Skills not roles: the key to better training and better patient care

The NHS faces unprecedented challenges in delivering efficient, effective and safe patient care; practical procedure skills are an essential component of this. Though the GMC outcome for graduates 2018 sets out expected core practical skills and procedures for medical graduates; they continue to feel underprepared for many of the clinical skills they encounter in practice.1,2 The NHS Long Term Workforce Plan offers a comprehensive plan to address some of these tribulations, including the expansion of physician associates (PAs).3 The latest 2022 PA census recorded between 47–70% of PAs routinely undertaking arterial blood gas (ABG) and cannulation and 11% routinely undertaking more complex skills such as lumbar puncture (LP).4 It is therefore essential for all groups to be competent with practical procedures and skills. A review of level of teaching and preparedness for practical procedures was undertaken at Darent Valley hospital. A lack of formal teaching and confidence was noted, only 62% respondents had received formal teaching on taking an ABG previously, only 8% had in ultrasound (US) guided cannulation, diagnostic ascitic tap or LP and nil had any formal teaching in diagnostic pleural taps. A practical procedure course was created, aimed at upskilling the multi-professional workforce (medical students, doctors in training, locally employed doctors, PA students and PAs). Practical procedures included, ABG, US guided cannulation, LP, diagnostic pleural and ascitic taps. The courses consisted of; videos with contextualised clinical narrative for each procedure, five carousel stations providing opportunity to practice on a part task trainer (facilitated by a subject-matter expert), and a booklet with comprehensive clinical details on each procedure. Pre- and post-course evaluations were collated to ascertain confidence levels and previous exposure to procedures. Pre course confidence varied across the clinical skills. None of the participants were confident in diagnostic pleural tap or LP, only 7% were confident in diagnostic ascitic tap and 15% were confident in US guided cannulation. The highest level of confidence pre-course was seen in ABG with 54% confidence. (See figure 1) Post course, the majority were confident in ABG (92%), US guided cannulation (77%), diagnostic ascitic tap (69%) and LP (69%). Confidence in diagnostic pleural tap increased to 46%. (See figure 2) All respondents enjoyed and would recommend the course. Qualitative feedback highlighted some reasons for this; transferrable ultrasound skill development and the ability to practice multiple times on part task trainers. The provision of teaching and practising practical procedures in a simulated environment is an essential step to delivering effective and safe care to patients. This training must be readily accessible to all cadres of clinicians. A bespoke practical procedure workshop incorporating theory and hands on practical experience is an effective intervention in improving competence and confidence in performing practical procedures. Moreover, transferrable skills may also be gained from such workshops e.g. US skills, which could be a segue to further training and learning.