This is a continuation in our series of MD Tech Tips — Technology tips to help physicians improve their craft and work more efficiently.
You are scheduled to precept an intern in minor procedures clinic tomorrow. You notice that the intern has several skin biopsies, a toenail removal and an IUD insertion on the schedule. The intern states she has done some biopsies, but isn’t confident about her suturing skills and has never performed an IUD insertion or toenail removal previously but saw them in medical school. How could you use Proceducate to enhance both her knowledge and confidence prior to procedure clinic tomorrow?
How to use the Proceducate medical app to enhance the learning for this resident and help ensure success during procedures clinic
Procedures in primary care are a common and enjoyable aspect of a busy primary care practice. In Family Medicine residencies, we teach everything from minor skin procedures to colposcopy to ultrasound to vasectomy. Learning curves for procedures are steep and some suggest a stepwise approach to teaching procedures including both testing, simulation and maintenance phases. In our Faculty Development Fellowship, we advise educators to use either George et al.’s “Five Instructional Phases” or Sawyer et al.’s “Learn, See, Practice, Prove, Do, Maintain” framework. Both are based on adult learning theories for learning technical skills and involve at least one step in which learners must review material prior to performing the procedure. In the past, most learners would review a textbook of procedures such as the excellent text by Pfenninger et al., but in today’s world of online learning and apps there are now many options. Both George and Sawyer recommend review of instructional videos for example to ensure learners know “what right looks like”. Here on iMedicalApps we previously reviewed regional anesthesia and injection apps such as ASRA Coags Regional, Regional Anesthesia Assistant, Block Buddy, Art of Injection and MSK Injections. For primary care providers, we have reviewed the excellent Procedures Consult (now available as part of Elsevier’s Clinical Key), OMT apps such as DO OMT, CRTech OMT, ultrasound apps for EM, and physical exam apps such as CORE and mskNAV.
The Proceducate app focuses on modules to improve suturing, knot tying and minor procedures such as joint aspiration/injection, biopsy, toenail removal, and gyn procedures such as IUD insertion and perineal laceration repair. Each section includes high quality videos as well as didactic information on the indications, contraindications, etc. of each procedure.
How to Incorporate the Proceducate medical App into Residency Education
First, we recommend meeting with the resident ahead of the procedures clinic to discuss their comfort, knowledge and goals for the procedure. Next, assign the resident the “Learn” step from Sawyer. They can review the procedure text in the Proceducate App or similar text in Pfenninger or Procedures Consult in Clinical Key. Ideally, you should then have them take a written test to prove they have learned the procedure basics.
Second, the resident must “see” a demo either via a video or literally watching the preceptor perform the procedure. The resident should then be able to explain each step of the procedure. You should use a procedure checklist like the ones in Proceducate, Procedures Consult or the Council of Academic Family Medicine.
Third, the resident must “practice” the procedure on a simulator before performing it on a patient. You must provide direct supervision of the practice and immediate correction and reinforcement. Only a handful of apps can function as a simulator at this point; Proceducate is not one of them. With improving virtual reality technology, this day is likely not far off. Until then, we recommend using static or more dynamic simulators found in your hospital or medical school simulation lab. Use the same checklists discussed above to assess their practice on the simulator.
Next, the resident must “prove” their competency on the simulator. You can again use the checklist to grade the resident’s performance and consider a hybrid evaluation tool that includes the overall resident performance as well as their confidence.
Finally, the resident must “do” the procedure on a live patient under direct supervision and once again be evaluated using a checklist, global rating or hybrid assessment tool. Furthermore, they must log their procedures per your residency program’s protocol.
Sawyer et al.’s final step is to “maintain” competency by periodically reviewing the procedure and preventing the “deskilling” that occurs over time. The Proceducate app and others like it are perfect for this final step. You can open the app and review the material anytime and anywhere.
Evidence based medicine
Please read our full review of the Proceducate medical app to learn more as it is part of an IRB approved study and follows current best practices in the literature recommending the use of multimedia in teaching technical skills such as procedures!