See One, Do One, Forget One: Early Skill Decay After Paracentesis Training.

Area of Science:

• Medical Education
• Gastroenterology
• Internal Medicine

Background:

• Internal medicine residency programs lack standardized methods for assessing paracentesis competence.
• Current competency assessment relies on the number of procedures performed, not objective skill evaluation.
• This gap highlights the need for reliable tools to measure and maintain procedural skills.

Purpose of the Study:

• To describe the changes in internal medicine resident competence in paracentesis over time.
• To evaluate the impact of periodic retraining on skill maintenance.
• To assess the utility of the Paracentesis Competency Assessment Tool (PCAT) for objective skill evaluation.

Main Methods:

• 118 internal medicine residents underwent paracentesis simulation training.
• Competence was assessed using the Paracentesis Competency Assessment Tool (PCAT), including checklist, global scale, and entrustment score.
• Residents were randomized to retraining at 3 and 6 months (Group A) or only at 6 months (Group B).

Main Results:

• All residents initially met the Minimum Passing Standard (MPS).
• Group A showed significant skill decline by 3 months post-training.
• At 6 months, Group A demonstrated significantly higher performance (89.7% MPS, 34.5% UPS) than Group B (46.3% MPS, 3.7% UPS).

Conclusions:

• Paracentesis skills decay as early as 3 months after initial training.
• Periodic retraining effectively interrupts skill decay and improves long-term performance.
• Objective assessment using the PCAT is essential for accurately evaluating resident competence and determining the need for supervision.