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Competence and Confidence With Basic Procedural Skills: The Experience and Opinions of Fourth-Year Medical Students at A Single Institution

Dehmer, Jeffrey J. MD; Amos, Keith D. MD; Farrell, Timothy M. MD; Meyer, Anthony A. MD, PhD; Newton, Warren P. MD, MPH; Meyers, Michael O. MD

Academic Medicine:
doi: 10.1097/ACM.0b013e31828b0007
Research Reports
Abstract

Purpose: Data indicate that students are unprepared to perform basic medical procedures on graduation. The authors’ aim was to characterize graduating students’ experience with and opinions about these skills.

Method: In 2011, an online survey queried 156 fourth-year medical students about their experience with, and actual and desired levels of competence for, nine procedural skills (Foley catheter insertion, nasogastric tube insertion, venipuncture, intravenous catheter insertion, arterial puncture, basic suturing, endotracheal intubation, lumbar puncture, and thoracentesis). Students self-reported competence on a four-point Likert scale (4 = independently performs skill; 1 = unable to perform skill). Data were analyzed by analysis of variance and Student t test. A five-point Likert scale was used to assess student confidence.

Results: One hundred thirty-four (86%) students responded. Two skills were performed more than two times by over 50% of students: Foley catheter insertion and suturing. Mean level of competence ranged from 3.13 ± 0.75 (Foley catheter insertion) to 1.7 ± 0.7 (thoracentesis). A gap in desired versus actual level of competence existed for all procedures (P < .0001). There was a correlation between the number of times a procedure had been performed and self-reported competence for all skills except arterial puncture and suturing.

Conclusions: Participants had performed most skills infrequently and rated themselves as being unable to perform them without assistance. Strategies to improve student experience and competence of procedural skills must evolve to improve the technical competency of graduating students because their current competency varies widely.

Author Information

Dr. Dehmer is a clinical fifth-year resident in general surgery, Department of Surgery, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina.

Dr. Amos is assistant professor of surgery, Division of Surgical Oncology, Department of Surgery, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina.

Dr. Farrell is professor of surgery, Division of Gastrointestinal Surgery, Department of Surgery, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina.

Dr. Meyer is Colin G. Thomas Distinguished Professor and Chair, Department of Surgery, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina.

Dr. Newton is William B. Aycock Distinguished Professor and Chair, Department of Family Medicine, and vice dean for medical education, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina.

Dr. Meyers is associate professor of surgery and program director for general surgery, Division of Surgical Oncology, Department of Surgery, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina.

Correspondence should be addressed to Dr. Meyers, 170 Manning Dr., 1150 Physicians Office Bldg., CB # 7213, Chapel Hill, NC 28599-7213; telephone: (919) 966-5221; fax: (919) 966-8806; e-mail: michael_meyers@med.unc.edu.

© 2013 Association of American Medical Colleges