Gaps in Procedural Experience and Competency in Medical School Graduates

Authors

  • Susan B. Promes MD,

    1. From the Department of Emergency Medicine, University of California San Francisco, (SBP) San Francisco, CA; Department of Medicine (SMC) and Office of the Dean (COG), Duke University School of Medicine, Durham, NC; Department of Emergency Medicine, Emory University, (PS) Atlanta, GA; Department of Emergency Medicine, Carolinas Medical Center, (JI) Charlotte, NC; Department of Emergency Medicine, University of North Carolina, (SWG, CBC) Chapel Hill, NC
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  • Saumil M. Chudgar MD,

    1. From the Department of Emergency Medicine, University of California San Francisco, (SBP) San Francisco, CA; Department of Medicine (SMC) and Office of the Dean (COG), Duke University School of Medicine, Durham, NC; Department of Emergency Medicine, Emory University, (PS) Atlanta, GA; Department of Emergency Medicine, Carolinas Medical Center, (JI) Charlotte, NC; Department of Emergency Medicine, University of North Carolina, (SWG, CBC) Chapel Hill, NC
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  • Colleen O’Connor Grochowski PhD,

    1. From the Department of Emergency Medicine, University of California San Francisco, (SBP) San Francisco, CA; Department of Medicine (SMC) and Office of the Dean (COG), Duke University School of Medicine, Durham, NC; Department of Emergency Medicine, Emory University, (PS) Atlanta, GA; Department of Emergency Medicine, Carolinas Medical Center, (JI) Charlotte, NC; Department of Emergency Medicine, University of North Carolina, (SWG, CBC) Chapel Hill, NC
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  • Philip Shayne MD,

    1. From the Department of Emergency Medicine, University of California San Francisco, (SBP) San Francisco, CA; Department of Medicine (SMC) and Office of the Dean (COG), Duke University School of Medicine, Durham, NC; Department of Emergency Medicine, Emory University, (PS) Atlanta, GA; Department of Emergency Medicine, Carolinas Medical Center, (JI) Charlotte, NC; Department of Emergency Medicine, University of North Carolina, (SWG, CBC) Chapel Hill, NC
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  • Jennifer Isenhour MD,

    1. From the Department of Emergency Medicine, University of California San Francisco, (SBP) San Francisco, CA; Department of Medicine (SMC) and Office of the Dean (COG), Duke University School of Medicine, Durham, NC; Department of Emergency Medicine, Emory University, (PS) Atlanta, GA; Department of Emergency Medicine, Carolinas Medical Center, (JI) Charlotte, NC; Department of Emergency Medicine, University of North Carolina, (SWG, CBC) Chapel Hill, NC
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  • Seth W. Glickman MD,

    1. From the Department of Emergency Medicine, University of California San Francisco, (SBP) San Francisco, CA; Department of Medicine (SMC) and Office of the Dean (COG), Duke University School of Medicine, Durham, NC; Department of Emergency Medicine, Emory University, (PS) Atlanta, GA; Department of Emergency Medicine, Carolinas Medical Center, (JI) Charlotte, NC; Department of Emergency Medicine, University of North Carolina, (SWG, CBC) Chapel Hill, NC
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  • Charles B. Cairns MD

    1. From the Department of Emergency Medicine, University of California San Francisco, (SBP) San Francisco, CA; Department of Medicine (SMC) and Office of the Dean (COG), Duke University School of Medicine, Durham, NC; Department of Emergency Medicine, Emory University, (PS) Atlanta, GA; Department of Emergency Medicine, Carolinas Medical Center, (JI) Charlotte, NC; Department of Emergency Medicine, University of North Carolina, (SWG, CBC) Chapel Hill, NC
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  • Presented at the Association of American Medical Colleges Annual Meeting, Washington, DC, November, 2007.

  • CoI: The author reports no conflict of financial interest.

Address for correspondence and reprints: Susan B. Promes, MD, e-mail: susan.promes@ucsf.edu.

Abstract

Objectives:  The goal of undergraduate medical education is to prepare medical students for residency training. Active learning approaches remain important elements of the curriculum. Active learning of technical procedures in medical schools is particularly important, because residency training time is increasingly at a premium because of changes in the Accreditation Council for Graduate Medical Education duty hour rules. Better preparation in medical school could result in higher levels of confidence in conducting procedures earlier in graduate medical education training. The hypothesis of this study was that more procedural training opportunities in medical school are associated with higher first-year resident self-reported competency with common medical procedures at the beginning of residency training.

Methods:  A survey was developed to assess self-reported experience and competency with common medical procedures. The survey was administered to incoming first-year residents at three U.S. training sites. Data regarding experience, competency, and methods of medical school procedure training were collected. Overall satisfaction and confidence with procedural education were also assessed.

Results:  There were 256 respondents to the procedures survey. Forty-four percent self-reported that they were marginally or not adequately prepared to perform common procedures. Incoming first-year residents reported the most procedural experience with suturing, Foley catheter placement, venipuncture, and vaginal delivery. The least experience was reported with thoracentesis, central venous access, and splinting. Most first-year residents had not provided basic life support, and more than one-third had not performed cardiopulmonary resuscitation (CPR). Participation in a targeted procedures course during medical school and increasing the number of procedures performed as a medical student were significantly associated with self-assessed competency at the beginning of residency training.

Conclusions:  Recent medical school graduates report lack of self-confidence in their ability to perform common procedures upon entering residency training. Implementation of a medical school procedure course to increase exposure to procedures may address this challenge.

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