Optimum number of procedures required to achieve procedural skills competency in internal medicine residents.
BACKGROUND
Procedural skills training forms an essential, yet difficult to assess, component of an Internal Medicine Residency Program. We report the development of process of documentation and assessment of procedural skills training.


METHODS
An explanatory sequential mixed methods design was adopted where both quantitative and qualitative information was collected sequentially. A survey was conducted within the Department of Internal Medicine at The Aga Khan University Hospital, Karachi, Pakistan to determine the optimum number of procedures needed to be performed by residents at each year of residency. Respondents included both faculty and the residents in the Department. Thereafter, all responses were compiled and later scrutinized by a focus group comprising of a mix of faculty from various subspecialties and resident representatives.


RESULTS
A total of 64 responses were obtained. A significant difference was found in eight procedural skills' status between residents and faculty, though none of these were significant after accounting for multiple consecutive testing. However, the results were reviewed and a consensus for the procedures needed was developed through a focus group. A finalized procedural list was generated to determine: (a) the minimum number of times each procedure needed to be performed by the resident before deemed competent; (b) the level of competency for each procedure for respective year of residency.


CONCLUSIONS
We conclude that the opinion of both the residents and the faculty as key stakeholders is vital to determine the number of procedures to be performed during an Internal Medicine Residency. Documentation of procedural competency development during the training would make the system more objective and hence reproducible. A log book was designed consisting of minimum number of procedures to be performed before attaining competency.
Department of Medicine, Aga Khan University, Hospital, Stadium Road, P.O. Box # 3500, Karachi, Pakistan. muhammed.tariq@aku.edu.
Muhammad
M
Tariq
Department of Medicine, Aga Khan University, Hospital, Stadium Road, P.O. Box # 3500, Karachi, Pakistan. nizar.bhulani@gmail.com.|Master of Public Health Candidate, The University of Texas, Health Sciences Center at Houston, Houston, USA. nizar.bhulani@gmail.com.
Nizar
N
Bhulani
Department of Biological and Biomedical Sciences, Aga Khan University, Hospital, Karachi, Pakistan. asifahsan_ali@yahoo.co.uk.
Asif
A
Jafferani
Department of Medicine, Aga Khan University, Hospital, Stadium Road, P.O. Box # 3500, Karachi, Pakistan. quratulain.naeem@aku.edu.
Quratulain
Q
Naeem
Department of Medicine, Aga Khan University, Hospital, Stadium Road, P.O. Box # 3500, Karachi, Pakistan. syed.ahsan@aku.edu.
Syed
S
Ahsan
Department of Medicine, Aga Khan University, Hospital, Stadium Road, P.O. Box # 3500, Karachi, Pakistan. afaqmotiwala@gmail.com.|University of Texas, Southwestern Medical Centre at Dallas, Dallas, TX, USA. afaqmotiwala@gmail.com.
Afaq
A
Motiwala
Communication Skills Training and Assessment, Skills Laboratory, Maastricht University, Maastricht, The Netherlands. j.vandalen@maastrichtuniversity.nl.
Jan
J
van Dalen
Department of Medicine, Aga Khan University, Hospital, Stadium Road, P.O. Box # 3500, Karachi, Pakistan. saeed.hamid@aku.edu.
Saeed
S
Hamid
D000328:Adult; D002983:Clinical Competence; D003430:Cross-Sectional Studies; D003906:Developing Countries; D004282:Documentation / Q000706:statistics & numerical data; D004503:Education, Medical, Graduate / Q000379:methods; D005260:Female; D017144:Focus Groups; D006785:Hospitals, University; D006801:Humans; D007388:Internal Medicine / Q000193:education; D007396:Internship and Residency / Q000458:organization & administration; D008297:Male; D010154:Pakistan; D018709:Statistics, Nonparametric; D011795:Surveys and Questionnaires