A Cork-based research team is this month starting an innovative programme to develop techniques to assess the performance of doctors internationally in carrying out technical procedures such as surgical operations.
The Department of Anaesthesia at Cork University Hospital (CUH) and University College Cork (UCC) are leading an international team of medical clinicians, psychologists, educators and computer scientists from the University of Graz in Austria, the University of Limerick, the University of Pecs, Hungary, and Medic Vision, a UK-based company developing simulators for medicine.
Prof George Shorten, Department of Anaesthesia, CUH, said the worldwide move towards competence-based training programmes in medicine had necessitated the search for valid and reliable competence assessment procedures by clinical training bodies both nationally and internationally.
"The development of this assessment model is therefore timely and also takes into account the fact that 2006 saw a change in the Medical Practitioners Act in Ireland which now stipulates that doctors have a statutory obligation to undergo ongoing competence assessment right throughout their career," he explained.
Dr Shorten said that as part of their training or practice, doctors needed to do a certain number of technical procedures, for example, surgical operations or anaesthetic procedures.
"Learning in the Western world predominantly uses the apprenticeship approach where a student is shown how to do something, learns the theory and then sets out to do it themselves sometimes on a model and sometimes on a patient. The problem is when it's necessary to make a high stakes decision that it's safe to let an individual doctor loose into independent practice and if they are currently competent, who is to say they will still be competent in five or 10 years," he said.
He explained that the assessment model must define each skill while taking account of the many factors which influence doctors' learning and performance, including cognitive, motor, communication, and human (eg, fatigue, anxiety and fear) factors.
"We are using a novel approach dreamt up by a group of psychologists and mathematicians at the University of Graz in Austria known as the 'competence-based knowledge space theory'. They have developed a clever way of applying this theory to assess whether somebody is good or bad at doing certain things. For example, it has been used to evaluate whether somebody is good at digital gaming," explained Prof Shorten.
The research team's work will now focus on adapting the model for use in relation to performing spinal anaesthesia, a stressful, potentially high-risk procedure which entails an injection of local anaesthetic close to the spinal cord. It is believed it will take two years to develop the assessment model.
"The objective of the Medical Competence Assessment Procedures [ MedCAP] project is to transfer this innovative approach to the medical domain using a spinal anaesthesia as the pilot. This project is particularly relevant to Ireland, as the Medical Council engages with the Irish medical training bodies to improve the ways in which Irish doctors monitor their performance.
"The principles employed in developing this procedure for spinal anaesthesia could be extrapolated to developing similar assessment tools for other medical procedural skills," concluded Prof Shorten.
The colleges of anaesthesia in Ireland and Hungary have agreed to use the model in the "real world" if the pilot testing proves successful.
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