Samenvatting
Background: Traditionally, the art and science of medical skills acquisition occur through an apprenticeship model where trainers supervise trainees who are learning on the patients exposed to variety of risk. The concern for patient safety and other limitations in provision of adequate training has necessitated the introduction of skills simulation for trainees to acquire certain proficiency before encounter with live patients.
Objectives: The study is aimed to determine the level of skills acquired and constraints experienced by newly graduated medical doctors during their training in various medical schools in Nigeria.
Method: Structured questionnaires were administered to interns undergoing orientation training programme at the University of Ilorin Teaching Hospital, Nigeria. Items were set to determine the frequency of practice and proficiency attained in basic clinical procedures during medical school training; and the factors that influenced their attempts of the procedures. The data was entered in SPSS for Windows version 17.0 and p value d” 0.05 was taken as statistically significant.
Results: There were 163 new interns who graduated from 11 medical schools (three outside Nigeria). The participants were aged between 22 and 35 years with no significant statistical difference between the mean ages of interns trained at home or abroad. Mean attempt of basic procedures ranged between 1.73 and 3.93 overall among 9.8 to 81.5% of the trainees. Most of them performed poorly on the pre-training self-assessed proficiency level. Urethral catheterization and intravenous cannulation were the commonest procedures done while the least performed procedures were nasogastric intubation, chest tube insertion;
and fracture reduction and splinting (1.53-2.10 mean attempt) among less than 25% of trainees. Inadequate training facilities and competition between undergraduate and postgraduate trainees for procedures on the available but reluctant patients were considered as limiting factors in the acquisition of skills. However, inadequate number of trainers was considered least of a preventive factor.
Conclusion: Most medical graduates had inadequate exposures to skills acquisition from various medical training institutions due to inadequate volunteers (patients) and lack of students’ call rooms for proximity to where and when the activity is taking place. We recommend that Clinical Skills acquisition through simulation should be integrated into the curricula of medical training institutions to facilitate acquisition of skills and ease practice on and safety of patients.
Keywords: Patient safety; medical errors, clinical skills, simulation; internship
Résumé
Contexte : Traditionnellement, l’art et la science de l’acquisition des compétences médicales reposent sur un modèle d’apprentissage dans lequel les formateurs supervisent les stagiaires qui apprennent sur des patients exposés à une variété de risques. Le souci de la sécurité des patients et d’autres limitations dans la fourniture d’une formation adéquate ont nécessité l’introduction d’une simulation des compétences permettant aux stagiaires d’acquérir certaines compétences avant de rencontrer des patients vivants.
Objectifs : L’étude a pour objectif de déterminer le niveau de compétences acquises et les contraintes rencontrées par les médecins récemment diplômés au cours de leur formation dans diverses facultés de médecine au Nigéria.
Méthode : Des questionnaires structurés ont été administrés à des stagiaires prenant part à une formation de programme d’orientation à l’Hôpital d’Enseignement de l’Université d’Ilorin, au Nigeria. Des éléments ont été définis pour déterminer la fréquence de pratique et de maîtrise des procédures cliniques de base au cours de la formation en médecine ; et les facteurs qui ont influencé leurs tentatives des procédures. Les données ont été entrées dans SPSS pour Windows version 17.0 et la valeur p d” 0,05 a été considérée comme statistiquement significative.
Résultats : Il y’avait 163 nouveaux stagiaires qui ont été diplômés de 11 facultés de médecine (trois hors du Nigéria). Les participants étaient âgés de 22 à 35 ans et ne présentaient aucune différence statistique significative entre les âges moyens des stagiaires formés au Nigeria ou à l’étranger. Le nombre moyen de tentatives de procédures de base variait globalement entre 1,73 et 3,93 chez 9,8 à 81,5% des stagiaires. La plupart d’entre eux ont eu de piètres résultats au niveau de compétence auto-évalué avant la formation.Le cathétérisme urétral et lacanulationintraveineuseétaient les procédures les plus courantes, alors que les procédures les moins pratiquées étaient l’intubation nasogastrique, l’insertion d’un drain thoracique ; et réduction de la fracture et attelles (tentative moyenne de 1,53 à 2,10) parmi moins de 25% des stagiaires.Le manque de facilités de formation et la concurrence entre les stagiaires du premier cycle et des cycles supérieurs pour les interventions sur les patients disponibles mais réticents ont été considérés comme des facteurs limitants dans l’acquisition de compétences.Cependant, le nombre insuffisant de formateurs a été considéré comme moins d’un facteur préventif.
