Confidence In Procedural Skills Research Articles

516 Ultrasound Cannulation Training: A Hit or a Miss

Abstract As a junior doctor, familiarisation with ultrasound skills can be very useful. This reduces stress for patients from multiple access attempts, as well as preserving venous access. In our District General Hospital (DGH), there was no teaching on ultrasound-guided venous access available. Our aim was to create a formal training programme on ultrasound-guided venous access for junior doctors. Discussions were held with the medical education team at our DGH in order to understand how to organise a formal teaching programme. The interest of junior doctors was gathered through informal discussion. Those interested were then asked to complete pre and post-course evaluation forms. Data was gathered on experience using ultrasound, confidence (out of 5) in performing ultrasound cannulation before and after the session, and usefulness of the session. Of the 16 participants, only 81% (n=13) filled in the pre-session form, therefore data was only analysed from these individuals. 54% of participants (n=7) had previous experience using an ultrasound machine. 100% (n=13) felt more confident performing ultrasound-guided venous access after attending the session. The average confidence score pre versus post-session was 1.69/5 vs 4.08/5. This programme has the potential to improve confidence in procedural skills amongst junior doctors whilst also minimising the stress for patients of multiple access attempts. Though the sample obtained was small, it is clear to see increased confidence in participants, regardless of prior experience. The results from this study will be critical in continuing this training programme in our hospital and hopeful roll out to a wider audience.

Initial report on special operations clinical training at a civilian academic medical center.

Military-civilian partnerships for combat casualty care skills training have mostly focused on traditional, combat surgical team training. We sought to better understand US Special Forces (SF) Medics' training at West Virginia University in Morgantown, West Virginia, a Level 1 trauma center, via assessments of medical knowledge, clinical skills confidence, and technical performance. Special Forces Medics were evaluated using posttraining medical knowledge tests, procedural skills confidence surveys (using a 5-point Likert scale), and technical skills assessments using fresh perfused cadavers in a simulated combat casualty care environment. Data from these tests, surveys, and assessments were analyzed for 18 consecutive SF medic rotations from the calendar years 2019 through 2021. A total of 108 SF Medics' tests, surveys, and assessments were reviewed. These SF Medics had an average of 5.3 years of active military service; however, deployed experience was minimal (73% never deployed). Review of knowledge testing demonstrated a slight increase in mean test score between the precourse (80% ± 14%; range, 50-100%) when compared with the postcourse (82% ± 14%; range, 50-100%). Skills confidence scores increased between courses, specifically within the point of injury care ( p = 0.09) and prolonged field care ( p < 0.001). Technical skills assessments included cricothyroidotomy, chest tube insertion, and tourniquet placement. This study provides preliminary evidence supporting military-civilian partnerships at an academic Level 1 trauma center to provide specialty training to SF Medics as demonstrated by increase in medical knowledge and confidence in procedural skills. Additional opportunities exist for the development technical skills assessments. Therapeutic/Care Management; Level IV.

An effective procedure skills training programme for GIM registrars

The Royal College of Physicians' Acute care toolkit 8 recommends procedural training for medical registrars at all hospitals. We aimed to determine the interest and need, and to pilot the delivery of such training in the procedures outlined by the Joint Royal Colleges of Physicians Training Board (2017). An online survey was sent to general internal medicine (GIM) trainees within the Thames Valley Deanery in January 2019. This identified a need for procedure skills training. Ninety per cent of trainees felt simulation training would improve their confidence in the outlined procedures. Thirty-two trainees attended across both sites. Excellent feedback was obtained and trainee confidence improved by visual analogue scale scoring post-training for all procedures. Almost 90% of trainees felt the sessions would improve safety on GIM on calls. Simulation training is an effective way to improve trainee confidence in procedural skills and this pilot shows such training is desired and necessitated in higher specialty training. Further work will assess its impact on maintaining trainee skillsets and impact on patient safety.

Confidence in Procedural Skills before and after a Two-Year Master's Programme in Family Medicine in Gezira State, Sudan.

