Identifying essential procedural competencies for medical students: a modified Delphi survey

Abstract

Background Although medical students need to acquire specific procedural skills during their undergraduate training, agreement on what skills they should be trained upon and the competency levels that need to be achieved in these skills is inconclusive. This study aimed to identify core procedural skills competencies for Sri Lankan medical students and establish the importance of pre-clerkship procedural training to improve these skills. Methods A three-round, online modified Delphi survey was used to identify consensus on essential procedural skills and competencies for graduating medical students in Sri Lanka. An initial questionnaire was developed using content identified from the literature and student logbooks. The expert panel included seventeen clinicians involved in undergraduate medical education and supervision of resident physicians. In Round 1, they rated their agreement on including 64 procedural skills, and 4 suggested additional procedures in undergraduate training. In Round 2, experts re-appraised 38 skills and rated the level of competency (i.e., Observer to Proficient). In Round 3, experts re-appraised the ratings of 35 essential procedures and rated the support for a pre-clerkship procedural curriculum for medical students. Results Consensus, defined as > 75% agreement, was established with 25 procedural skills across eight categories: cardiovascular, respiratory, gastrointestinal, surgical, gynecology and obstetrics, urogenital, diagnostic, and injections. Nasogastric tube insertion, venipuncture, handwashing, nose/throat/wound swab, measuring capillary packed cell volume, surgical scrub, gown, and gloving were rated with the highest level of agreement as requiring a 'proficient' level of competency. A majority of the experts were in support of a pre-clerkship procedural curriculum for medical students. Conclusions The findings from this Delphi survey provide critical information about core procedural skills and competencies for Sri Lankan undergraduate medical curricula. The results support the importance of teaching these procedures within the pre-clerkship years of medical curricula. Including highly experienced clinician educators in the expert panel validates the study findings, which demonstrate the importance of aligning existing medical curricula with competency-based medical education.