Hostname: page-component-cd9895bd7-8ctnn Total loading time: 0 Render date: 2024-12-25T07:00:36.007Z Has data issue: false hasContentIssue false
  • English
  • Français

Emergency medicine procedural skills: what are residents missing?

Published online by Cambridge University Press:  04 March 2015

Andrew Petrosoniak ,
Jodi Herold  and
Karen Woolfrey
Andrew Petrosoniak
Affiliation:
Royal College Emergency Medicine Residency Training Program, Toronto, ON
Jodi Herold
Affiliation:
Wilson Centre for Research in Education, University Health Network, Faculty of Medicine, Toronto, ON
Karen Woolfrey*
Affiliation:
Royal College Emergency Medicine Residency Training Program, Toronto, ON Division of Emergency Medicine, Department of Medicine, University of Toronto, Toronto, ON
*
Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, C7-53, Toronto, ON M4N 3M5; [email protected]

Abstract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.
Objective:

This study sought to establish the current state of procedural skills training in Canadian Royal College emergency medicine (EM) residencies.

Methods:

A national Web-based survey was administered to residents and program directors of all 13 Canadian-accredited Royal College EM residency programs. Programdirectors rated the importance and experience required for competence of 45 EM procedural skills. EM residents reported their experience and comfort in performing the same procedural skills.

Results:

Thirteen program directors and 86 residents responded to the survey (response rate of 100% and 37%, respectively). Thirty-two (70%) procedures were considered important by > 70% of program directors, including all resuscitation and lifesaving airway procedures. Four procedures deemed important by program directors, including cricothyroidotomy, pericardiocentesis, posterior nasal pack for epistaxis, and paraphimosis reduction, had never been performed by the majority of senior residents. Program director opinion was used to categorize each procedure based on performance frequency to achieve competence. Overall, procedural experience correlated positively with comfort levels as indicated by residents.

Conclusions:

We established an updated needs assessment of procedural skills training for Canadian Royal College EM residency programs. This included program director opinion of important procedures and the performance frequency needed to achieve competence. However, we identified several important procedures that were never performed by most senior residents despite program director opinion regarding the experience needed for competence. Further study is required to better define objective measures for resident competence in procedural skills.

Keywords

clinical competenceemergency medicinemedical education
Type
Education • Enseignement
Information
Canadian Journal of Emergency Medicine , Volume 15 , Issue 4 , July 2013 , pp. 241 - 248
Copyright
Copyright © Canadian Association of Emergency Physicians 2013

