Training effect of skills courses on confidence of junior doctors performing clinical procedures

Junior doctors face several challenges including how to acquire procedural skills as they embark on their professional careers. There has been a trend away from the less structured opportunistic teaching style of senior doctors towards teaching procedural skills in short courses in skills training centres.

To determine the impact of a procedural skills course and of ongoing experience on the confidence of junior doctors undertaking procedures in clinical practice, and to identify any relationship between confidence level and amount of ongoing experience.

An intake of junior doctors (n=33) attended a procedural skills course and learnt six procedures, comprising exploration and debridement of a contaminated wound, nasogastric tube insertion, urethral catheterisation, lumbar puncture, pleural aspiration, and intercostal drain insertion and removal. Three questionnaires assessing their experience with the procedures and their confidence were completed before and immediately after the course, and 5 months later.

The procedural skills course had a positive impact on the immediate confidence of junior doctors performing all of the clinical procedures as measured by a confidence survey pre- and post-course. Only nasogastric tube insertion, urethral catheterisation, and pleural aspiration demonstrated a maintained increase in confidence when comparing pre-course to five months follow-up confidence levels. Only urethral catheterisation was associated with an overall increase in confidence at 5 months' follow-up. Overall there was a strong positive correlation between changes in experience and changes in confidence.

The procedural skills course produced a significant increase in confidence in the short term, but this decreased unless there was ongoing clinical experience with the procedure. The benefit of short courses is eroded by the lack of reinforcement through continuing experience.