Start Documenting your Skills Today
In the fast-paced world of emergency medicine, professionals like Debbie, Joe, and Sue face a common challenge: accurately recalling their specific experiences and skills. Despite significant advancements in medical training, a gap remains in personal skill documentation. This lack of record-keeping hinders the ability to quantify and reflect on professional growth and competencies.
The article emphasizes the importance of meticulous skill documentation, advocating for the use of simple tools like Excel spreadsheets. Regular and detailed recording of procedures not only aids in personal development but also provides a clearer picture of one's professional capabilities.
Another eventful year is drawing to a close. Emergency Phycisian Debbie responded to 52 calls, often intubated, and sometimes held a scalpel in her hand. Medical student Joe in his clinical practice year, rotated through three departments over the year and completed another 8 weeks of practical training – acquiring some new ultrasound skills along the way. And Paramedic Sue performed several CPRs and successfully intubated more than once. But wait… STOP! What exactly did they do? And how? If we asked the three of them, could they tell us? Could YOU recall what you did off the top of your head?
“Every day, we implement emergency medical measures in our patients. But only a few of us keep a record of it. That’s a pity, as it says a lot about our skill level in case of need…”
Reality Check. Relax, take a moment and reflect for a minute. To the emergency physician: How many Rapid Sequence Intubations (RSIs) have you initiated, what was your first-pass success rate, and how many thoracic drainages did you need to perform? To the medical student: How many independent abdominal ultrasounds have you performed on patients and what pathologies did you discover? And to the paramedic: How often did you really intubate or successfully establish an IV line?
Often, the immediate response to these questions is… silence! Because very few of us continuously document our skills. Which is a pity!
Our past training says very little about your skill set at the moment.
Whether as an emergency physician, a medical student, or a paramedic: we all repeatedly reach points in our careers where we must attest to our emergency medical skillset. Upon closer examination, this infact IS not so simple, because we hardly ever document what has been achieved in between courses and trainings and thus what we are truly capable of.
It’s a bit like it used to be back in the old days: Fifty years ago, as an aspiring doctor, you simply completed your studies and were then unleashed on patients with the knowledge acquired in your studies, supplemented by a practical “apprenticeship” (e.g., residency, specialist training). Back in the days attending the “continuing education”-courses was often more like a relaxation program sponsored by the pharmaceutical industry. Only over the last few decades have uniform standards for medical education and training, such as the Diploma Continuing Education Program of the Austrian Medical Association (DFP), increasingly become established.
And even in 2023, theoretical instruction still dominates many emergency medical training and continuing education programs. Simulation and high-quality, practical training are often expensive, and it’s only with great effort that the “big letter courses” of guideline-setting organizations like the ERC have become established (ALS, AMLS, EPALS, PHTLS, ETC), which are now rightly seen as a solid standard within the community. In most of these programs, skills are increasingly valued over background knowledge. Following standardized procedures (SOPs) taught in these courses has often proven superior in emergency medicine to mere book knowledge, and certificates of successful completion are nowadays a prerequisite for many applications.
However, what someone has in his toolbox is still a different question, and it’s hard to predict based solely on a CV supplemented by course confirmations. Keeping a precise record of what one accomplishes in daily practice, aside from training, makes sense – it somewhat objectivizes different standards and reports on what one does regularly and frequently.
Start documenting your skills! Today!
In 2023, I intubated a total of 16 times. My First Attempt Success Rate was 93.3%, meeting all the requirements expected of a preclinical healthcare professional, at least according to the statements of ILCOR and different anesthesiological societies. I can say this because I meticulously keep track of all the procedures I perform. Unfortunately, I started doing this much later during my ultrasound training. Cause in the field of sonography, this documentation also serves as proof of competence on the way to the ÖGUM stage certificates, the final examination of which involves detailed inspection of these lists by the examiner. If only I had sat down after each patient to write down what I had just done, I would have achieved my ÖGUM Emergency Sonography Level 1 much faster!
Personally – and also at the Vienna Professional Rescue Service – I use the online software Monday.com to continuously record my skills. Just like in this chart, where I document my endotracheal intubations. Of course, this doesn't require expensive software: a simple Google or Excel spreadsheet works just as well.
So, what needs to be documented?
In my opinion, it's better to document more rather than less – even if I can't always predict whether what I document this year will ever be viewed by someone else. Moreover, the lists I keep are also a good gauge for me personally of which topics I might need to focus on more in the following year. For me, as a preclinical emergency physician, this primarily includes my RSIs, the endotracheal intubations I perform, and the thoracic drainages I place. I'm a bit more meticulous with my ultrasound skills, as I adhere to the clear guidelines of the ÖGUM necessary for achieving the next stage certificate.
Particularly in the field of sonography, well-documented cases in many training curricula serve as proof of competence about everything we have sonicated and seen over the course of a year…
In conclusion
To continuously document your skills, you don't need complicated software. A simple Excel spreadsheet is sufficient. The important thing is to do it regularly – and ideally, get the confirmation of a mentor. Such a practice ensures maximum transparency, both internally and externally, earns a great deal of respect from colleagues, and is also fun...
...at least for me.
