A procedures curriculum for medical students


  • Michael T Fitch,

  • David E Manthey

Michael T Fitch MD, PhD, Department of Emergency Medicine, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, North Carolina 27157, USA. Tel: 00 1 336 716 4626; Fax: 00 1 336 716 5438; E-mail: mfitch@wfubmc.edu

Context and setting Recent studies report that many medical schools do not rigorously teach or evaluate procedural skills and do not require students to track procedures. These skills should be taught and evaluated as part of the medical curriculum.

Why the idea was necessary A recently published study identifying clinical procedures essential for students found a majority did not receive comprehensive training in procedures like i.v. placement, lumbar puncture and laceration repair. No mechanism was available for tracking student education or experience in completing procedures. Therefore, we designed a curriculum providing educational resources and a web-based system for tracking procedures.

What was done A multidisciplinary group of clinicians identified, evaluated and developed materials for teaching basic procedures. We created a 14-module, web-based, self-study curriculum using multimedia videos, handouts, competency checklists and multiple-choice question quizzes. The modules incorporated external multimedia web resources and materials created by our faculty. Student progress through each module and the curriculum is recorded electronically.

A web-based tracking system records numbers of procedures observed, participated in and completed during student rotations. Clerkship directors can track additional procedures during individual rotations.

Evaluation of results and impact The procedures curriculum was implemented in April 2008 to supplement the typical informal bedside teaching of procedures. A student focus group reported enthusiasm about the educational resources and use of procedure tracking.

The impact of the curriculum implemented for 120 students has been evaluated 1 year into the planned 2-year programme. During the first 12 months, the curriculum website containing 14 modules was accessed 2078 times from 472 computer IP addresses, demonstrating student use of the resources. During this first year, 33 of 120 students (28%) finished one or more of the curriculum modules, completing a total of 112 modules between them.

Over this first year, the procedure tracking system was used by all 120 students (100%) to track 8064 occurrences of 24 procedures in the core curriculum. Most student involvement in procedures consisted of observation (56%), followed by completing the procedure (31%) and participation (13%). The procedures most commonly completed by students were phlebotomy (40%), obstetrical delivery (8%), female urinary catheter placement (8%), male urinary catheter placement (7%), arterial blood gas (7%), bag valve mask airway (6%), and peripheral i.v. placement (6%). Success rates exceeded 70% for all core procedures except intubation (52% success rate) and lumbar puncture (51% success rate). An additional 21 858 occurrences of procedures and performances of clinical skills outside the curriculum were tracked.

Based on this success, the procedures curriculum is now a longitudinal course for our final two clinical years and is required for graduation. Initially, there were no deadlines for completing specific educational modules; this is now addressed by assigning individual modules during each core rotation to increase the number completed during the first year. A commercial subscription expands our educational materials to 30 required and 50 optional modules. Minimum required numbers of observed and completed procedures were established using numbers of procedures tracked during the first year of operation and faculty consensus.