Procedural Competence Research Articles

A novel homemade simulator for training and assessing competency of totally implantable venous access port implantation via venous cutdown.

Total implantable venous access port (TIVAP) by cephalic vein cutdown (CVCD) is one of the first procedures surgery residents can be performed independently under supervision. There is currently a lack of affordable simulators for teaching and assessing TIVAP competency to improve patient safety. A panel of 10 experts divided the TIVAP by CVCD procedure into 9 steps. A homemade, low-cost ($3 USD) simulator was then designed for practicing standardized procedural steps in the context of a simulation-based mastery learning course. Residents were given a simulator for at-home practice and completed a survey evaluating the simulator and their learning experience. Twenty-eight first-year surgery residents participated in the course and completed the survey. They were highly satisfied with the simulator (mean score = 8.7 of 10) and generally agreed with its anatomical appearance and functional fidelity. They also appreciated the educational value of using this simulator to learn and practice basic techniques and procedural steps. Our novel, homemade simulator of CVCD TIVAP implantation is a cost-effective way of achieving procedural competence of a basic operation for inexperienced surgery residents. We envision the same principle can be applied to other procedures to enhance resident education.

Creativity in the South Korean Workplace: Procedural Justice, Abusive Supervision, and Competence.

Innovation is now a feature of daily life. In a rapidly changing market environment and amid fierce competition, organizations pursue survival and growth through innovation, and the key driver of innovation is the creativity of employees. Because the value of creativity has been emphasized, many organizations are looking for effective ways to encourage employees to be creative at work. From a resource perspective, creativity at work can be viewed as a high-intensity job demand, and organizations should encourage it by providing and managing employee resources. This study is an attempt to empirically investigate how competence and abusive supervision affect the relationship between procedural justice and creativity from the conservation of resources perspective. Findings from two-wave time-lagged survey data from 377 South Korean employees indicate that procedural justice increases creativity through the mediation of competence. Furthermore, abusive supervision has a negative moderating effect on the relationship between procedural justice and competence. The findings show that competence moderates the relationship between procedural justice and creativity and that the lower the level of abusive supervision, the greater the effect of procedural justice on competence and creativity.

Old Dog, New Trick: Efficacy of Self-Directed Procedural Training for Attending Critical Care Physicians.

BackgroundIn teaching hospitals, the majority of central venous lines (CVL) are placed by trainees, resulting in little opportunity for attending critical care physicians to maintain this procedural skill. Additionally, not all attending critical care physicians have been trained in the most up-to-date method of dynamic ultrasound (US) guided CVL placement. Furthermore, there is no standardized method to assess procedural competency of attending critical care physicians or to train them in the evolving practice of CVL placement. Despite these limitations, attending critical care physicians are ultimately responsible for supervision of CVL placement by trainees.ObjectiveTo assess the utility of an instructional video to impact attending critical care physicians’ competency and confidence in dynamic US guided CVL placement.MethodsA pre-post intervention study was conducted at an academic medical center. Attending critical care physicians were first asked to obtain CVL access on a gelatin model using US guidance. They then participated in the intervention, which consisted of watching a short instructional video demonstrating a method of dynamic US guided CVL placement. They were then asked to obtain access again, this time using the described method. All CVL placements were video recorded to assess competency in dynamic US guided CVL placement as well as the time required to obtain CVL access. Two blinded and independent reviewers evaluated each video with discrepancies resolved by a third reviewer. Participants were also surveyed pre and post intervention to assess their confidence in performing and supervising CVL placement.ResultsA total of 21 attending critical care physicians were included. Pre-intervention, four used dynamic US guidance compared to 16 post-intervention (P < .001). Confidence in both CVL placement and supervision improved post-intervention (P = .03 each). Time required to obtain CVL access did not differ significantly pre and post intervention. The majority (20/21) believed there should be required competency testing for CVL placement.ConclusionsPre-intervention dynamic US guided CVL competency was poor in this sample of attending critical care physicians but improved significantly with an instructional video intervention. This study suggests there is a role for procedural competency testing among attending critical care physicians, and that significant improvement is achievable with relatively minimal instruction.