Many postgraduate family medicine training programmes have been developed to meet the worldwide dire need for practicing family physicians. This study was conducted in Gezira state of Sudan in a “before-and-after” design in the period of 2010–2012 with the aim to assess improvements in candidates' confidence in performing certain clinical skills. A self-evaluation questionnaire was used with a five-grade scale (1–5) to assess candidates' confidence in performing 46 clinical skills. A group of 108 participants responded for both the “before” and the “after” questionnaire: the response rate was 91% (before) and 90% (after). In general, a positive progress trend was detected. The mean skill value for all skills was 3.23 (before) and 3.93 (after) with a mean increase of 21.7% (P < 0.001). Male students scored constantly higher than females both before and after completing the master's programme, while females showed a higher percentage in progress. Scores in certain medical disciplines were higher than others. However, disciplines with low scores in the beginning, such as psychiatry and ophthalmology, showed the highest progress percentage. The results show a significant increase in confidence in performing procedural skills designed in the curriculum of the GFMP master's programme.

Increasing Medical Students' Confidence in Procedural Skills Using a Junior Doctor-Delivered Bedside Supervision Program

Problem:Clinical procedural skills are formally taught to medical students in clinical skills centers using mannequins. Exposure to procedural skills involving patients and opportunities to practice under the supervision of doctors are limited. Intervention: A bedside supervision program was piloted at a district general hospital in the United Kingdom. The supervision model was chosen as the method to increase medical students' practice in basic procedural skills because it allowed safe practice with patients. Context: The program was an optional component of the medical students' clinical clerkships. Off-duty junior doctors were recruited as voluntary trainers. The trainers obtained requests for procedural tasks from the on-call doctors and ward nurses, following which the trainers supervised medical students performing the basic procedures with patient consent. Outcome: The pilot program was successfully run for 4 weeks. Fourteen students took part, and 9 (64%) completed a postintervention feedback questionnaire. The students' confidence (rating scale = 1–5) in performing procedural skills improved from a mean of 3.0 (SD ± 0.9) to 4.7 (SD ± 0.5) following a supervision session. Although the range of skills was limited to opportunistic encounters, the students reported high satisfaction and felt supervision enabled them to identify areas for improvement. Lessons Learned: It is feasible to implement a junior doctor-delivered bedside program to supplement procedural skills training provided by medical schools. The challenges include reconciling the tension between junior doctors' service work and their teaching commitment, logistical issues such as recruiting a sufficient number of trainers and ensuring adequate coverage of training tasks.

G285(P) Can we do better with DOPS?

AimsDOPS (Direct Observation of Procedural skills) assessment was first introduced in UK medical training in 2007. A qualitative study aimed at finding out the views of paediatric trainees on DOPS...

Treatment of Osteomyelitis

<h3>ABSTRACT</h3> <h3>Background</h3> The Royal College of Physicians’ <i>Acute care toolkit 8</i> recommends procedural training for medical registrars at all hospitals. We aimed to determine the interest and need, and to pilot the delivery of such training in the procedures outlined by the Joint Royal Colleges of Physicians Training Board (2017). <h3>Methods</h3> An online survey was sent to general internal medicine (GIM) trainees within the Thames Valley Deanery in January 2019. This identified a need for procedure skills training. Ninety per cent of trainees felt simulation training would improve their confidence in the outlined procedures. <h3></h3> We trialled a simulation programme for GIM registrars between September 2019 and October 2019. Sessions lasted 3–3.5 hours and trainees rotated through four stations. Feedback was obtained from trainees and trainers during each pilot session. <h3>Results</h3> Thirty-two trainees attended across both sites. Excellent feedback was obtained and trainee confidence improved by visual analogue scale scoring post-training for all procedures. Almost 90% of trainees felt the sessions would improve safety on GIM on calls. <h3>Conclusion</h3> Simulation training is an effective way to improve trainee confidence in procedural skills and this pilot shows such training is desired and necessitated in higher specialty training. Further work will assess its impact on maintaining trainee skillsets and impact on patient safety.