Emergency medicine procedural skills: what are residents missing?

Abstract

Objective: This study sought to establish the current state of procedural skills training in Canadian Royal College emergency medicine (EM) residencies. Methods: A national Web-based survey was administered to residents and program directors of all 13 Canadian-accredited Royal College EM residency programs. Program directors rated the importance and experience required for competence of 45 EM procedural skills. EM residents reported their experience and comfort in performing the same procedural skills. Results: Thirteen program directors and 86 residents responded to the survey (response rate of 100% and 37%, respectively). Thirty-two (70%) procedures were considered important by . 70% of program directors, including all resuscitation and lifesaving airway procedures. Four procedures deemed important by program directors, including cricothyroidotomy, pericardiocentesis, posterior nasal pack for epistaxis, and paraphimosis reduction, had never been performed by the majority of senior residents. Program director opinion was used to categorize each procedure based on performance frequency to achieve competence. Overall, procedural experience correlated positively with comfort levels as indicated by residents. Conclusions: We established an updated needs assessment of procedural skills training for Canadian Royal College EM residency programs. This included program director opinion of important procedures and the performance frequency needed to achieve competence. However, we identified several important procedures that were never performed by most senior residents despite program director opinion regarding the experience needed for competence. Further study is required to better define objective measures for resident competence in procedural skills.

Simulation in Canadian postgraduate emergency medicine training – a national survey

“…A participation bias among residents was also noted, with a stepwise decline in the response rate with advancing postgraduate year. This finding was similar to other surveys of EM residents 30 and may be due to increasing survey fatigue with advancing training or a focus on the final board certification exams, in the case of the final year residents. This may have acted to falsely inflate resident hours of reported simulation at institutions where simulation is offered to junior residents only.…”

Introducing a Fresh Cadaver Model for Ultrasound-guided Central Venous Access Training in Undergraduate Medical Education

“… 7 , 12 – 14 This is especially concerning for a procedure-rich residency such as emergency medicine, anesthesia, and general surgery, where numerous procedures such as CVC are performed and can lead to complications. 15 , 16 The use of US has been shown to significantly decrease CVC complication risk, which may be further mitigated by improving procedural familiarity and competence through simulation education. 17 , 18 In fact, the Agency for Healthcare Research and Quality has identified US-guided central venous placement as one of the practices in which strong evidence supports its widespread implementation.…”

Critical Procedures in Children: Skills Training for Pediatric Emergency Medicine Providers

“…These include differences in training length, volume of patients in the emergency department (ED), trauma designation, geographic area, and amount of clinical time spent in the ED. Several studies have documented that neither pediatric EM (PEM) fellows nor EM residents have an opportunity to perform any of these critical procedures on children (Al-Eissa et al, 2008;Petrosoniak, Herold and Woolfrey, 2013). Furthermore, pediatric faculty who may be in charge of teaching and supervising fellows about these procedures are likely to also have limited to no experience performing these procedures as well (Mittiga et al, 2013b;Mittiga, FitzGerald and Kerrey, 2016;Nguyen and Craig, 2016;Burns and Uspal, 2017).…”