Virtual Reality Training in Right Heart Catheterisation

Right heart catheterisation is the gold standard for assessing patients with pulmonary hypertension. Doctors require training in this procedure in a safe and friendly environment with minimal risk to patients. During the COVID-19 pandemic, we sought to develop a Virtual Reality Right Heart Catheterisation (VRRHC) training program to fulfil this area of need without face-to-face contact. The aim was to improve procedure competency, aid diagnosis and reduce medical error.

Is the teaching of Immediate Life Support useful in the medium term for medical students?

IntroductionImmediate Life Support training is under-represented in medical degrees and little information is available on the medium-term effectiveness of its teaching. Our aim was to analyse the forgetting curve in medical students who received specific training in the three main procedural competencies of Immediate Life Support. Material and methodsA prospective 3-month longitudinal study was conducted on final year medical students at a Spanish university. The items assessed were grouped into three competencies: the performance of cardiopulmonary resuscitation (nine items), instrumentalised airway management with a supraglottic device (five items) and the identification of basic arrhythmias responsible for cardiorespiratory arrest (four items). All measurements were assessed immediately after the training programme and at three months. McNemar's tests were used for statistical analyses. ResultsThe medical students recruited showed high rates of correct execution of the manoeuvres for all assessed items, both immediately after the programme and at three months. Over 90% of students performed all the manoeuvres correctly at three months, except for appropriate cardiac massage frequency (85.71%). No significant differences were appreciated between the two assessments. ConclusionThe 3-month forgetting curve in Immediate Life Support was non-existent for medical students, suggesting that these programmes are effective in the medium term. This study provides further evidence on a discipline that is undertrained in medical degrees and that is scarcely studied in the current literature.

PROCEDURAL PARTICULARS OF ADOPTING A DECISION ON THE APPLICATION OF REMOVAL FROM OFFICE

In the article, the author considered certain procedural aspects of decision-making on the application of suspension from office. The concept of ‘application’ in the context of measures to ensure criminal proceedings is considered. It was established that the term ‘application’ in the context of measures to ensure criminal proceedings, including removal from office, actually implies a complex approach, which includes both the selection of a specific coercive measure and its direct application. The author notes that making a decision on the expediency of applying to a person the very removal from the position of investigator, prosecutor depends to a certain extent on his criminal procedural competence. It is indicated that the analysis of the criminal procedural legislation shows that removal from office can be carried out both at the stage of pre-trial investigation and directly during court proceedings. The existence of procedural differences in the procedure for applying removal from office to a person depending on the stage of criminal proceedings is substantiated, in particular, at the stage of pre-trial investigation, the prosecutor, the investigator, in agreement with the prosecutor, apply for removal from office to the investigating judge, at the stage of court proceedings directly to the court. It is argued that it is inexpedient to submit in the motion for removal from office at the stage of court proceedings information containing a statement of the circumstances that give grounds to suspect a person of committing a criminal offense, since the indictment contains information about the circumstances of the commission of the criminal offense and the involvement of the person in its commission, which are substantiated by arguments, and with which the court familiarizes itself in the preparatory court session. The author emphasizes the importance of the criminal procedural regulation, the possibility for the inquirer, upon agreement with the prosecutor, during the investigation of criminal offenses and in the presence of reasonable grounds, to file a petition for the application of a person's removal from office.

Kardiyoloji Asistanlarının Çekirdek Eğitim Programında Tanımlanan Klinik Yetkinliklere İlişkin Özdeğerlendirmeleri

