Learning procedural skills in family medicine residency: comparison of rural and urban programs
- PMID: 17327892
- PMCID: PMC1531718
Learning procedural skills in family medicine residency: comparison of rural and urban programs
Abstract
Objective: To determine whether family medicine residents graduating from rural programs assess themselves as more experienced and competent in a range of procedural skills than graduates of urban programs do.
Design: Self-administered written survey.
Setting: Ontario.
Participants: Residents from 5 Ontario family medicine programs in 2000 and 2001; a total of 535 surveys were available for analysis (response rate of 78%).
Main outcome measures: Mean self-assessed experience and competence scores for 53 procedures at residency entry, end of year 1, and graduation.
Results: Upon entry, there was no difference in mean procedural experience (2.89 vs 2.85, P = .54) or mean competence (2.34 vs 2.36, P = .88) scores between rural residents and their urban counterparts. There was a significant increase in procedural experience (P < .001) and competence (P < .001) scores during residency training. At graduation, mean experience (3.98 vs 3.70, P < .001) and competence (3.67 vs 3.39, P = .004) scores were significantly higher for rural residents than for their urban colleagues. A statistically larger proportion of residents graduating from rural programs assessed themselves as competent in 16 procedures. These included skills necessary for treating patients in emergency settings (establish intravenous lines for adults and infants, obtain arterial blood gas measurements, intubate adults and neonates, perform cautery for epistaxis, remove corneal foreign body, aspirate or inject knee and shoulder joints, and apply forearm or walking casts), for diagnostic procedures (endometrial biopsy and bone marrow aspiration), and for management of labour and delivery (vaginal delivery; vacuum extraction; and repair of first-, second-, and third-degree tears).
Conclusion: Graduates of rural programs who have had a substantial component of training in communities of fewer than 10,000 people report greater self-assessed experience and competence in procedural skills than graduates of urban programs do. The difference likely reflects the unique aspects of rural training sites, including preceptors' competence in performing procedures.
OBJECTIF: Déterminer si les diplômés de la résidence en médecine familiale rurale considèrent qu’ils ont plus d’expérience et de compétences que ceux des programmes urbains en ce qui regarde diverses techniques cliniques.
TYPE D’ÉTUDE: Enquête écrite auto-administrée.
CONTEXTE: Ontario.
PARTICIPANTS: Résidents de 5 programmes de médecine familiale ontariens en 2000 et 2001; un total de 535 enquêtes ont été utilisées pour l’analyse (taux de réponse: 78%).
PRINCIPAUX PARAMÈTRES ÉTUDIÉS: Scores moyens que les résidents s’attribuent concernant l’expérience et les compétences qu’ils ont relativement à 53 techniques, tel que mesuré au début de la résidence, après un an et à la fin du programme.
RÉSULTATS: Au début du programme, il n’y avait pas de différence entre les scores des résidents ruraux et urbains pour ce qui est de l’expérience (2,89 vs 2,85, P = 0,54) ou des compétences techniques (2,34 vs 2,36, P = 0,88). Une augmentation significative des scores d’expérience (P < 0,001) et de compétences (P < 0,001) s’est produite durant la résidence. À l’obtention du diplôme, les résidents ruraux avaient des scores moyens significativement plus élevés que leurs collègues urbains pour l’expérience (3,98 vs 3,70, P < 0,001) et les compétences (3,67 vs 3,39, P = 0,004). Un nombre significativement plus élevé de diplômés des programmes ruraux se jugeaient compétents dans 16 techniques. Cela comprenait les compétences requises pour traiter des patients des services d’urgence (installer un cathéter intraveineux chez un adulte et un nourrisson, effectuer la mesure des gaz artériels, intuber des adultes et des nouveaux-nés, faire une cautérisation pour une épistaxis, extraire un corps étranger cornéen, faire une infiltration ou une aspiration de liquide dans les articulations du genou et de l’épaule, et faire un plâtre de l’avant-bras ou un plâtre de marche), pour des techniques diagnostiques (biopsie de l’endomètre et aspiration de moelle osseuse), et pour la prise en charge du travail et de l’accouchement (accouchement vaginal; extraction par ventouse; réparation de déchirure des premier, deuxième et troisième degrés).
CONCLUSION: Les diplômés des programmes ruraux qui ont passé une partie substantielle de leur formation dans des collectivités de moins de 10 000 habitants considèrent qu’ils ont une expérience et des compétences techniques cliniques supérieures à celles des diplômés des programmes urbains. Cela résulte vraisemblablement des particularités propres aux sites de formation ruraux, incluant la compétence des enseignants dans l’exécution des techniques.
Conflict of interest statement
Competing interests: None declared
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