Doctors question standardized training requirements

Doctors lack confidence in their procedural skills after completing the current NHS postgraduate training curriculum. A survey of 181 doctors, published in the open access journal BMC Medical Education, has shown that from ten of the procedures medics are officially required to be competent at, most are only confident of their ability to perform five.

Dr Effrossyni Gkrania-Klotsas from Addenbrooke's Hospital, Cambridge, worked with a team of colleagues to poll doctors from two East Anglia hospitals, Addenbrooke's and Ipswich, about how confident they feel in their abilities to perform supposedly key tasks. She said, "A doctor's confidence is important because it impacts on their willingness to undertake procedures, ask for support, and their ability to assess their own skills. Procedural confidence also affects performance and is therefore an important target for maintaining competency."

The NHS' Postgraduate Medical Education and Training Board (PMETB) sets the training curriculum, which features seventeen different procedures that a trainee is expected to be competent in by the end of core medical training. According to Gkrania-Klotsas, "Until now, the level of confidence amongst hospital practitioners to perform some of these 'key' procedures has been unknown. Clearly, it is unrealistic to expect all doctors to perform all procedures with competence and confidence at all levels of training, however guidance on what would represent an acceptable standard is limited."

Confidence scores for all procedures were graded on a four-point scale, with the majority of responses either 'not at all confident' or 'very confident'. Only two doctors out of the 181 were 'confident' or 'very confident' in all ten procedures. Six procedures emerged as the most commonly performed. Given that one of these was largely performed by a small number of specialists, five key service requirement procedures remain. The authors say that, "The PMETB requirement for all trainees to demonstrate competency in the remaining procedures is unachievable and potentially unnecessary."

1. Procedural confidence in hospital based practitioners: implications for the training and practice of doctors at all grades
Ronna MJ Connick, Peter Connick, Angelos-Emmanouil Klotsas, Petroula-Anastasia Tsagkaraki and Effrossyni Gkrania-Klotsas
BMC Medical Education (in press)

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