Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
Cincinnati Veteran's Affairs Medical Center, Cincinnati, OH, USA.
J Gen Intern Med. 2021 May;36(5):1346-1351. doi: 10.1007/s11606-020-06242-x. Epub 2020 Sep 23.
Internal medicine residents perform paracentesis, but programs lack standard methods for assessing competence or maintenance of competence and instead rely on number of procedures completed. This study describes differences in resident competence in paracentesis over time.
From 2016 to 2017, internal medicine residents (n = 118) underwent paracentesis simulation training. Competence was assessed using the Paracentesis Competency Assessment Tool (PCAT), which combines a checklist, global scale, and entrustment score. The PCAT also delineates two categorical cut-point scores: the Minimum Passing Standard (MPS) and the Unsupervised Practice Standard (UPS). Residents were randomized to return to the simulation lab at 3 and 6 months (group A, n = 60) or only 6 months (group B, n = 58). At each session, faculty raters assessed resident performance. Data were analyzed to compare resident performance at each session compared with initial training scores, and performance between groups at 6 months.
After initial training, all residents met the MPS. The number achieving UPS did not differ between groups: group A = 24 (40%), group B = 20 (34.5%), p = 0.67. When group A was retested at 3 months, performance on each PCAT component significantly declined, as did the proportion of residents meeting the MPS and UPS. At the 6-month test, residents in group A performed significantly better than residents in group B, with 52 (89.7%) and 20 (34.5%) achieving the MPS and UPS, respectively, in group A compared with 25 (46.3%) and 2 (3.70%) in group B (p < .001 for both comparison).
Skill in paracentesis declines as early as 3 months after training. However, retraining may help interrupt skill decay. Only a small proportion of residents met the UPS 6 months after training. This suggests using the PCAT to objectively measure competence would reclassify residents from being permitted to perform paracentesis independently to needing further supervision.
内科住院医师进行腹腔穿刺术，但各项目缺乏评估能力或维持能力的标准方法，而是依赖完成的操作数量。本研究描述了住院医师在腹腔穿刺术方面的能力随时间的变化。
从 2016 年到 2017 年，内科住院医师（n=118）接受了腹腔穿刺模拟培训。使用腹腔穿刺能力评估工具（PCAT）评估能力，该工具结合了检查表、总体评分和委托评分。PCAT 还划定了两个分类截止分数：最低通过标准（MPS）和无监督实践标准（UPS）。住院医师被随机分配到模拟实验室 3 个月和 6 个月（A 组，n=60）或仅 6 个月（B 组，n=58）后返回。在每次会议上，教师评估员评估住院医师的表现。分析数据以比较每次会议与初始培训评分的住院医师表现，以及 6 个月时组间的表现。
在初始培训后，所有住院医师均达到 MPS。达到 UPS 的人数在组间无差异：A 组 24 人（40%），B 组 20 人（34.5%），p=0.67。当 A 组在 3 个月时再次接受测试时，每个 PCAT 成分的表现都显著下降，达到 MPS 和 UPS 的住院医师比例也下降。在 6 个月的测试中，A 组的住院医师表现明显优于 B 组，A 组 52 人（89.7%）和 20 人（34.5%）达到 MPS 和 UPS，B 组分别为 25 人（46.3%）和 2 人（3.70%）（p<0.001 均）。
腹腔穿刺术的技能在培训后仅 3 个月就开始下降。然而，再培训可能有助于中断技能的衰退。只有一小部分住院医师在培训后 6 个月达到 UPS。这表明使用 PCAT 客观衡量能力将重新分类住院医师，从允许独立进行腹腔穿刺术到需要进一步监督。
