Gaps in Procedural Experience and Competency in Medical School Graduates

Abstract

Objectives: The goal of undergraduate medical education is to prepare medical students for residency training. Active learning approaches remain important elements of the curriculum. Active learning of technical procedures in medical schools is particularly important, because residency training time is increasingly at a premium because of changes in the Accreditation Council for Graduate Medical Education duty hour rules. Better preparation in medical school could result in higher levels of confidence in conducting procedures earlier in graduate medical education training. The hypothesis of this study was that more procedural training opportunities in medical school are associated with higher first-year resident self-reported competency with common medical procedures at the beginning of residency training.Methods: A survey was developed to assess self-reported experience and competency with common medical procedures. The survey was administered to incoming first-year residents at three U.S. training sites. Data regarding experience, competency, and methods of medical school procedure training were collected. Overall satisfaction and confidence with procedural education were also assessed.Results: There were 256 respondents to the procedures survey. Forty-four percent self-reported that they were marginally or not adequately prepared to perform common procedures. Incoming first-year residents reported the most procedural experience with suturing, Foley catheter placement, venipuncture, and vaginal delivery. The least experience was reported with thoracentesis, central venous access, and splinting. Most first-year residents had not provided basic life support, and more than one-third had not performed cardiopulmonary resuscitation (CPR). Participation in a targeted procedures course during medical school and increasing the number of procedures performed as a medical student were significantly associated with self-assessed competency at the beginning of residency training.Conclusions: Recent medical school graduates report lack of self-confidence in their ability to perform common procedures upon entering residency training. Implementation of a medical school procedure course to increase exposure to procedures may address this challenge.ACADEMIC EMERGENCY MEDICINE 2009; 16:S58-S62 ª

Assessing Patient Care: Summary of the Breakout Group on Assessment of Observable Learner Performance

“…Invasive procedural skills are an essential component of resident training. There is ample evidence that there are significant gaps in medical student and resident procedural competence, [100][101][102][103] as well as variability in the correct and safe performance of procedures among residents when performing procedures on patients. 104 There is strong evidence supporting the need for audit and feedback after teaching procedural skills such as central venous catheter insertion to ensure a prolonged and profound behavioral change.…”

National Undergraduate Medical Core Curriculum in Turkey: Evaluation of Residents

“…In a study investigating the proficiencies of newly graduated doctors, the skills noted as being performed more than five times within the first year of junior employment were wound suturing, urinary catheter placement and venipuncture (11). In another study, students who performed a skill more than twice achieved a self-confidence score in that particular skill of 4. out of 5 on average (21).…”

Lumbar puncture training using simulation-based educational strategies. Experience in a clinical pediatric residency

“…The pre-training survey showed that PR1 had a low level of confidence with the procedure, even after learning the theory. Promes, et al, 9 reported that less than 29% of …”