Aim: The clinical and procedural competencies that a cardiology resident should gain during the residency programme are defined as Cardiology Core Curriculum (CCC). Clinical competencies defined in the CCC are leveled as diagnosis (D), diagnosis and therapy (DT), diagnosis and therapy in a team (DTT); whereas emergency (E) and prevention (Pre) levels are added on these. Residents are expected to gain all these clinical competencies in the first half of their residency program. The aims of this study were to assess the self-evaluation of cardiology residents from different hospitals in Turkey on the level of achievement of the clinical competencies described in CCC and further investigate the factors that could affect the results. Methods: A survey was conducted to obtain self-evaluation of cardiology residents on levels of clinical competency defined in CCC. Residents on the second and third years of training were grouped as first half and fourth and fifth year as the second half. The self-evaluation levels of residents were compared according to their educational levels (first vs second half) and the type of educational centers (university vs training and research hospital). Results: Eighty-four residents from 36 different centers in Turkey were included in the survey; 59% of the residents were in the first half and 41% in the second half of their education. Fifty-five residents were getting cardiology training in university hospitals (53 government and 2 foundation university) and 29 in training and research hospitals. Among the clinical competencies grouped as DT-E-Pre the residents reported highest competence in management of hypertension (88%) followed by acute heart failure (80%). As expected, residents in the second half of their training were more competent in all of clinical competencies listed in the CCC. This difference was significant at the DT level for sudden cardiac death, vascular disease, adult congenital heart disease, valvular diseases, cor pulmonale, chronic ischemic heart disease and pericardial disease and at Pre level for sudden cardiac death (p&amp;lt;0.05). No difference was observed between the education centers at DT and E levels, however residents in the university hospitals had stated higher competence at Pre level in all of the clinical competencies listed in the CCC compared to residents training in training and research hospitals and the difference was significant in more than half of competencies (p&amp;lt;0.05). Conclusions: The self-evaluation level of cardiology residents on the competencies defined in the CCC are lower than expected. There is a striking difference at Pre level between university and training and research hospitals. The results of this survey are expected to contribute to CCC update and residence programme development studies.

Short‐term intensive gastrointestinal endoscopy training program

AbstractBackgroundIn Japan there are limited opportunities for pediatric gastrointestinal (GI) trainees to learn GI endoscopy. This study investigated whether a short‐term intensive training for 3 months in an adult GI unit enabled pediatric GI trainees to acquire the required number of cases and the technical competence to perform pediatric GI endoscopic procedures.MethodsThis was a retrospective case series of pediatric GI trainees who underwent 3 months of intensive endoscopy training, which also included direct observation and a questionnaire. The numbers of esophagogastroduodenoscopies (EGD), ileocolonoscopies, and snare polypectomies each trainee performed as well as cecal intubation rates were collected with the goal of meeting the standards of overseas educational guidelines. The trainees were also asked about continuing experience with pediatric endoscopic procedures after the intensive training.ResultsThere were 10 enrolled trainees, 9 men, average age, 34 (range, 29–41). The average number (range) of EGD and ileocolonoscopies that the 10 trainees had done before this training period was 52 (0–200) and 15 (0–20), respectively. The average number (range) of EGD, ileocolonoscopies and snare polypectomies per each trainee was 651.7 (485–814), 159.2 (130–195) and 25.8 (10–55), respectively, over 3 months: all trainees thus fulfilled all of the criteria of the minimal training requirements. All trainees also reached the required threshold in the cecal intubation rate (&gt;90%). In addition, all trainees were able to perform pediatric endoscopic procedures alone after the intensive training period.ConclusionsShort‐term intensive training for 3 months in an adult GI setting enabled pediatric GI trainees to acquire technical competence for pediatric endoscopic procedures.

Assessment of Chief Resident Practice Readiness in a Porcine Lab: A 4-Year Experience

General surgery training prepares residents for the autonomous practice of surgery; however, assessment for readiness for independent practice presents several challenges. The simulation lab offers a safe and standardized environment for assessing the technical skills of a resident in the absence of numerous confounders of the real operating room. We describe our experience with evaluation and remediation of chief resident assessments in a porcine simulation lab. Operative skill assessment of surgical residents was conducted using anesthetized porcine models. Procedure's representative of basic and complex operative skill was chosen for the assessment. Faculty assessed the residents using a checklist for the completion of all critical operative steps. A "failing" score or "critical fail" on a given procedure determined mandatory remediation. For remediation, faculty provided immediate post-procedure feedback on all errors, and residents were offered supervised practice. Residents were then retested to demonstrate competency. Large animal research center at Indiana University School of Medicine, Indianapolis, IN PARTICIPANTS: From 2017 to 2020, thirty-seven PGY5 residents participated in the porcine lab over a 4-year period. These general surgery residents were assessed at the beginning of their chief year. There were a total of 6 residents that failed 1 or more procedures. There were no failures in the cholecystectomy, 3 failures for Nissen, 4 failures for Hand sewn anastomosis, and 1 failure for stapled anastomosis. Two residents failed 2 procedures. All residents received remediation with a faculty member and were subsequently able to perform the procedure competently. A formal simulation-based assessment of procedural competence can identify technical performance deficiencies even at the chief resident level. Combined with a formal remediation program, such deficiencies can be addressed well in advance of residency graduation. Determining the relationship of such simulation-based assessments with operative performance is currently underway.

