Abstract
BackgroundGraduating Internal Medicine residents must possess sufficient skills to perform a variety of medical procedures. Little is known about resident experiences of acquiring procedural skills proficiency, of practicing these techniques, or of being assessed on their proficiency. The purpose of this study was to qualitatively investigate resident 1) experiences of the acquisition of procedural skills and 2) perceptions of procedural skills assessment methods available to them.MethodsFocus groups were conducted in the weeks following an assessment of procedural skills incorporated into an objective structured clinical examination (OSCE). Using fundamental qualitative description, emergent themes were identified and analyzed.ResultsResidents perceived procedural skills assessment on the OSCE as a useful formative tool for direct observation and immediate feedback. This positive reaction was regularly expressed in conjunction with a frustration with available assessment systems. Participants reported that proficiency was acquired through resident directed learning with no formal mechanism to ensure acquisition or maintenance of skills.ConclusionsThe acquisition and assessment of procedural skills in Internal Medicine programs should move toward a more structured system of teaching, deliberate practice and objective assessment. We propose that directed, self-guided learning might meet these needs.
Highlights
Graduating Internal Medicine residents must possess sufficient skills to perform a variety of medical procedures
Analysis of the focus group data yielded 174 distinct comments from participants, which we grouped into five emergent themes: 1) learning procedural skills; 2) method of assessment; 3) realism of mannequins; 4) direct observation and feedback; and
Learning procedural skills Participants reported that the acquisition of a procedural skill in their day to day activities required both the availability of learning opportunities and the supervision of those opportunities
Summary
Graduating Internal Medicine residents must possess sufficient skills to perform a variety of medical procedures. In Canada these skills include central venous line and arterial line insertion, endotracheal intubation, thoracentesis, abdominal paracentesis, lumbar puncture and knee joint aspiration [3]. Acquiring these skills requires the development of several different abilities including psychomotor, clinical judgment, communication, decision making, and patient-focused interaction abilities [4]. Logbooks are a means of monitoring the breadth of experiences encountered and of documenting trainee progress They do not reflect the performance, ensure direct observation or feedback nor ascertain the level of achievement of a trainee [12]
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