Interns in emergency: Experience does not mean confidence

Dear Sir

As junior doctors progress through their first postgraduate year, there is an expectation that they will learn new skills and grow in confidence. As a core term for Australian interns, Emergency Medicine is valuable in the development of key clinical skills (Marel et al. 2000). However, ‘little is known about patterns of clinical skills acquisition among junior doctors undertaking clinical training in the early postgraduate period’ (Marel et al. 2000).

A study was conducted at The Townsville Hospital, a tertiary hospital in the tropical north Queensland, Australia, to see what effect the order of term rotation had on intern self-reported confidence in a number of key emergency skills. One hundred and eight interns (68%) over three-year cohorts (2009–2011) completed a questionnaire regarding their confidence in nine clinical and 16 professional skills prior to commencing their term in Emergency Medicine. The data was then analysed to determine whether the order of term rotation had an effect on either the overall self-reported confidence, or any specific clinical skills.

The results showed no significant difference in the overall mean confidence in a range of clinical and professional skills (80.28; SD = 9.22; 95% Confidence Interval = 78.3–82.73) between the five terms of the year (p = 0.468). From the beginning to the end of the year, there was a trend towards increased confidence in only three out of 25 skill areas, including intravenous cannulation, prescribing analgesia for abdominal pain and appropriate investigation ordering in a patient with unilateral weakness.

The interns from our study reported no significant change in their confidence to perform a number of key emergency clinical skills, despite having undertaken a varying number of other core terms. This supports the ongoing need to include Emergency Medicine as a core term, as it appears that interns do not confidently acquire many essential skills associated with Emergency Medicine in other rotations. Further studies to map the acquisition of these skills across all intern core terms may be useful in both streamlining intern education as well as informing medical school curricula.