Procedural skills in paediatric residency: Re-evaluating the competencies

Abstract

Background: The Royal College of Physicians and Surgeons of Canada (RCPSC) sets objectives for residency training, including many skills that may not be commonly performed in practice.

Objective: To describe attitudes of residents enrolled in Canadian paediatric residency programs toward procedural skills training, including perception of importance and perceived proficiency of the RCPSC-required procedures.

Methods: An anonymous electronic survey was distributed to all senior residents enrolled in Canadian paediatric residencies, using a five-point Likert scale to address procedural importance and corresponding proficiency. Data were analyzed using descriptive statistics, with Pearson correlation coefficients used to describe relationships among variables.

Results: A total of 68 residents responded. Fifteen skills had a mean importance ≥4 (very or extremely important) and five skills had a mean rating <3 (somewhat or not important). Residents believed they were extremely or very proficient (mean rating ≥4) for three skills (bag-mask ventilation, lumbar puncture and chest x-ray interpretation). They reported 23 procedures for which they felt somewhat to not proficient (mean <3). The correlation between importance and proficiency was high (Pearson's correlation coefficient = 0.87). However, proficiency was significantly lower than importance (P<0.05) for the majority of procedures (88%). The largest gaps between importance and proficiency were observed for chest tube insertion, gathering evidence of child maltreatment, defibrillation and intraosseous insertion.

Conclusion: Many, but not all, RCPSC-required procedures are believed to be important. Residents do not believe that they are adequately proficient in many of these procedures. Skills with the greatest gap between importance and proficiency may be targets for curricular interventions.

Keywords: Clinical skills; Education; Paediatrics; Procedures; Residency.

Figure 1)

Mean importance and perceived proficiency scores for each of the Royal College of Physicians and Surgeons-required procedural skills. BMV Bag-mask ventilation; CPR Cardiopulmonary resuscitation; CVL Central venous line; IO Intraosseous; ECG Electrocardiogram; FB Foreign body; GU Genitourinary; ID Infectious disease; IV Intravenous; NG Nasogastric; OG Orogastric; PFT Pulmonary function test; TB Tuberculosis; UA Umbilical artery; UV Umbilical vein

Figure 2)

Mean importance and perceived proficiency of skills categorized according to subgroup