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Procedural confidence in hospital based practitioners: implications for the training and practice of doctors at all grades.

Connick RM, Connick P, Klotsas AE, Tsagkaraki PA, Gkrania-Klotsas E - BMC Med Educ (2009)

Bottom Line: Both trainees and consultants provide significant service provision.The procedural confidence is dependent upon gender, number of procedures performed in the previous year and total number of procedures performed.This has implications for those designing the training curriculum and with regards the move to shorten the duration of training.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Acute Medicine, Hinchingbrooke Hospital, Hinchingbrooke Health Care NHS Trust, Hinchingbrooke, UK. rona.connick@hichingbrookes.nhs.uk

ABSTRACT

Background: Medical doctors routinely undertake a number of practical procedures and these should be performed competently. The UK Postgraduate Medical Education and Training Board (PMETB) curriculum lists the procedures trainees should be competent in. We aimed to describe medical practitioner's confidence in their procedural skills, and to define which practical procedures are important in current medical practice.

Methods: A cross sectional observational study was performed measuring procedural confidence in 181 hospital practitioners at all grades from 2 centres in East Anglia, England.

Results: Both trainees and consultants provide significant service provision. SpR level doctors perform the widest range and the highest median number of procedures per year. Most consultants perform few if any procedures, however some perform a narrow range at high volume. Cumulative confidence for the procedures tested peaks in the SpR grade. Five key procedures (central line insertion, lumbar puncture, pleural aspiration, ascitic aspiration, and intercostal drain insertion) are the most commonly performed, are seen as important generic skills, and correspond to the total number of procedures for which confidence can be maintained. Key determinants of confidence are gender, number of procedures performed in the previous year and total number of procedures performed.

Conclusion: The highest volume of service requirement is for six procedures. The procedural confidence is dependent upon gender, number of procedures performed in the previous year and total number of procedures performed. This has implications for those designing the training curriculum and with regards the move to shorten the duration of training.

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Cumulative confidence score by grade. FY1 = Foundation year 1, FY2 = Foundation year 2, SHO = Senior house officer, SpR = Specialist registrar.
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Figure 1: Cumulative confidence score by grade. FY1 = Foundation year 1, FY2 = Foundation year 2, SHO = Senior house officer, SpR = Specialist registrar.

Mentions: Procedural confidence responses showed an "all or nothing" effect. Twenty seven percent (522/1762) of responses were "not at all confident", twenty seven percent (474/1762) of responses were "very confident", twenty one percent (376/1762) of responses were "confident" and nineteen percent (330/1762) of responses were "not so confident". This effect was seen for all procedures (supplementary figure 2 ). The individual cumulative confidence score ("not at all confident" = 1, "not so confident" = 2, "confident" = 3, "very confident" = 4; giving a cumulative confidence score range of 10 – 40) shows the trend that confidence for these ten procedures peaks in the specialist registrar grade, and declines in consultant practice (figure 1). Overall, clinicians at any grade are "confident" or "very confident" to perform 4 – 5 procedures, although this also exhibits variation by grade similar to that for cumulative confidence scores (table 3). The procedures which >50% responders felt "confident" or "very confident" to perform are lumbar puncture, pleural aspiration, ascitic aspiration, intercostal drain insertion, DC cardioversion and central line insertion. Few responders were confident in CPAP management or temporary cardiac pacing (figure 2).


Procedural confidence in hospital based practitioners: implications for the training and practice of doctors at all grades.

Connick RM, Connick P, Klotsas AE, Tsagkaraki PA, Gkrania-Klotsas E - BMC Med Educ (2009)

Cumulative confidence score by grade. FY1 = Foundation year 1, FY2 = Foundation year 2, SHO = Senior house officer, SpR = Specialist registrar.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2651872&req=5

Figure 1: Cumulative confidence score by grade. FY1 = Foundation year 1, FY2 = Foundation year 2, SHO = Senior house officer, SpR = Specialist registrar.
Mentions: Procedural confidence responses showed an "all or nothing" effect. Twenty seven percent (522/1762) of responses were "not at all confident", twenty seven percent (474/1762) of responses were "very confident", twenty one percent (376/1762) of responses were "confident" and nineteen percent (330/1762) of responses were "not so confident". This effect was seen for all procedures (supplementary figure 2 ). The individual cumulative confidence score ("not at all confident" = 1, "not so confident" = 2, "confident" = 3, "very confident" = 4; giving a cumulative confidence score range of 10 – 40) shows the trend that confidence for these ten procedures peaks in the specialist registrar grade, and declines in consultant practice (figure 1). Overall, clinicians at any grade are "confident" or "very confident" to perform 4 – 5 procedures, although this also exhibits variation by grade similar to that for cumulative confidence scores (table 3). The procedures which >50% responders felt "confident" or "very confident" to perform are lumbar puncture, pleural aspiration, ascitic aspiration, intercostal drain insertion, DC cardioversion and central line insertion. Few responders were confident in CPAP management or temporary cardiac pacing (figure 2).

Bottom Line: Both trainees and consultants provide significant service provision.The procedural confidence is dependent upon gender, number of procedures performed in the previous year and total number of procedures performed.This has implications for those designing the training curriculum and with regards the move to shorten the duration of training.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Acute Medicine, Hinchingbrooke Hospital, Hinchingbrooke Health Care NHS Trust, Hinchingbrooke, UK. rona.connick@hichingbrookes.nhs.uk

ABSTRACT

Background: Medical doctors routinely undertake a number of practical procedures and these should be performed competently. The UK Postgraduate Medical Education and Training Board (PMETB) curriculum lists the procedures trainees should be competent in. We aimed to describe medical practitioner's confidence in their procedural skills, and to define which practical procedures are important in current medical practice.

Methods: A cross sectional observational study was performed measuring procedural confidence in 181 hospital practitioners at all grades from 2 centres in East Anglia, England.

Results: Both trainees and consultants provide significant service provision. SpR level doctors perform the widest range and the highest median number of procedures per year. Most consultants perform few if any procedures, however some perform a narrow range at high volume. Cumulative confidence for the procedures tested peaks in the SpR grade. Five key procedures (central line insertion, lumbar puncture, pleural aspiration, ascitic aspiration, and intercostal drain insertion) are the most commonly performed, are seen as important generic skills, and correspond to the total number of procedures for which confidence can be maintained. Key determinants of confidence are gender, number of procedures performed in the previous year and total number of procedures performed.

Conclusion: The highest volume of service requirement is for six procedures. The procedural confidence is dependent upon gender, number of procedures performed in the previous year and total number of procedures performed. This has implications for those designing the training curriculum and with regards the move to shorten the duration of training.

Show MeSH
Related in: MedlinePlus