New house officers lack clinical skills

Medical students and house officers receive inadequate training in core clinical skills, research published this week shows.

Final year medical students lack adequate education and experience in carrying out basic procedures such as taking blood samples and suturing wounds, the report states. Also, most house officers do not receive further practical training after qualification.

“Many practical skills are practised during the house officer year despite inadequate training, and with no supervision to ensure correct technique,” the authors of the report concluded.

The results are based on a survey of Sheffield medical students who had completed their clinical training and were about to sit their final examinations (Journal of the Royal Society of Medicine 2001;94:516).

Students were questioned about their experience in eight “core skills.” These skills included the insertion of nasogastric tubes, intravenous cannulas, and bladder catheters, as well as venous and arterial blood sampling. Of the 122 final year students surveyed, “a substantial number” had little or no experience in some core skills. Almost a third had never practised passing a urinary catheter, and over half had “negligible” experience in doing electrocardiography.

In the same study, a survey of house officers working in Sheffield hospitals showed the extent to which the core skills are demanded during the preregistration year. Most house officers had to do three to 10 catheterisations and a similar number of electrocardiograms every month. Despite inadequate training as undergraduates, most house officers received no further training in the selected core skills after qualification.

No formal training was provided in the prevention and management of needlestick injuries, and almost two thirds of house officers said they had never received any guidance on the subject. The authors, Mr Peter Goodfellow and Dr Peter Claydon, asserted that because of the growing recognition of the risk to health workers from bloodborne pathogens this matter required “urgent attention at both undergraduate and house officer levels.”

Students blamed the “haphazard and random” education provided in traditional ward “firms.” In these settings no time is allocated for learning specific skills and no documentation of learning is required.

The authors suggested that the situation could be improved if log books and skills laboratories were provided for undergraduates and induction courses were run for new house officers. These initiatives have now been introduced in Sheffield. The authors plan to repeat their survey in two years' time to assess the impact of changes.