Procedural and examination skills of first-year postgraduate doctors do not improve with clinical experience alone.

Aim: To look for factors mitigating for or against first-year postgraduate house surgeons (PGY1) gaining experience in examination and procedural skills.

Methods: Ten PGY1s at Hutt Hospital (Lower Hutt, New Zealand) filled in self-reporting questionnaires to assess the impact of 6 months of on-the-ward training on their baseline competence in clinical examination and procedural skills. Opportunities for skills acquisition, and barriers (if any) towards gaining experience were assessed.

Results: The small numbers of PGY1s limit generalisation of the findings, however certain trends are evident. Improvements were seen in commonly carried out procedures, though gaps in these areas could still be present after 6 months. Commonly performed examinations such as auscultation of heart sounds and murmurs improved, though in the area of intimate exams and fundoscopy there was little confidence gained. Log diaries show that opportunities for practice of clinical procedures were limited and that regular weekly practice only occurred with arterial blood gases and intravenous (IV) cannulation. A discussion group analysis revealed that competition with other PGY1s for the limited number of opportunities and the random occurrence of practical procedures were barriers to gaining skills.

Conclusions: Clinical on-the-ward experience is not always enough to gain clinical skills and perhaps alternate means such as simulation need to be explored.