Conclusion : La plupart des diplômés en médecine ont été exposés de manière inadéquate à l’acquisition de compétences auprès de divers établissements de formation en médecine en raison du nombre insuffisant de volontaires (patients) et du manque de chambres d’appel pour les étudiants, à proximité du lieu et du moment de l’activité. Nous recommandons que l’acquisition de compétences cliniques par simulation soit intégrée aux programmes des établissements de formation médicale afin de faciliter
l’acquisition de compétences et de faciliter la pratique sur et la sécurité des patients. Mots-clés : sécurité des patients ; erreurs médicales, compétences cliniques, simulation ; stage
Correspondence: Dr. L. O. Abdur-Rahaman, Clinical Skills and Simulation Laboratory, College of Health Sciences,
University of Ilorin, Ilorin, Nigeria. E-mail: bolarjide@yahoo.com
Referenties
Dolmans DHJM, Wolfhagen IHAP, Essed GGM, Scherpbier AJJA and van der Vleuten CPM. The impacts of supervision, patient mix, and numbers of students on the effectiveness of clinical rotations. Academic Medicine, 2002; 77(4): 332–335.
Dornan T. Experience based learning. Learning clinical medicine in workplaces. (2006). Dissertation, Maastricht University, Maastricht.
Berk RA, Berg J and Mortimer R. Measuring the effectiveness of faculty mentoring relationships. Acad Med.2005;80:66–71
Taylor TK and Care WD. Nursing education as cognitive apprenticeship: A framework for clinical education. Nurse Education 1999; .24(4):31–36.
Williams S, Dale J, Glucksman E and Wellesley A. Senior house officers’ work related stressors, psychological distress, and confidence in performing clinical tasks in accident and emergency: a questionnaire study. BMJ 1997;314:713–718.
Remmen R, Scherpbier A, Derese A, et al. Unsatisfactory basic skills performance by students in traditional medical curricula. Med Teacher 1998;20:579–582.
Aloia JF, Esswein AJ and Weissman MB. House staff performance of the lumbar puncture as a measure of clinical skills teaching. J Med Educ 1977;52:689–690.
Carter R, Aitchison M, Mufti G and Scott R. Catheterisation: your urethra in their hands. BMJ 1990;301:905.
Ziv Amitai MD; Wolpe Paul Root PhD; Small Stephen D. MD and Glick Shimon MD. Simulation Based Medical Education: An Ethical Imperative. Academic Medicine. 2003;78(8):783–788.
Walton M, Woodward H, Van Staalduinen S, et al. The WHO patient safety curriculum guide for medical schools. Quality and Safety in Health Care 2010;19:542-546. http://dx.doi.org/10.1136/qshc.2009.036970
Medical and Dental Council of Nigeria. https://mdcn.gov.ng/page/guidelines-for-registration-as-a-medical-or-dental. Last updated and cited on June 12, 2017
Internship (medicine): https://en.wikipedia.org/wiki/Internship_(medicine). Internship (medicine): http://www.internsnetwork.org.uk/internship-medicine/index.html
Minimum standards of accommodation for medical students on clinical placements. British Medical Association (BMA) https://www.bma.org.uk/advice/career/studying-medicine/get-ready-for-clinical-medicine/minimum-standards-of-accomodation. Last updated: 12 July 2016. Cited on 12th June 2017.
Mark Butler. Living and Working Conditions for Hospital Doctors in Training. NHS Circular: HDL (2001) 50. June 20, 2001. http://www.sehd.scot.nhs.uk/mels/HDL2001_50.pdf
Brennan TA. The Institute of Medicine report on medical errors: could it do harm? N Engl J Med 2000;342 (15) 1123- 1125
Kaldjian LC, Jones EW, Wu BJ, et al. Reporting Medical Errors to Improve Patient Safety: A Survey of Physicians in Teaching Hospitals. Arch Intern Med. 2008;168(1):40-46
Motola I, Devine LA, Chung HS, Sullivan JE and Issenberg SB. Simulation in healthcare education: A best evidence practical guide. AMEE Guide No. 82. Med Teach 2013.35:e1511-e1530
Walters, Queen Victoria, “Simulation and Educational Strategies to Decrease Incidence of Medication Errors in A Small Rural Acute Care Hospital” (2015). Doctoral Nursing Capstone Projects. Paper 6.
Bradley P and Bradley K P. Setting up a clinical skills learning facility. Medical Education 2003;37 (Suppl.1):6–13.
Hao J, Estrada J and Tropez-Sims S. The clinical skills laboratory: a cost-effective venue for teaching clinical skills to third-year medical students. Acad Med 2002;77:152.
Issenberg SB, Pringle S, Harden RM, Khogali S and Gordon MS. Adoption and integration of simulation-based learning technologies into the curriculum of a UK UndergraduateEducation Programme. Medical Education 2003;37(Suppl. 1):42–49.
Aggarwal R, Mytton OT, Derbrew M, et al. Training and simulation for patient safety. Qual Saf Health Care 2010;19:i34-i43 doi:10.1136/qshc.2009.038562.