Emory University Hospital Midtown Atlanta, Georgia, USA
Introduction: Many new graduate APPs lack confidence in ICU procedural skills. In response, healthcare organizations developed APP fellowship programs to support the development of these skills. This study examines the relationship between APP's confidence and procedural competency.
Methods: This retrospective study examined 36 APP critical care fellows over 12 years. A survey measured trainee confidence in ICU procedures using a 10-question Likert scale (1-5). This was completed at the beginning and end of the fellowship program. The number of procedures, including intubations, arterial line, and central line placements, was recorded. Trainees were divided into terciles based on pre-test confidence scores (T1 < 1.9, T2 1.9-2.1, T3 >2.1). Spearman method was used to compare pre- and post-test confidence scores, while the Wilcoxon Mann-Whitney test assessed the interaction between the number of procedures and confidence scores.
Results: The average pre-test confidence score was 1.93, the average post-test confidence score was 4.27, showing an average confidence increase of 2.34 (p < 0.0001). There was a significant correlation between the total number of procedures performed and the post-test confidence score (p < 0.0124). Trainees in the lowest confidence group (T1) experienced the highest increase in confidence, with an increase of 2.63, followed by T2 with an increase of 2.33, and T3 with an increase of 1.70 (T1 vs. T3, p=0.0001). Trainees in T1 completed the fewest procedures (59.8) compared to T2 (70.4) and T3 (92.4) (T1 vs. T3, p=0.0226). Analysis indicates that completing around 80 procedures may be the target number to achieve optimal confidence improvement for trainees.
Conclusions: While the fellowship training program increased trainees' confidence, there was a significant correlation between the number of procedures completed and confidence levels. The more procedures a trainee performed, the higher their confidence score. Programs can tailor educational experiences based on trainees' pre-confidence scores to optimize confidence. In our program, trainees with lower pre-confidence scores were less likely to undertake procedures, indicating a need to arrange procedural experiences specific to each trainee’s confidence level. This can enhance program efficiency and optimize the training experience.
