Abstract

1. Maintaining Procedural Skill Competence • Gregory E Stewart BMScMD CCFP Abstract Department of Family Medicne Schulich School of Medicine & Dentistry The University of Western Ontario London, Ontario, Canada Findings Conclusions Table 1. Maintaining Procedural Skill Competence Summary A core principle of Family Medicine is that the Family Physician is a skilled clinician. Thus, they have an expert knowledge of a wide range of health issues of patients in their community and of less common, but life-threatening and treatable emergencies of all ages. The importance of simulation based learning is highlighted by the dual process model which describes efficient reasoning and judgment as distinguishing characteristics in safety critical environments. The model describes two cognitive systems for problem solving: System 1: intuitive and rapid reasoning System 2: deliberate and careful reasoning Key Point: Simulation based learning allows a trainee to develop essential reasoning and judgment while deliberate practice allows unfamiliar procedural skills to become more automated and efficient. Objective: Assemble, critically appraise and synthesize important findings from recent primary investigations addressing procedural skill training and maintenance of competence. Methods: Reference materials were selected with an online PubMed literature search using three separate key-word phrases related to the topic of study and published within the last five years. One hundred ninety-three results were reviewed and sixteen primary research papers were selected for further discussion based on their relevance to the study. Key Findings: Simulation based learning to proficiency in procedural skills improves performance in clinical settings and results in durable skill retention. This may be procedure specific and depend on the trainee’s stage of learning as well as the perceived need for the procedure in the physicians practice. Conclusions: Simulation based learning allows a trainee to develop essential reasoning and judgment while deliberate practice alllows unfamiliar procedural skills to become more automated and efficient. Further studies should confirm that procedural skills mastered in a simulation environment transfer to the variable clinical milieu and reduce adverse patient outcomes. References 1. Wetmore SJ, Rivet C, Tepper J, Tatemichi S, Donoff M, Rainsberry P. Defining core procedure skills for canadian family medicine training. Can Fam Physician [Internet]. 2005 Oct;51:1364-5. 2. van der Goes T, Grzybowski SC, Thommasen H. Procedural skills training. canadian family practice residency programs. Can Fam Physician [Internet]. 1999 Jan;45:78-85. 3. Grantcharov TP, Reznick RK. Teaching procedural skills. BMJ [Internet]. 2008 May 17;336(7653):1129-31. 4. Ericsson KA. Deliberate practice and acquisition of expert performance: A general overview. AcadEmerg Med [Internet]. 2008 Nov;15(11):988-94. Introduction In 2005, The College of Family Physicians of Canada commissioned a Working Group on Procedural Skills to generate a list of core and enhanced skills by surveying and analyzing suggestions from practicing family physicains (1,2). Interestingly, all physicians indicated more procedures in the core list than they performed in practice. This suggests that training for new family physicians should be refined in ways that enhance procedural skill acquisition and competence (3,4).