Optimum number of procedures required to achieve procedural skills competency in internal medicine residents

BMC Medical Education

Saeed Hamid³  Jan van Dalen⁴  Afaq Motiwala⁵  Syed Ahsan³  Quratulain Naeem³  Asif Jafferani²  Nizar Bhulani¹  Muhammad Tariq³ 

[1] Master of Public Health Candidate, The University of Texas, Health Sciences Center at Houston, Houston, USA;Department of Biological and Biomedical Sciences, Aga Khan University, Hospital, Karachi, Pakistan;Department of Medicine, Aga Khan University, Hospital, Stadium Road, Karachi, Pakistan;Communication Skills Training and Assessment, Skills Laboratory, Maastricht University, Maastricht, The Netherlands;University of Texas, Southwestern Medical Centre at Dallas, Dallas, TX, USA

关键词: Competency;    Internal medicine;    Residency;    Residents;    Procedural skills;   

Others  :  1233411
DOI  :  10.1186/s12909-015-0457-4

 received in 2015-02-24, accepted in 2015-10-05,  发布年份 2015

【 摘 要 】

Background

Procedural skills training forms an essential, yet difficult to assess, component of an Internal Medicine Residency Program. We report the development of process of documentation and assessment of procedural skills training.

Method

An explanatory sequential mixed methods design was adopted where both quantitative and qualitative information was collected sequentially. A survey was conducted within the Department of Internal Medicine at The Aga Khan University Hospital, Karachi, Pakistan to determine the optimum number of procedures needed to be performed by residents at each year of residency. Respondents included both faculty and the residents in the Department. Thereafter, all responses were compiled and later scrutinized by a focus group comprising of a mix of faculty from various subspecialties and resident representatives.

Results

A total of 64 responses were obtained. A significant difference was found in eight procedural skills’ status between residents and faculty, though none of these were significant after accounting for multiple consecutive testing. However, the results were reviewed and a consensus for the procedures needed was developed through a focus group. A finalized procedural list was generated to determine: (a) the minimum number of times each procedure needed to be performed by the resident before deemed competent; (b) the level of competency for each procedure for respective year of residency.

Conclusion

We conclude that the opinion of both the residents and the faculty as key stakeholders is vital to determine the number of procedures to be performed during an Internal Medicine Residency. Documentation of procedural competency development during the training would make the system more objective and hence reproducible. A log book was designed consisting of minimum number of procedures to be performed before attaining competency.

【 授权许可】

   
2015 Tariq et al.

【 图 表 】

Fig. 1.