Feasibility study of cumulative sum (CUSUM) analysis as a competency assessment tool for ultrasound-guided venous access procedures.

Typically, physician training programs use a self-reported case-log competency assessment that does not measure procedure success or objectively assess competency. Cumulative sum (CUSUM) analysis could provide objective assessments of competency and progress over the training period. Our study objective was to determine the feasibility of CUSUM analysis to assess competency of ultrasound-guided peripheral intravenous (USG-PIV) line placement in pediatric anesthesiology fellows. We applied a CUSUM analysis to assess competency in USG-PIV placement in three consecutive pediatric anesthesia fellowship classes. After a didactic and hands-on training session, fellows placed a USG-PIV line and self-reported the outcomes via a web-based application. Fellows were deemed competent if the CUSUM curve crossed two consecutive boundary lines from above. Twenty-nine fellows reported 1,388 USG-PIV attempts, with 74% success. Most fellows (26/29; 90%) achieved competency by the end of the fellowship. Two fellows identified in the mid-year CUSUM as not progressing towards competency achieved competency after targeted interventions. Fellows achieving competency (11/29 vs 25/29; odds ratio, 15; 95% confidence interval [CI], 1.98 to 113.56; P = 0.01) and attempts needed to achieve competency (19 vs 11; mean difference, 8.5; 95% CI, 3.3 to 13.7; P = 0.002) were significantly lower in younger patients and significantly higher in older patients. Our study showed that CUSUM can be used to assess competence in USG-PIV procedures performed by pediatric anesthesia fellows and to identify learners not progressing toward competency in procedural skills. Ultrasound-guided venous access required more attempts to achieve competency in younger patients.

Endoscopic resection outcomes and predictors of failed en bloc endoscopic mucosal resection of colorectal polyps ≤ 20 mm among advanced endoscopy trainees.

Background and study aims En bloc endoscopic mucosal resection (EMR) is preferred over piecemeal resection for polyps ≤ 20 mm. Data on colorectal EMR training are limited. We aimed to evaluate the en bloc EMR rate of polyps ≤ 20 mm among advanced endoscopy trainees and to identify predictors of failed en bloc EMR. Methods This was a multicenter prospective study evaluating trainee performance in EMR during advanced endoscopy fellowship. A logistic regression model was used to identify the number of procedures and lesion cut-off size associated with an en bloc EMR rate of ≥ 80 %. Multivariate analysis was performed to identify predictors of failed en bloc EMR. Results Six trainees from six centers performed 189 colorectal EMRs, of which 104 (55 %) were for polyps ≤ 20 mm. Of these, 57.7 % (60/104) were resected en bloc. Trainees with ≥ 30 EMRs (OR 6.80; 95 % CI: 2.80–16.50; P = 0.00001) and lesions ≤ 17 mm (OR 4.56;95 CI:1.23–16.88; P = 0.02) were more likely to be associated with an en bloc EMR rate of ≥ 80 %. Independent predictors of failed en bloc EMR on multivariate analysis included: larger polyp size (OR:6.83;95 % CI:2.55–18.4; P = 0.0001), right colon location (OR:7.15; 95 % CI:1.31–38.9; P = 0.02), increased procedural difficulty (OR 2.99; 95 % CI:1.13–7.91; P = 0.03), and having performed < 30 EMRs (OR: 4.87; 95 %CI: 1.05–22.61; P = 0.04). Conclusions In this pilot study, we demonstrated that a relatively low proportion of trainees achieved en bloc EMR for polyps ≤ 20 mm and identified procedure volume and lesion size thresholds for successful en bloc EMR and independent predictors for failed en bloc resection. These preliminary results support the need for future efforts to define EMR procedure competence thresholds during training.

