Residents' Procedural Experience Does Not Ensure Competence: A Research Synthesis

Area of Science:

• Medical Education
• Surgical Skills Simulation
• Graduate Medical Training

Background:

• Medical certifying bodies mandate minimum procedure numbers for board eligibility.
• The link between resident procedure volume and clinical competence is not well-established.

Purpose of the Study:

• To assess the relationship between residents' simulated medical procedure skills and their self-reported experience and training year.
• To evaluate procedural skill acquisition in residency.

Main Methods:

• Synthesized data from 7 research reports (2006-2016) involving internal medicine, emergency medicine, anesthesiology, and neurology residents.
• Assessed simulated performance of central venous catheter insertion, lumbar puncture, paracentesis, and thoracentesis.
• Compared simulated skills with self-reported procedure numbers and postgraduate year (PGY).

Main Results:

• Significant associations found between passing skills exams and higher self-reported procedures (P=.011) and PGY (P<.001).
• Overall performance was poor, with only 10% of residents passing simulated assessments (mean 48% checklist items correct).
• Improved performance was mainly observed between PGY-1 and later training years.

Conclusions:

• While self-reported experience and training year correlate with simulated procedure performance, overall skill levels are inadequate.
• Resident clinical experience does not serve as a reliable proxy for procedural competence.