【 参考文献 】

• [1]Touchie C, Humphrey-Murto S, Varpio L. Teaching and assessing procedural skills: a qualitative study. BMC Med Educ. 2013; 13:69. BioMed Central Full Text
• [2]Sectish TC, Zalneraitis EL, Carraccio C, Behrman RE. The state of pediatrics residency training: a period of transformation of graduate medical education. Pediatrics. 2004; 114(3):832-41.
• [3]Mandel JH, Rich EC, Luxenberg MG, Spilane MT, Kern DC, Parrino TA. Preparation for practice in internal medicine. A study of ten years of residency graduates. Arch Intern Med. 1988; 148(4):853-6.
• [4]Kern DC, Parrino TA, Korst DR. The lasting value of clinical skills. JAMA. 1985; 254(1):70-6.
• [5]Harper MB, Mayeaux EJ, Pope JB, Goel R. Procedural training in family practice residencies: current status and impact on resident recruitment. J Am Board Fam Pract. 1995; 8(3):189-94.
• [6]Nothnagle M, Sicilia JM, Forman S, Fish J, Ellert W, Gebhard R et al.. Required procedural training in family medicine residency: a consensus statement. Fam Med. 2008; 40(4):248-52.
• [7]McGaghie WC, Issenberg SB, Cohen ER, Barsuk JH, Wayne DB. Medical education featuring mastery learning with deliberate practice can lead to better health for individuals and populations. Acad Med. 2011; 86(11):e8-9.
• [8]Wigton RS, Nicolas JA, Blank LL. Procedural skills of the general internist. A survey of 2500 physicians. Ann Intern Med. 1989; 111(12):1023-34.
• [9]Wigton RS, Alguire P. The declining number and variety of procedures done by general internists: a resurvey of members of the American College of Physicians. Ann Intern Med. 2007; 146(5):355-60.
• [10]Duffy FD, Holmboe ES. What procedures should internists do? Ann Intern Med. 2007; 146(5):392-3.
• [11]Wigton RS, Blank LL, Nicolas JA, Tape TG. Procedural skills training in internal medicine residencies. A survey of program directors. Ann Intern Med. 1989; 111(11):932-8.
• [12]Cation LJ, Durning SJ. Procedure skill competence and certification in internal medicine residency training. Teach Learn Med. 2003; 15(3):175-9.
• [13]Tariq M, Jafri W, Ansari T, Awan S, Ali F, Shah M et al.. Medical mortality in Pakistan: experience at a tertiary care hospital. Postgrad Med J. 2009; 85(1007):470-4.
• [14]Barbour RS. Making sense of focus groups. Med Educ. 2005; 39(7):742-50.
• [15]Burke Johnson R, Onwuegbuzie AJ. Mixed methods research: a research paradigm whose time has come. Educ Res. 2004; 33(7):14-26.
• [16]Creswell JW. Mixed methods design educational research: planning, conducting, and evaluating quantitative and qualitative research. 2012.
• [17]Wigton RS. Measuring procedural skills. Ann Intern Med. 1996; 125(12):1003-4.
• [18]Norris TE, Cullison SW, Fihn SD. Teaching procedural skills. J Gen Intern Med. 1997; 12 Suppl 2:S64-70.
• [19]Wigton RS. Training internists in procedural skills. Ann Intern Med. 1992; 116(12 Pt 2):1091-3.
• [20]Thammasitboon S, Mariscalco MM, Yudkowsky R, Hetland MD, Noronha PA, Mrtek RG. Exploring individual opinions of potential evaluators in a 360-degree assessment: four distinct viewpoints of a competent resident. Teach Learn Med. 2008; 20(4):314-22.
• [21]Lenchus JD. End of the “see one, do one, teach one” era: the next generation of invasive bedside procedural instruction. J Am Osteopath Assoc. 2010; 110(6):340-6.
• [22]Moriates C, Soni K, Lai A, Ranji S. The value in the evidence: teaching residents to “choose wisely”. JAMA Intern Med. 2013; 173(4):308-10.
• [23]Gaies MG, Landrigan CP, Hafler JP, Sandora TJ. Assessing procedural skills training in pediatric residency programs. Pediatrics. 2007; 120(4):715-22.
• [24]Long DM. Competency-based residency training: the next advance in graduate medical education. Acad Med. 2000; 75(12):1178-83.
• [25]Gustin W, Batra R, Amin A, Rucker L. Education first: reforming the first-year curriculum of the internal medicine residency. Acad Med. 2009; 84(3):368-73.
• [26]Blake GH, Skye E, Biggs WS, Pugno PA. Residency program solutions: making a difference in quality residency education. Fam Med. 2013; 45(3):187-92.
• [27]Brydges R, Dubrowski A, Regehr G. A new concept of unsupervised learning: directed self-guided learning in the health professions. Acad Med. 2010; 85(10 Suppl):S49-55.
• [28]Thomas KG, West CP, Popkave C, Weinberger SE, Kolars JC. Internal medicine resident perceptions of optimal training duration. Acad Med. 2007; 82(10):996-9.
• [29]Durning SJ, Cation LJ, Jackson JL. Are commonly used resident measurements associated with procedural skills in internal medicine residency training? J Gen Intern Med. 2007; 22(3):357-61.
• [30]Druck J, Valley MA, Lowenstein SR. Procedural skills training during emergency medicine residency: are we teaching the right things? West J Emerg Med. 2009; 10(3):152-6.
• [31]Karam MD, Pedowitz RA, Natividad H, Murray J, Marsh JL. Current and future use of surgical skills training laboratories in orthopaedic resident education: a national survey. J Bone Joint Surg Am. 2013; 95(1):e4.
• [32]Batalden P, Leach D, Swing S, Dreyfus H, Dreyfus S. General competencies and accreditation in graduate medical education. Health Aff (Millwood). 2002; 21(5):103-11.
• [33]Swing SR. Perspectives on competency-based medical education from the learning sciences. Med Teach. 2010; 32(8):663-8.