SP10.2.8 Trainee led Emergency Laparotomy operating; does it impact on outcomes?

Abstract Introduction To achieve completion of training in general surgery, trainees are required to demonstrate competency in common procedures performed at Emergency Laparotomy (Em Lap). We describe the patterns of trainee led emergency laparotomy operating and the association between post-operative outcomes. Methods All patients who had an Em Lap were extracted from the National Emergency Laparotomy Audit database from December 2013 to November 2017. Patients were grouped by grade of operative surgeon; trainee (speciality registrar) or Consultant (including Post Certificate of Completion (CCT) fellows). Trends in trainee operating by education deanery, hospital size and time of day of surgery were investigated. Adjusted regression analysis for the outcomes of 90-day mortality and return to theatre in operative subgroups of segmental colectomy, Hartmann's procedure, adhesiolysis and repair of perforated peptic ulcer disease were performed. Results The study cohort contained 95 520 patients. There were no increased odds of death by 90 days or of return to theatre across any of the operative groups when a trainee was listed as the most senior surgeon present in theatre. Trainees were more likely to operate independently in the Welsh deanery, high volume centres and at night (all P &amp;lt; 0.001). Conclusion There is significant variation in trainee led operating in Em Lap cases by deanery, hospital size and by time of day. However, this involvement in cases required for CCT in general surgery does not appear to impact on mortality or return to theatre in patients when adjusting for various pre-operative features.

Time between endobronchial ultrasound needle passes as a metric to monitor progress of trainees

ABSTRACT Background Methods to assess and track progress of new endobronchial ultrasound (EBUS) operators and trainees is desirable to ensure training goals and procedural competence are achieved. Relying on the diagnostic yield or on question-based assessments alone is not sufficient. This study examined the longitudinal change in times taken between needle passes (needle pass time; NPT) during EBUS lymph node sampling as a metric to monitor progress. Research Design and methods :The EBUS database of a tertiary hospital was accessed to extract data on the first 50 EBUS procedures for three trainees. The NPT was derived using PACS images that are stored to document every needle pass during an EBUS procedure and an average NPT was calculated. Results Between the three trainees, 157 procedures were carried out within the study period with 302 nodal stations sampled. The mean NPT (n = 204 stations) was 2:49 ± 0:49 mins. The mean node short axis diameter was 15.5 ± 8.7 mm. There was a negative correlation between node size and time per pass (r − 0.146, p = 0.045). The average NPT showed a negative correlation with procedure order through the first 50 procedures. Less variation between procedures was noted for the three trainees from the 30th procedure onward. On multivariate regression, NPT was significantly associated with procedure order regardless of station sampled or lymph node diameter. Conclusion NPT is novel, easy, and robust metric that can potentially help ensure EBUS trainees are advancing in a given training program.

Gender and Other Factors Associated with Endoscopy Volume Among U.S. Gastroenterology Fellows

Gastroenterology (GI) fellows' ability to perform procedures are evaluated by the level of competency in the cognitive and technical components of procedures in Accreditation Council for Graduate Medical Education-accredited fellowship programs.1 However, competency in endoscopic procedures correlates with the number of procedures performed.2 The American Society for Gastrointestinal Endoscopy has recommended that a minimum of 130 esophagogastroduodenoscopies (EGDs) and 275 colonoscopies be performed before procedural competency can be assessed.3 Few studies have examined program or trainee-related factors, such as trainee gender, that may influence procedural volume. In other procedural subspecialties, a gender gap exists in trainee procedural volumes, with female residents performing fewer surgical cases than males.4,5 However, whether gender-related disparities exist in endoscopy volume among GI trainees is unknown. The primary aim of this study was to determine the impact of GI fellow gender on endoscopic procedural volume during training. Secondary aims were to determine if fellow career choice or other training program-related factors, such as program size, location, or setting, affect procedure volume during fellowship.

Procedural skill maintenance: Perspectives and motivations of pediatric emergency medicine faculty.

