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Competence and Confidence with Basic Procedural Skills: The Experience and Opinions of Fourth-Year Medical Students at a Single Institution. Dehmer JJ et al. Academic Medicine 2103; 88(5): 682-687.
Reviewed by Patricia McBurney

What was the study question?
How experienced and confident are students with procedures deemed key for medical school graduates by the American Association of Medical Colleges?

How was the study done?
156 fourth-year students at University of North Carolina (UNC) completed a web-based questionnaire. The survey included demographics, career plans, and experience before medical school. Students were asked to record the number of times they had performed specific procedures. They were asked to rank their confidence and competence for each procedure.

What were the results?
The survey response rate was 86%. Only 3 skills (foley [63%], suturing [87%], venipuncture [48%]) had been performed more than twice by a near majority or more. More than half the students had never performed an intubation or thoracentesis. Roughly forty percent had never performed an LP or placed a NGT or IV. The students' mean confidence level ranged from a high of 3.83 +/- 1.05 for suturing to a low of 1.75 =/- 1.04 for thoracentesis. For only four procedures (Foley, venipuncture, IV, and suturing), the majority rated their competence as needing minor or no assistance. The gap between actual and desired level of competence was significant for all procedures (p<.0001).

What are the implications of these findings?
Despite provision of simulated opportunities in several areas, the students still lacked clinical experience and confidence in procedures. The students want the experiences. The authors plan to expand the survey to other schools in order to inform curriculum development.

Editor's Note: The authors discuss all the reasons students' experiences are so paltry: the growth of EMR's, change in coding requirements, increase in ancillary staff, and duty hours, to name a few. It is unlikely that these pressures will change soon. In addition to more reliance on simulations, we may have to adjust our expectations about what procedures medical students can reasonably learn in four years. (JG)

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