Title : Proficiency-based progression as a paradigm shift in peripheral nerve blocks training
Currently, procedural skills in medicine are widely taught by means of an apprenticeship model, whereby trainees perform procedures under a graded level of supervision during clinical practice on live patients. Due to a variable and unpredictable clinical workload especially with the introduction of work-time directives, the trainee may have limited opportunity for repeated ‘hands on’ practice to acquire and maintain skills during clinical practice. Increasing patient expectation and high profile error cases compounds the problem even more. The current shift towards outcome-based training may require the trainee to achieve a level of competency before graduating from training program and performing procedures on patients. Competence is “the minimal level of skill, knowledge and/or expertise derived through training and experience, required to safely and proficiently perform a task or procedure”. Outcome-based training entitles that progression on the training program is determined on trainee’s objectively assessed performance. Simulation could be part of a solution to such a problem as it provides realistic situations where trainees can rehearse procedural skills in a relaxed environment without endangering patients. Deliberate practice with feedback in a simulated environment has been reported to accelerate the rate of skill acquisition and facilitate the transfer to clinical practice. The advent of newer skills set such as laparoscopic surgery and ultrasound-guided peripheral nerve blocks pose a daunting challenge to training bodies in the current atmosphere of medical education. A paradigm shift is the introduction of proficiency-based progression (PBP) training (Gallagher et. al.) where trainee must achieve a proficiency benchmark before being permitted progression through training. This approach involves a procedure specific task characterization undertaken by those experts to the procedure of interest. Performance metrics and errors are first identified and defined for a reference procedure in an objective manner. Subsequently a validation process (face, content and construct) must be achieved for the set of metrics and errors. The final component of this approach is the design of a specific metric-based curriculum, establishing a benchmark of performance and deployment of the validated assessment tool.