Common Emergency Department Procedures: Competency, Knowledge, and Frequency of Performance by Emergency Medicine Trainees

Abstract

BACKGROUND Trainees ought to master specific procedural skills throughout the course of the emergency residency programme they are enrolled in. AIMS We aim to assess the level of exposure to procedures, the confidence towards performing such procedures during each level of training, and an estimate of the minimum number of procedures required to influence trainee confidence and knowledge. METHODS The authors constructed a survey that was distributed using a snowball sampling method, targeting a sample of emergency trainees at nine training hospitals in Riyadh, Saudi Arabia. Participants were asked to answer multiple questions related to 6 different emergency procedures, including the amount of times the procedure had previously been performed and a personal assessment of confidence level related to each procedure using a five-point scale. The mean levels of knowledge and confidence were calculated and used as parameters to reflect on the training of participants. RESULTS The survey was completed by a total of 104 participants and revealed that the most common overall procedure performed was endotracheal intubation with the least common being vaginal delivery. A significant difference was noted between senior trainees and trainees at junior levels in the mean knowledge score for procedures [F(3,100)= 6.03, p= 0.001]. A positive correlation was found between the number of procedures performed and the confidence level. The minimum number of procedures according to the survey revealed the need for more than 15 intubation attempts, 6-10 central line insertions, 1-5 chest tube placements, 1-5 shoulder reductions and 6-10 lumbar punctures to build confidence in trainees. CONCLUSION Procedures that are less frequently performed in specific settings should be noted and attempts should be made to broaden exposure through simulations or rotations at other centres with higher procedural exposure rates.