title: Procedural skills practice and training needs of doctors, nurses, midwives and paramedics in rural Victoria.
abstract: BACKGROUND
  Procedural skills are a significant component of clinical practice. Doctors, nurses, midwives and paramedics are trained to use a variety of procedural skills. Rural clinicians in particular are often required to maintain competence in some procedural skills that are used infrequently, and which may require regular and repeated rehearsal. This paper reports on a research project conducted in Gippsland, Victoria, to ascertain the frequency of use, and relevance to clinical practice, of a range of skills in the fields of medicine, nursing, midwifery, and paramedic practice. The project also gathered data on the attitudes of clinicians regarding how frequently and by what means they thought they needed to practice these skills with a particular focus on the use of simulation as an educational method.
  
  
  METHODS
  The research was conducted following identification of a specific set of procedural skills for each professional group. Skills were identified by an expert steering committee. We developed online questionnaires that consisted of two parts: 1) demographic and professional characteristics, and 2) experience of procedural skills and perceived training needs. We sought to invite all practicing clinicians (doctors, nurses, midwives, paramedics) working in Gippsland. Online surveys were distributed between November 2011 and April 2012 with three follow-up attempts. The Monash University Human Research Ethics Committee approved the study.
  
  
  RESULTS
  Valid responses were received from 58 doctors, 94 nurses, 46 midwives, and 30 paramedics, whom we estimate to represent not more than 20% of current clinicians within these professions. This response rate reflected some of the difficulties experienced in the conduct of the research. Results were tabulated for each professional group across the range of skills. There was significant correlation between the frequency of certain skills and confidence with maintenance of these skills. This did not necessarily correlate with perceptions of respondents as to how often they need to practice each skill to maintain mastery. The more complex the skill, the more likely the respondents were to report a need for frequent rehearsal of the skill. There was variation between the professional groups as to how to retain mastery; for some skills, professional groups reported skill maintenance through clinical observation and clinical practice; for other skills, simulation was seen to be more appropriate.
  
  
  CONCLUSIONS
  This project provided insight into the clinical application of procedural skills for clinicians comprising a relatively large professional population within a defined geographical region in rural Victoria, as well as attitudes to skills maintenance and competency. Although not the focus of the study, an unexpected outcome was the design of questionnaires on procedural skills. We believe that the questionnaires may have value in other rural settings. We acknowledge the limitations of the study in the text. The project provides some information on which to base planning for procedural skills education, including simulation-based training, and directions for further research.
authors.affiliation: East Gippsland Regional Clinical School, School of Rural Health, Monash University, Melbourne, VIC, Australia.
authors.forename: David
authors.initials: D
authors.lastname: Campbell
authors.affiliation: Simconhealth Healthcare Simulation Consultancy Group, Linsfield, NSW, Australia.
authors.forename: Irwyn
authors.initials: I
authors.lastname: Shepherd
authors.affiliation: School of Rural Health, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia.
authors.forename: Matthew
authors.initials: M
authors.lastname: McGrail
authors.affiliation: Southern General Practice Training, Churchill, VIC, Australia.
authors.forename: Lisa
authors.initials: L
authors.lastname: Kassell
authors.affiliation: East Gippsland Regional Clinical School, School of Rural Health, Monash University, Melbourne, VIC, Australia ; Central Gippsland Health Service, Sale, VIC, Australia.
authors.forename: Marnie
authors.initials: M
authors.lastname: Connolly
authors.affiliation: Department of Community Emergency Health and Paramedic Practice, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia.
authors.forename: Brett
authors.initials: B
authors.lastname: Williams
authors.affiliation: School of Rural Health and HealthPEER, Monash University, Melbourne, VIC, Australia.
authors.forename: Debra
authors.initials: D
authors.lastname: Nestel
keywords: procedural skills; rural health education; simulation; skills maintenance
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