Competency‐based assessment of procedural skills in resident training

Abstract

Background No standardized summative tools exist to assess competency in bedside procedures or provide residents and programs with summative feedback. Objective To provide competency‐based procedure training and feedback to residents, we created a procedure competency committee (PCC). Here, we describe the PCC process, its impact on procedure training, and examine residents' attainment of competency in bedside procedures. Design, Setting, and Participants The PCC consisted of hospitalists and met twice annually to review resident procedure portfolios for three academic years 2019–2022 at a university‐based internal medicine residency program. Residents were designated to one of the five competency levels; being able to participate, perform under supervision with assistance, perform under direct supervision (DS) without assistance, perform independently with indirect supervision (IS), and perform independently with IS and supervise others. We analyzed the probability of advancing competency levels with each additional procedure using multinomial logistic regression models. Results Of the 97 residents, 48 (49.5%) were women and 60 (62%) subsequently matched in procedure‐oriented fields. More residents achieved IS level for paracentesis than for lumbar puncture (LP) or central venous catheterization (CVC) (62 vs. 25 and 37, respectively; p < .001). Each incremental procedure performed was associated with a higher chance of being advanced to IS group from the DS group; 1.31 times for paracentesis (95% confidence interval [CI] = 1.07, 1.60; p < .008), 1.83 times for LP (95% CI = 1.35, 2.47; p = .0001), and two times for CVC (95% CI = 1.32, 3.05; p = .001). Conclusion The PCC provided competency‐based assessment of a resident's procedural skills and may be used to assess the impact of curriculum changes.