References

REFERENCES

1.Epstein, RM. Assessment in medical education. N Engl J Med 2007;356:387–96, doi:10.1056/NEJMe078002.Google Scholar
2.Bancroft, GN, Basu, CB, Leong, M, et al. Outcome-based residency education: teaching and evaluating the core competencies in plastic surgery. Plast Reconstr Surg 2008;121:441e-8e, doi:10.1097/PRS.0b013e318170a778.CrossRefGoogle ScholarPubMed
3.Shah, VA, Reddy, AK, Bonham, AJ, et al. Resident surgical practice patterns for vitreoretinal surgery in ophthalmic training programs in the United States. Ophthalmology 2009;116:783-9, doi:10.1016/j.ophtha.2008.11.010.Google Scholar
4.Sherbino, J, Bandiera, G, Frank, JR. Assessing competence in emergency medicine trainees: an overview of effective methodologies. CJEM 2008;10:365–71.CrossRefGoogle Scholar
5.Goroll, AH, Sirio, C, Duffy, FD, et al. A new model for accreditation of residency programs in internal medicine. Ann Intern Med 2004;140:902–9.CrossRefGoogle ScholarPubMed
6.Reznick, RK, MacRae, H. Teaching surgical skills—changes in the wind. N Engl J Med 2006;355:2664–9, doi:10.1056/NEJMra054785.Google Scholar
7.Leape, LL, Brennan, TA, Laird, N, et al. The nature of adverse events in hospitalized patients. Results of the Harvard Medical Practice Study II. N Engl J Med 1991;324:377–84, doi:10.1056/NEJM199102073240605.Google Scholar
8.Nettleman, MD, Bock, MJ, Nelson, AP, et al. Impact of procedure-related complications on patient outcome on a general medicine service. J Gen Intern Med 1994;9:66–70, doi:10.1007/BF02600202.CrossRefGoogle ScholarPubMed
9.Dijksterhuis, MG, Voorhuis, M, Teunissen, PW, et al. Assessment of competence and progressive independence in postgraduate clinical training. Med Educ 2009;43:1156–65, doi:10.1111/j.1365-2923.2009.03509.x.CrossRefGoogle ScholarPubMed
10.Mourad, M, Kohlwes, J, Maselli, J, et al. Supervising the supervisors—procedural training and supervision in internal medicine residency. J Gen Intern Med 2010;25:351–6, doi:10.1007/s11606-009-1226-z.CrossRefGoogle ScholarPubMed
11.Thomas, HA, Beeson, MS, Binder, LS, et al. The 2005 Model of the Clinical Practice of Emergency Medicine: the 2007 update. Acad Emerg Med 2008;15:776–9, doi:10.1111/j.1553-2712.2008.00194.x.Google Scholar
12.Royal College of Physicians and Surgeons. Objectives of training in emergency medicine. Ottawa: Royal College of Physicians and Surgeons; 2008.Google Scholar
13.Farion, K, Morrison, LJ. Redefining emergency medicine procedures: Canadian competence and frequency survey. Acad Emerg Med 2001;8:731–8, doi:10.1111/j.1553-2712.2001.tb00193.x.Google Scholar
14.Dire, DJ, Kietzman, LI. A prospective survey of procedures performed by emergency medicine residents during a 36-month residency. J Emerg Med 1995;13:831–7, doi:10.1016/0736-4679(95)02012-8.Google Scholar
15.Langdorf, MI, Montague, BJ, Bearie, B, et al. Quantification of procedures and resuscitations in an emergency medicine residency. J Emerg Med 1998;16:121–7, doi:10.1016/S0736-4679(97)00252-7.Google Scholar
16.Hayden, SR, Panacek, EA. Procedural competency in emergency medicine: the current range of resident experience. Acad Emerg Med 1999;6:728–35, doi:10.1111/j.1553-2712.1999.tb00444.x.CrossRefGoogle Scholar
17.Al-Eissa, M, Chu, S, Lynch, T, et al. Self-reported experience and competence in core procedures among Canadian pediatric emergency medicine fellowship trainees. CJEM 2008;10:533–8.Google Scholar
18.Accreditation Council for Graduate Medical Education. Emergency medicine guidelines - procedures and resuscitations. Available at: http://www.acgme.org/acgmeweb/tabid/292/ProgramandInstitutionalGuidelines/Hospital-BasedAccreditation/EmergencyMedicine/EmergencyMedicineGuidelines.aspx (accessed February 14, 2013).Google Scholar
19.Gaies, MG, Landrigan, CP, Hafler, JP, et al. Assessing procedural skills training in pediatric residency programs. Pediatrics 2007;120:715–22, doi:10.1542/peds.2007-0325.Google Scholar
20.Wigton, RS, Blank, LL, Nicolas, JA, et al. Procedural skills training in internal medicine residencies. A survey of program directors. Ann Intern Med 1989;111:932–8.Google Scholar
21.Dillman, DA. Mail and Internet surveys: the tailored design method. New York: John Wiley & Sons; 2000.Google Scholar
22.Huang, GC, Smith, CC, Gordon, CE, et al. Beyond the comfort zone: residents assess their comfort performing inpatient medical procedures. Am J Med 2006;119:71 e17-24, doi:10.1016/j.amjmed.2005.08.007.Google Scholar
23.Naik, VN, Devito, I, Halpern, SH. Cusum analysis is a useful tool to assess resident proficiency at insertion of labour epidurals. Can J Anaesth 2003;50:694–8, doi:10.1007/BF03018712.Google Scholar
24.Spier, BJ, Benson, M, Pfau, PR, et al. Colonoscopy training in gastroenterology fellowships: determining competence. Gastrointest Endosc 2010;71:319–24, doi:10.1016/j.gie.2009.05.012.Google Scholar
25.Zevin, B, Aggarwal, R, Grantcharov, TP. Simulation-based training and learning curves in laparoscopic Roux-en-Y gastric bypass. Br J Surg 2012;99:887–95, doi:10.1002/bjs.8748.Google Scholar
26.Ball, CG, Lord, J, Laupland, KB, et al. Chest tube complications: how well are we training our residents? Can J Surg 2007;50:450–8.Google ScholarPubMed
27.Leung, J, Duffy, M, Finckh, A. Real-time ultrasonographicallyguided internal jugular vein catheterization in the emergency department increases success rates and reduces complications: a randomized, prospective study. Ann Emerg Med 2006;48:540–7, doi:10.1016/j.annemergmed.2006.01.011.Google Scholar
28.Harvey, A, Bandiera, G, Nathens, AB, et al. Impact of stress on resident performance in simulated trauma scenarios. J Trauma 2012;72:497–503.Google Scholar
29.Tintinalli, JE, Shofer, F, Biese, K, et al. Toward a new paradigm: goal-based residency training. Acad Emerg Med 2011;18 Suppl 2:S71-8.Google Scholar
30.Luyet, C, Schupfer, G, Wipfli, M, et al. Different learning curves for axillary brachial plexus block: ultrasound guidance versus nerve stimulation. Anesthesiol Res Pract 2010;2010:309462. Epub 2011 Jan 20.Google Scholar
31.McLeod, R, Mires, G, Ker, J. Direct observed procedural skills assessment in the undergraduate setting. Clin Teach 2012;9:228–32, doi:10.1111/j.1743-498X.2012.00582.x.CrossRefGoogle ScholarPubMed
32.Druck, J, Valley, MA, Lowenstein, SR. Procedural skills training during emergency medicine residency: are we teaching the right things? West J Emerg Med 2009;10:152–6.Google ScholarPubMed
33.Baciarello, M, Zasa, M, Manferdini, ME, et al. The learning curve for laryngoscopy: Airtraq versus Macintosh laryngoscopes. J Anesth 2012 Feb 21. [Epub ahead of print]Google Scholar
34.Reeder, TJ, Brown, CK, Norris, DL. Managing the difficult airway: a survey of residency directors and a call for change. J Emerg Med 2005;28:473–8, doi:10.1016/j.jemermed.2004.11.027.CrossRefGoogle Scholar