Pediatric emergency medicine (PEM) physicians receive training in critical procedures, but these procedures are rare in practice. The literature on maintenance of procedural skills focuses on ways to practice (e.g., via simulation) and pays little attention to motivation's role. Understanding what motivates PEM physicians to maintain procedural skills can inform the design of supportive policies and interventions. Our study explores how PEM physicians conceptualize maintenance of procedural skills, what motivates them to maintain procedural skills, and barriers to procedural skill maintenance. This was a qualitative study of 12 PEM faculty guided by the self-determination theory (SDT) of motivation. SDT describes a typology that distinguishes extrinsic and intrinsic motivation, with intrinsic motivation based on autonomy, competence, and relatedness. Interviews were transcribed and coded using constant-comparative technique, and interviews continued until thematic sufficiency was achieved. Participants had difficulty defining procedural skill maintenance by specific criteria and expressed ambivalence about external standards for competence, noting the need to account for individual and local practice factors. Three themes characterizing participants' motivation for procedural skills maintenance included: (1) desire to provide optimal patient care and fear of unsuccessful performance (competence), (2) procedural competence as part of the identity of a PEM physician who teaches and performs procedures (competence and relatedness), and (3) desire for accessibility and choice of options in maintaining procedural skills (autonomy). Participants identified lack of opportunities, time, and support as barriers to motivation and skills maintenance. SDT concepts were integral to understanding faculty motivation, and this highlights the need for prioritizing faculty autonomy, competence, and relatedness in designing supports for procedural skill maintenance. Our findings regarding the difficulty in defining maintenance of skills emphasize the need for further discussion and study of this topic.

14 Is Coaching Using Video Laryngoscopy Superior to Traditional Method for Improving Pediatric Intubation Skills?

Pediatric intubations are critical procedures that can have significant morbidity or even mortality. Complexity and low frequency make it challenging for trainees to attain procedural competency. In traditional direct laryngoscopy (DL) training, the learner practices intubation on a mannequin while the instructor provides feedback. The use of video laryngoscopy (VL) allows others to have identical views of the airway as the operator and has been shown to improve the acquisition of DL intubation skills.

75 Impact of Lighting Conditions of Procedural Competence With Emergency Cricothyrotomy

Surgical cricothyrotomy (SC) is a difficult procedure in the best of conditions with high failure rates in the battlefield environment. The difficulty of this procedure is particularly great in a low-light tactical environment where white light cannot be utilized. Traditionally, red light has been the preferred light source in such environments, but is less than ideal for medical procedures. This study examines use of Red+Green (RG) light versus Red (R) light alone.

Peer coaching increases emergency medicine faculty ability to perform and teach awake fiberoptic intubation.

This study sought to evaluate the impact of peer coaching as a continuing medical education (CME) modality to improve faculty performance and teaching of a low-frequency, high-complexity procedure, awake fiberoptic intubation (AFOI). Academic emergency medicine faculty at a single tertiary care, Level I trauma center participated in a prospective pre-/postinterventional assessment of a peer coaching educational intervention. Participants completed a preintervention online survey to identify comfort and previous experience with performing and teaching AFOI. The participants reviewed presession materials and then completed a 25-min didactic session with a peer coach. Participants were then broken into dyads where they initially each practiced the procedure and then attempted to teach the procedure to their colleague. An institutional standardized checklist for AFOI was utilized to assess participants procedural competency. Postintervention online surveys were compared to the preintervention surveys. A total of 15 faculty members were recruited for the study andcompleted pre- and postintervention surveys. All participants showed ability to perform AFOI as proven by successful completion of the procedural checklist. There was a statistically significant increase for self-perceived efficacy in performing (p<0.001, 95% confidence interval [CI]=1.34 to 3.06) and teaching AFOI (p<0.001, 95% CI=1.56 to 3.05). All participants felt more likely to attempt AFOI after a single peer coaching session and most (14/15, 93.3%) were more likely to teach AFOI. Participants identified peer coaching as more effective at instilling confidence to perform and teach the skill than other CME activities that they have experienced. This study demonstrates that peer coaching increases practicing faculty's ability to perform and teach a low-frequency, high-complexity procedure, AFOI. Peer coaching may offer an opportunity to improve the utility of learning compared to more traditional didactic-based CME initiatives.

