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Competency-based assessment of procedural skills in resident training
Pete Meliagros1, Adam Garber2, Nargiza Sadr3
1Department of Internal Medicine, Hospital Medicine, Virginia Commonwealth University Health System/VCU Health, Richmond, Virginia, USA.
Journal of Hospital Medicine
|July 17, 2023
Summary
A procedure competency committee (PCC) improved resident training and feedback for bedside procedures. Performing more procedures increased the likelihood of residents achieving independent procedural skills.
Area of Science:
- Medical Education
- Internal Medicine Residency Training
- Clinical Skills Assessment
Background:
- Standardized summative tools for assessing bedside procedure competency are lacking.
- Residents and programs need effective summative feedback mechanisms for procedural skills.
Purpose of the Study:
- To describe the creation and implementation of a procedure competency committee (PCC).
- To evaluate the PCC's impact on resident procedure training and feedback.
- To examine residents' progression in bedside procedure competency.
Main Methods:
- A procedure competency committee (PCC) comprising hospitalists reviewed resident portfolios biannually over three academic years.
- Residents were assigned one of five competency levels, from participation to independent performance and supervision.
- Multinomial logistic regression analyzed the probability of advancing competency levels with increased procedure experience.
Main Results:
- More residents achieved independent supervision (IS) for paracentesis compared to lumbar puncture (LP) or central venous catheterization (CVC).
- Each additional procedure performed increased the likelihood of advancing from direct supervision (DS) to IS.
- Specific odds ratios for advancement to IS were 1.31 for paracentesis, 1.83 for LP, and 2.00 for CVC.
Conclusions:
- The PCC offers a structured approach for competency-based assessment of resident procedural skills.
- This committee-based assessment can inform and evaluate changes in medical curricula.
- The PCC process facilitates objective feedback and tracks resident skill development.
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