Self-Directed Skills Laboratories Increase Emergency Medicine Physician Confidence in High-Acuity, Low-Opportunity Procedures

Introduction: The critical role of emergency physicians in military settings underscores the necessity for a broad and proficient skill set, especially in life-saving procedures such as thoracostomies, endotracheal intubations, and cricothyrotomies, to maintain combat readiness. The current peacetime phase, however, presents challenges in maintaining these skills because of decreased exposure to high-acuity medical scenarios. This decrease in exposure jeopardizes skills retention among military emergency medicine physicians, highlighted by studies showing a significant decline in performance over time because of reduced practice.

Materials and methods: This study was carried out at the Naval Medical Readiness Training Center Portsmouth under IRB approval, employing a prospective, observational, mixed-methods design. Participants included board-certified emergency medicine physicians engaged in a self-directed, small-group skills lab focusing on central venous catheterization, thoracostomy, intraosseous access, endotracheal intubation, cricothyrotomy, and resuscitative thoracotomy. Pre- and post-lab surveys on a 5-point confidence scale assessed the impact of the lab, with data analyzed via the Wilcoxon signed-rank test to evaluate significant changes.

Results: Fourteen physicians reported pre-lab confidence levels, showing high confidence in central venous catheter access, thoracostomy tube placement, intraosseous catheter placement, and endotracheal intubation. The interventions of cricothyrotomy, resuscitative thoracotomy, and suprapubic catheterization started with notably lower confidence levels. Statistically significant improvements in confidence were observed post-lab for cricothyrotomy, resuscitative thoracotomy, and suprapubic catheterization suggesting the lab's effectiveness in addressing less frequently practiced procedures.

Conclusions: The Military Health System must find avenues to maintain the clinical skills of wartime procedures in the peacetime environment. Although there is no substitute for clinical encounters, alternative modalities are needed to augment skills retention in high-acuity, low-frequency procedures. Self-directed, small-group task trainers and cadaveric labs are a lower maintenance mechanism by which faculty can improve their confidence in certain procedural skills. Further studies should evaluate if this translates to changes in clinically oriented outcomes and how to optimize such training evolutions within the skills retention paradigm.