White Jessica, Rowan-Legg Anne, Writer Hilary, Chanchlani Rahul, Gupta Ronish
Department of Pediatric Critical Care Medicine, University of Toronto, Toronto, Ontario.
Department of Pediatrics, University of Ottawa, Ottawa, Ontario.
Paediatr Child Health. 2020 Nov 7;26(6):e265-e271. doi: 10.1093/pch/pxaa103. eCollection 2021 Oct.
Procedural practice by paediatricians in Canada is evolving. Little empirical information is available on the procedural competencies required of general paediatricians. Accordingly, the aim of this study was to conduct a needs assessment of Canadian general paediatricians to identify procedural skills required for practice, with the goal of informing post-graduate and continuing medical education.
A survey was sent to paediatricians through the Canadian Paediatric Surveillance Program (CPSP) (www.cpsp.cps.ca/surveillance). In addition to demographic information about practice type and location, participants were asked to indicate the frequency with which they performed each of 32 pre-selected procedures and whether each procedure was considered essential to their practice.
The survey response rate was 33.2% (938/2,822). Data from participants who primarily practice general paediatrics were analyzed (n=481). Of these, 71.0% reported performing procedures. The most frequently performed procedures were: bag-valve-mask ventilation of an infant, lumbar puncture, and ear curettage, being performed monthly by 40.8%, 34.1%, and 27.7% of paediatricians, respectively. The procedures performed by most paediatricians were also those found most essential to practice, with a few exceptions. Respondents performed infant airway procedures with greater frequency and rated them more essential when compared to the same skill performed on children. We found a negative correlation between procedures being performed and difficulty maintaining proficiency in a skill.
This report of experiences from Canadian general paediatricians suggests a wide variability in the frequency of procedural performance. It helps establish priorities for post-graduate and continuing professional medical education curricula in the era of competency-based medical education.
加拿大儿科医生的诊疗操作实践正在不断发展。目前关于普通儿科医生所需诊疗操作能力的实证信息较少。因此，本研究旨在对加拿大普通儿科医生进行需求评估，以确定实践所需的诊疗技能，为毕业后医学教育和继续医学教育提供参考。
通过加拿大儿科监测项目（CPSP）（www.cpsp.cps.ca/surveillance）向儿科医生发送调查问卷。除了关于执业类型和地点的人口统计学信息外，还要求参与者指出他们执行32项预先选定操作的频率，以及每项操作是否被认为对其执业至关重要。
调查回复率为33.2%（938/2822）。对主要从事普通儿科诊疗的参与者数据进行分析（n = 481）。其中，71.0%报告进行过诊疗操作。最常进行的操作是：婴儿球囊面罩通气、腰椎穿刺和耳部刮治，分别有40.8%、34.1%和27.7%的儿科医生每月进行一次。大多数儿科医生进行的操作也是那些对实践最为关键的操作，少数情况除外。与对儿童进行相同技能操作相比，受访者进行婴儿气道操作的频率更高，且认为其更为关键。我们发现操作执行情况与维持技能熟练程度的难度之间存在负相关。
这份来自加拿大普通儿科医生的经验报告表明，诊疗操作执行频率存在很大差异。它有助于在基于能力的医学教育时代确定毕业后医学教育和继续专业医学教育课程的重点。
