia: a systematic review

“…The two systematic reviews were assessed as of moderate quality, however, the focus of those reviews have limited applicability to the research questions [11,12]. The three narrative reviews included in our study were rated as of moderate quality [13][14][15]. The findings of these reviews should be treated with caution as the number of participants in each of the included studies were low and follow-up times were short.…”

“…The review identified two narrative reviews, a randomised controlled trial and five cohort studies that examine skills decay in active practitioners following training that are of medium to low quality [13][14][15][16][17][18][19][20][21]. In addition, a highly relevant systematic review of skills fade conducted by the General Medical Council (GMC) in 2014 is cited by a systematic literature review identified in this study [11].…”

“…For instance emergency airways management and defibrillation skills decrease between four and six months after training [4,12,15,19], whereas laparoscopic surgical skills decrease six to eight months after training, and catheter insertion skills for haemodialysis do not decrease until after one year [4]. Longer breaks were generally associated with greater skill decay [14].…”

“…Regular repeated assessments of basic surgical skills during surgical residents' research years improved errors associated with rule-based procedures, but did not improve errors associated with the strategic approach to the surgical intervention compared to residents returning to surgery who had not undergone repeated assessment [18]. Residents and faculty perceive that the extent of skills decay is related to the level of skill difficulty, with the greatest loss perceived in technical skills, followed by a decrease in knowledge of procedural steps [4,14].…”

Dual surgeon operating to improve patient safety

“…6 Many surgeons will have experienced a prolonged period without performing complex non-urgent surgery (a ‘layoff’ period) and may experience skill fade or loss of confidence. 8 , 9 An extensive systematic review by the General Medical Council (GMC) highlights the deterioration of both technical and non-technical skills after an extended time without practice. 10 In aviation, this is known as being ‘out of currency’ or ‘not current’.…”