Clinical skills in early postgraduate medical trainees: patterns of acquisition of confidence and experience among junior doctors in a university teaching hospital.

Abstract

Little is known about patterns of clinical skills acquisition among junior doctors undertaking clinical training in the early postgraduate period. A better understanding would assist in the design of effective educational interventions for this group. We conducted a cross-sectional survey of the levels of confidence and experience with a broad raft of clinical skills among early PGY1 trainees (interns), PGY2s and PGY3s within a university teaching hospital network in Sydney at the beginning of the clinical year in 1999. The instrument was a new validated 69 item questionnaire. A total of 92 respondents took part, representing 100% of the PGY1 (n=36), PGY2 (n=31) and PGY3 (n=25) cohorts. Commencing interns reported high confidence levels with a small group of practical skills but less confidence with clinical management skills. Significant positive differences were found for confidence with all skill areas between early PGY1 and PGY3. We identified three patterns for skills acquisition. Pattern A was the most common, with a significant difference in levels of confidence and experience between PGY1 and PGY2 but not between PGY2 and PGY3 (e.g. suturing a simple laceration). In Pattern B, significant differences were found in levels of confidence and experience between PGY1 and PGY2 as well as between PGY2 and PGY3 (e.g. cardiopulmonary resuscitation). In Pattern C, significant differences were found in levels of experience between PGY2 and PGY3 but not between PGY1 and PGY2 (e.g. endotracheal intubation). There was a significant correlation between reported confidence and experience for all skill areas. Early postgraduate medical trainees in a Sydney teaching hospital acquire high levels of confidence and experience in most skill areas after two years of training. The first postgraduate year is particularly significant for the development of clinical skills.