Historically, attaining medical procedural competency during training has been challenging [1–3]. At a small district general hospital, initiatives were implemented to address these mandatory curriculum components.
1) Ten skill-sessions were organized, to encompass all mandatory procedures such as skills in central venous catheter, chest drain, ascitic drain, lumbar puncture, DC cardioversion, pacing, and interosseous access. Doctors, advanced clinical and nurse practitioners were invited to attend a face-to-face procedure session. Manikins alongside medical procedure toolkits were provided to assist in simulation training. Pre- and post-Likert Scale questionnaire was used to assess skill-specific confidence levels.
2) A specific WhatsApp group was used to alert doctors of procedural training opportunities within the hospital. Terms of reference and clear clinical governance guidance were provided prior to sign-up. To assess the effectiveness of this method, a questionnaire was distributed amongst the users.
Thirty-eight professionals in training attended the sessions. The cumulative rating of all skills revealed an improvement in skill confidence from 15% to 80%. This was most marked in the interosseous access (17% to 100%) and abdominal paracentesis (27% to 100%). However, aptitude in central venous catheter was identified as having the lowest confidence skill level both pre-and post-sessions (0% to 60%). 86% of trainees found the WhatsApp group to be effective or very effective to communicate procedural training opportunities within the hospital. Within six-months, bedside training in DC cardioversion, ascitic drains, interosseous access, pleural aspiration, and drains were achieved.
The training sessions improved skill-specific confidence. Equally, the more challenging procedural skills were identified for more training. Further plans for this Quality Improvement Programme will include utilizing the hospital’s online communication platform, organizing procedure-specific human factors teaching, and extending training sessions to consultants to evidence the upkeep of procedural competency.
We would like to thank and acknowledge the contribution of the Dinwoodie Charity Company of Physicians. The medical registrar: Empowering the unsung heroes of patient care. RCP, 2013.
1. Tasker F, Dacombe P, Goddard AF, Burr B. Improving core medical training – Innovative and feasible ideas to better training. Clinical Medicine. 2014;14(6):612–617.
2. Tasker F, Newbery N, Burr B, Goddard AF. Survey of core medical trainees in the United Kingdom 2013 – Inconsistencies in training experience and competing with service demands. Clinical Medicine. 2014;14(2):149–156.
3. Lim CT, Gibbs V, Lim CS. Invasive medical procedure skills amongst Foundation Year Doctors – a questionnaire study. JRSM Open. 2014;5(5):2054270414527934.
Medical procedures initiative from simulation laboratory to medical wards
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