Appendices
Appendix 4Transitioning to Clerkship: Procedural Skills Expectations
Procedural Clinical Skills in Medical School:
Introduction: Throughout pre-clerkship and clerkship, you will be exposed to a number of procedures in different clinical settings. Procedures is an umbrella term encompassing processes either diagnostic or therapeutic. While some rotations will have a natural exposure to these procedures where you will be required to demonstrate competence (e.g. anesthesiology, surgical rotations, clerkship orientation), some will be optional on your core rotations (opting out meaning that senior learners or allied health perform them). Participate in these opportunities where you can – clerkship is the perfect time to learn them when there are senior learners above your level to model, observe & provide feedback, and step in when needed. A number of student interest groups may also run simulation-based procedural skills sessions or conferences towards building a foundational Level 2 competency to be later refined in the clinical setting. A useful resource for becoming familiar with different procedures is the Videos in Clinical Medicine series by NEJM (http://www.nejm.org/multimedia/medical-videos).
The AFMC National Clinical Skills Document has listed 33 procedures, detailed below. Their varying expectations are sorted according to the following schema:
- Level 1: Describe the indications, contraindications, risks, common Complications, and process of the procedure
- Level 2: Perform the procedure in a simulation with supervision in a non-clinical setting
- Level 3: Perform the procedure in a stable patient with supervision in a controlled clinical setting
- Level 4: Perform the procedure in a stable patient without supervision in a controlled clinical setting
Procedures & Associated Expectations (as per AFMC National Clinical Skills Document):
| Procedure Name | Pre-Clerkship | Clerkship |
|---|---|---|
| Aseptic Technique | 4 | 4 |
| Use of an AED: may be included with BCLS | 4 | 4 |
| BCLS | 4 | 4 |
| Venipuncture | 2 | 4 |
| I.V. line insertion | 2 | 4 |
| Wound closure (suturing superficial skin wound and/or incision); aseptic technique | 2 | 4 |
| Urinary catheterization | 2 | 4 |
| Use oximeter to measure oxygen saturation | 2 | 4 |
| Spirometry: peak flow meter and portable spirometer | 2 | 4 |
| Stool for occult blood | 2 | 4 |
| Bag-mask ventilation with an oral and nasal airway | 2 | 3 |
| Pap smear (pelvic exam needs to be mastered before Pap smear) | 2 | 3 |
| Ophthalmological exam: tonometry, fluorescein, use of slit lamp | 1 | 4 |
| Universal Precautions | 1 | 4 |
| Glucometer | 1 | 4 |
| Throat/nasopharyngeal swab | 1 | 4 |
| Urinalysis: dipstick | 1 | 4 |
| External cardiac pacemaker as part of ACLS | 1 | 3 |
| Arterial blood gases | 1 | 3 |
| Abscess incision and drainage | 1 | 3 |
| Skin biopsy | 1 | 3 |
| N/G tube | 1 | 3 |
| Ear syringing | 1 | 3 |
| IM, subcutaneous and intradermal injection | 1 | 3 |
| Endotracheal intubation | 1 | 2 |
| Thoracentesis | 1 | 2 |
| Abdominal paracentesis | 1 | 2 |
| Lumbar puncture | 1 | 2 |
| Joint aspiration | 1 | 2 |
| Performance of EKG | 1 | 2 |
| Primary casting for fracture | 1 | 2 |
| Bone Marrow aspiration | 1 | 1 |
*http://clinicalskills.machealth.ca/index.php/content/procedural. Accessed July 25, 2016.