132 Faculty Procedural Skills in Academic Emergency Medicine: A Multisite Survey

Emergency physicians must be competent to perform numerous procedures. It is unclear if clinical practice alone is sufficient to maintain procedural skills, particularly for academic faculty who supervise trainees. Formal assessment of procedural skills beyond training is uncommon. There is a paucity of literature on faculty skills attrition or their preferences for skills maintenance. The faculty procedural skills (FPS) survey sought to determine faculty attitudes, beliefs and experience with procedures to inform programming aimed at skills maintenance. This was a multisite, cross-sectional study of emergency medicine (EM) and pediatric EM (PEM) physician faculty at five large US academic EM departments. Subjects were board certified or board eligible in EM or PEM and provided both clinical care and supervision of trainees. Subjects completed the FPS survey online which consisted of three sections: (1) respondent characteristics and experience performing and supervising EM procedures; (2) degree of confidence performing critical procedures; and (3) attitudes about skills attrition and learning preferences. Internal consistency of each survey section was calculated using Cronbach’s alpha. Items related to beliefs and attitudes were graded on a 5-point scale (strongly disagree to strongly agree), with higher values representing greater agreement. Response agreement (with 95% confidence interval [CI]) was calculated by combining “strongly disagree” with “disagree” and “strongly agree” with “agree” responses. A total of 186 faculty completed the survey (44% response rate). Scale reliability was good (Cronbach’s alpha performance = 0.82; supervision = 0.86; confidence = 0.85). All respondents agreed that ongoing procedural skills training is important for the clinical practice of EM. The majority of respondents agreed: that faculty should have opportunities to retrain for uncommon procedures (98%, 95% CI: ±2%); that skills attrition is a concerning problem (91%, 95% CI: ± 4.1%); that skills attrition is a patient safety issue (89%, 95% CI: ± 4.5%); that attrition was more likely in academic settings (93%, 95% CI: ± 3.7%); that faculty should be required to demonstrate procedural competence (83%, 95% CI: ± 5.4%). The majority of respondents (73%, 95% CI: ± 6.4%) personally experienced procedural skill attrition and a similar number (68%, 95% CI: ± 6.7%) observed it in peers. The most preferred method for skills maintenance was simulation (83%, 95% CI: ± 5.4%). The most preferred learning environment was in groups with peers (89%, 95% CI: ± 4.5%). A majority of faculty reported skills attrition, both personally and observed in peers. Respondents also overwhelmingly agreed they should be competent to perform procedures for which they are credentialed. These findings raise questions about the need for technical skill competency assessments for continued clinical practice. Faculty preferred simulation-based learning and peer environments for skills maintenance. Further study is needed to determine the attitudes, beliefs, and experiences of non-academic emergency physicians with procedural skills attrition.

Supervising students in a complex nursing practice- a focus group study in Norway

BackgroundThe supervisory role of registered nurses and intellectual disability nurses will be even more essential in the future, to support the education of competent newly graduated candidates. To our knowledge few studies have explored nursing student supervisors’ perspectives on supervision across primary- and hospital healthcare services and also across nurse educational programs. The aim of the current study was to investigate supervisors’ perspectives on supervising from different clinical settings, and across registered nurses’ and intellectual disability nurses’ clinical practice.MethodsThe study had an exploratory and descriptive design. The study was conducted within one university college catchment area in Southeastern-Norway. Eight focous group interviews were conducted in primary healthcare (n = 4) and hospital (n = 4) wards. A total of 31 registered nurses and three intellectual disability nurses participated. Hsieh and Shannon’s conventional content analysis was used to analyze the data.ResultsParticipants across primary- and hospital healthcare agreed that clinical practice was complex, and required that students gained competence in both technical and non-technical skills. Moreover, needed skills were described both as general and arena specific, and as both basic and advanced. Participants perceived that technical and non-technical skills together, ideally should lead to students being able to «see the person» behind the patient.ConclusionsSupervisors emphasized the challenges of supervising students in a complex nursing practice. Students should gain both procedural competence and an ability to provide person-centred care, and this challenged the supervisors’ own competence. Our findings indicate a need to support supervisors, to enable them to meet these challenges.