Procedural skill needs for Canadian paediatricians: A national profile

Abstract

Background and objectives: Procedural practice by paediatricians in Canada is evolving. Little empirical information is available on the procedural competencies required of general paediatricians. Accordingly, the aim of this study was to conduct a needs assessment of Canadian general paediatricians to identify procedural skills required for practice, with the goal of informing post-graduate and continuing medical education.

Methods: A survey was sent to paediatricians through the Canadian Paediatric Surveillance Program (CPSP) (www.cpsp.cps.ca/surveillance). In addition to demographic information about practice type and location, participants were asked to indicate the frequency with which they performed each of 32 pre-selected procedures and whether each procedure was considered essential to their practice.

Results: The survey response rate was 33.2% (938/2,822). Data from participants who primarily practice general paediatrics were analyzed (n=481). Of these, 71.0% reported performing procedures. The most frequently performed procedures were: bag-valve-mask ventilation of an infant, lumbar puncture, and ear curettage, being performed monthly by 40.8%, 34.1%, and 27.7% of paediatricians, respectively. The procedures performed by most paediatricians were also those found most essential to practice, with a few exceptions. Respondents performed infant airway procedures with greater frequency and rated them more essential when compared to the same skill performed on children. We found a negative correlation between procedures being performed and difficulty maintaining proficiency in a skill.

Conclusions: This report of experiences from Canadian general paediatricians suggests a wide variability in the frequency of procedural performance. It helps establish priorities for post-graduate and continuing professional medical education curricula in the era of competency-based medical education.

Keywords: Educational needs; Graduate medical education; Paediatric; Procedural skills assessment.

Figure 1.

Study profile.

Figure 2.

Procedural skill data. (A) Performance frequency and essentiality by percentage of respondents. (B) Difficulty in maintenance of proficiency by percentage of respondents. Procedures listed in descending order of percentage performed. BVM Bag-valve-mask ventilation; C-spine Cervical spine; CVL Central venous line; G-tube Gastrostomy tube; LMA Laryngeal mask airway insertion; NG/OG Nasogastric tube/orogastric tube; PICC Peripherally inserted central catheter; PIV Peripheral intravenous line.

Figure 3.

Percentage of respondents performing a procedural skill as part of their practice vs their perceived ability to maintain proficiency in that skill. Linear regression analysis represented with coefficient of determination (R²). BVM-I Bag-valve-mask ventilation of infant; BVM-C Bag-valve-mask ventilation of child; C-spine Cervical spine; CVL Central venous line; G-tube Gastrostomy tube; IO Intraosseous line; LMA Laryngeal mask airway insertion; LP Lumbar puncture; NG/OG Nasogastric tube/orogastric tube; PICC Peripherally inserted central catheter; PIV Peripheral intravenous line; SPA Suprapubic aspiration.