Stages of competency for medical procedures

Basic medical procedures have historically been taught at the bedside, without a formal curriculum. The supervision of basic procedures is often provided by the next most senior member of the health care team, who themselves may have very little experience. This approach does not allow for preparatory reading or deliberate practise of the procedure, and trainees often track the number of completed procedures as the only evidence of competency, without documented assessments of quality.

The conscious competence model is a learning paradigm for acquiring a new skill that can be applied to teaching medical procedures. There are multiple stages for effectively learning how to competently perform a procedure, which should not be distilled down into bedside demonstration alone. Learners can be guided through these stages to allow progression towards competency to perform a procedure unsupervised.

We propose a novel approach that divides procedural education into a four-step process that covers knowledge, experience, technical skill development and competency evaluation. The stages of competency outlined here can be tailored, with incremental expectations for any medical procedure and any level of learner.

This educational paradigm alters the current structure of teaching procedures at any level of medical education, with the goals of better comprehension, skill retention and decreased adverse outcomes. Graded objectives based on learner level can be determined by educators for each clinical procedure. This four-step framework for teaching medical procedures will make the adage 'see one, do one, teach one' obsolete.