Letter to the Editor

Practical skills acquisitionduring the houseman year

Editor – The pre-registration house of-

ficer (PRHO) year represents an op-

portunity to increase skills, but studies

suggest that the undergraduate curricu-

lum does not furnish the required skills

and more detailed training may be

required.1

All PRHOs in Northern Ireland re-

ceived a questionnaire after 9 months of

residency. They were asked to indicate

whether they had seen each of a list 20

skills performed, the number of times

they had personally performed each

skill, and their confidence in their ability

to do so. Answers were recorded for skill

levels at the start of the houseman year

and at the time of assessment. The

procedures assessed were: venepunc-

ture, intravenous cannulation, urethral

catheterisation, recording an ECG,

rectal examination, arterial blood

sampling, cardiopulmonary resuscita-

tion, blood pressure measurement,

nasogastric tube insertion, assisting at

an operation, peritoneal aspiration,

endotracheal intubation, pleural aspir-

ation, lumbar puncture, sigmoidoscopy,

diagnostic peritoneal lavage, chest drain

insertion, suprapubic catheterisation,

central line insertion and sengstaken

tube insertion.

The response rate was 64% (111 in-

dividuals). At the start of the houseman

year, more than 70% (n > 78) of re-

spondents were confident in performing

venepuncture, recording an ECG,

cardiopulmonary resuscitation and

blood pressure measurement. After

9 months, more than 70% (n > 78) of

respondents were also confident in in-

travenous cannulation, urethral cathe-

terisation, performing a rectal examina-

tion, arterial blood gas sampling and

nasogastric tube insertion. More than

50% (n > 56) expressed confidence in

assisting at an operation or performing a

peritoneal aspiration. Less than 20% of

respondents felt confident performing

skills that had either only been seen or

had not been seen at all.

At the start of the year, skills per-

formed more than three times were:

venepuncture, intravenous cannulation,

cardiopulmonary resuscitation and

blood pressure measurement. Skills

performed once or twice were: urethral

catheterisation, ECG recording, rectal

examination, arterial blood sampling,

assisting at an operation and endotra-

cheal tube insertion. All the remaining

skills under assessment had only been

seen, except for suprapubic catheterisa-

tion and sengstaken tube insertion,

which had usually not been seen.

By the end of the assessment period,

the skills performed three or more times

now also included urethral catheterisa-

tion, ECG recording and performing a

rectal examination. Additional skills

performed once or twice were: nasogas-

tric tube insertion, peritoneal aspiration

and pleural aspiration. The remaining

skills had usually been seen, except for

sengstaken tube insertion. Exposure to

all skills improved significantly, except

blood pressure measurement and assist-

ing at an operation, although neither

decreased significantly (P ¼ 0Æ56 and

P ¼ 0Æ06, respectively, chi-squared test).

Confidence in ability to perform the fol-

lowing skills did not improve signifi-

cantly: endotracheal intubation (P¼0Æ22), sigmoidoscopy (P ¼ 0Æ05), chest

drain insertion (P¼ 0Æ126), central line

insertion (P ¼ 0Æ46) and sengstaken tube

insertion (P ¼ 0Æ09).

This study shows that the PRHO year

provides limited opportunities to de-

velop complex skills. Skills performed

frequently and confidently were simple,

ward-based skills that do not require

supervision. As the degree of complexity

increases, the frequency and confidence

with which the skill is performed falls. It

may be useful to demonstrate the skills

that have previously been performed

fewer than three times as part of a for-

mal training day at the beginning of the

senior house officer grade.

Brian Little,1 Somaiah Aroori,2

Lucy Scott2 & Jon Clarke1

1Glasgow & 2Belfast, UK

Reference

1 Issenberg SB, McGaghie MC. Clinical

skills training – practice makes perfect.

Med Educ 2002;36:210–1.

Correspondence: Brian Little, 6 Innellan

Gardens, Glasgow G20 0DX, UK. Tel.: 00

44 28 38 612559; Fax: 00 44 28 38 333839;

E-mail: b.little@ntlworld.com

� Blackwell Publishing Ltd MEDICAL EDUCATION 2003;37:387 387