J. Carr1, M. Meyers1, A. Deal1, F. Johnson2, T. Schwartz2 1University Of North Carolina At Chapel Hill,Chapel Hill, NC, USA 2St. Louis University,St. Louis, MO, USA
Introduction: Ensuring that medical students acquire basic procedural skills is increasingly challenging. We previously reported experience and expectations of students over several years at our institution. In this study, we compare students’ experience and expectations at two institutions over two years.
Methods: With IRB approval, an online survey was conducted at the end of 3rd year in 2013 and 2014 at the University of North Carolina at Chapel Hill (UNC) (n = 76, 91 respectively) and St Louis University (SLU) (n = 54, 55). Opinions were sought as to experience, level of competence and desired level of competence for nine procedural skills (Foley, NG placement, venipuncture, IV placement, arterial puncture, basic suturing, LP, thoracentesis, intubation) using a 4-point Likert scale (1=unable to perform; 2=require major assistance; 3=require minor assistance; 4=independent). Responses were compared by Student’s t-test.
Results: Gender (UNC 51% male, SLU 46%) and plans to enter a procedural-based specialty (49% vs. 51%) were comparable. No differences were seen in perceived or desired competence for any skill in 2013 or 2014 at either institution. Differences were seen for the mean number of procedures performed between the two schools for Foley (4.2±1.06 at UNC vs 2.98±1.34 at SLU; p<0.0001), IV placement (2.24±1.35 vs 1.55±1.06; p<0.0001), arterial puncture (1.47±.88 vs 2.03±1.13; p<0.0001), LP (1.49±.77 vs 1.30±.63; p=0.037) and basic suturing (4.74±.78 vs 4.42±.90; p=0.002). UNC students reported their self-perceived competence was greater than at SLU for Foley (3.63±0.63 vs 3.15±0.82; p<0.0001), NG tube (2.45±0.88 vs 1.75±0.89; p<0.0001), IV placement (3.08±0.75 vs 2.71±0.84; p=0.0002), arterial puncture (1.67±0.62 vs 1.50±.70; p=0.01) and LP (2.18±0.74 vs 1.69±0.75; p<0.0001). A difference between desired competence between the two schools was observed for Foley (UNC 3.78±0.43 vs SLU 3.65±0.50; p=0.02), NGT (3.38±0.68 vs 3.06±0.75; p=0.0002) and LP (2.84±0.71 vs 2.66±0.75; p=0.045). For all skills at both schools, there was a significant difference in actual vs. desired competence (p<0.0001 for all).
Conclusions: A significant gap between medical students’ self-assessed competence and their desired competence at performing basic procedural skills persists over years and across institutions. Several differences exist between institutions in self-perceived competence, a finding that may be partially explained by disparities in experience level. Differences in desired competence between institutions is more difficult to explain, and is not influenced by desire to pursue a procedural specialty. These data suggest that despite decreasing student procedural experience, the desire still exists for greater proficiency during medical school.