Procedural Skills Decay in Emergency Medicine: A Scoping Review

While the concept of "skill decay," or the gradual loss of acquired skills after a period of non-use, has been discussed in the literature, it is not clear how and when this occurs for different procedural skills within the practice of emergency medicine (EM). In this scoping review, we explore the findings and highlight the gaps in the literature about procedural skill decay in EM. Following PRISMA-ScR guidelines, a systematic scoping review with descriptive content analysis was performed. We screened 1349 published abstracts and articles. Thirty-seven (37) articles met the inclusion criteria. Five key themes were identified: (1) limited focus on skill decay as a primary outcome, (2) short and variable timeframes of assessment, (3) limited representation of procedural diversity, (4) heavy reliance on simulation and checklist-based assessments, and (5) sparse data on attending physicians and community-based practice. While there is growing recognition that technical skill decay is a relevant concern in EM, this scoping review reveals a literature base that is heterogeneous in design, limited in range and scope, and still evolving. This review may serve as a call to action for further study on EM procedural skill decay starting points and inform future study design. More rigorous, longitudinal, and generalizable research is required to establish clear, evidence-based practices for maintaining procedural competency across the continuum of emergency physician training and practice.