Abstract
Background: Emergency Medical Care (EMC) in South Africa provides prehospital emergency care to the ill and injured. The competent performance of both basic low-risk and advanced high-risk clinical skills is essential for achieving positive outcomes for patients who are ill or injured. Consequently, maintaining a high clinical skill competence level is crucial, as any shortfall in proficiency may lead to adverse consequences for the patient.
In South Africa, Advanced Life Support (ALS) providers are recognized as the most highly trained professionals in the field of prehospital care. Consequently, they boast an extensive array of advanced skills within their scope of practice, enabling them to deliver sophisticated life-saving interventions. All emergency care providers, regardless of their level (basic, intermediate, or advanced), must be registered with the Health Professions Council of South Africa (HPCSA). The HPCSA maintains two ALS provider registers: the ANT/paramedic and Emergency Care Practitioners (ECP) Register. During their training, aspiring ALS providers must pass practical and theoretical exams to showcase their clinical proficiency. However, there is currently no post-graduation obligation to sustain these skills. Clinical skills that go unused tend to deteriorate over time. To tackle this challenge, the HPCSA has sought to address it by requiring Continuous Professional Development (CPD) for all registered healthcare professionals in South Africa. Nevertheless, there is a scarcity of scientific data demonstrating the effectiveness of CPD in maintaining clinical skills among ALS providers.
Aim: The research aim was to investigate and describe the need for, and approaches to, maintenance of competency in rarely performed clinical skills for Gauteng-based ALS providers.
Design and Methodology: The researcher used a sequential, exploratory, and descriptive mixed-methods design. This design allowed for the collection of both quantitative and qualitative data, which enabled an exploration into the maintenance of competency in rarely performed clinical skills among advanced life support providers in Gauteng, South Africa, and provided deeper insights into the subject matter.
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Findings: The questionnaire consisted of 55 clinical skills. Among these, 28 were rarely or never performed by most respondents, indicating a potential risk of skill decay for these 28 clinical skills. Notably, all obstetric management skills were infrequently practiced by the majority of respondents, suggesting limited exposure or inadequate opportunity for training. A noteworthy observation was the presence of a positive correlation between confidence levels and the frequency of skill performance, except for skills that were less technically demanding and posed minimal patient risk, in which case confidence remained high despite infrequent practice. Participants of the focus group discussions acknowledged that regular practice improved their confidence and competence in clinical skills. During the focus group discussions, various methods for skill maintenance emerged, including diversifying work environments, engaging in peer discussions, using videos, and participating in CPD-accredited courses. Notably, physically practicing skills in such courses was seen as the most effective approach. Critically, some of the participants from the focus group discussion criticized the CPD points system, administered by the Health Professions Council of South Africa (HPCSA), for its failure to adequately address clinical skill maintenance. They pointed out loopholes that allowed practitioners to meet CPD requirements without genuinely refreshing their skills. To address this, the responsibility for skill maintenance evolved into a collective effort involving individual practitioners, employers, and the HPCSA.
Conclusion: Clinical skill refresher training is critical to maintaining competence and confidence among ALS providers. However, numerous clinical skills are rarely or never practiced, raising concerns about potential skill decay that could jeopardize patient safety. Currently, no mandatory HPCSA regulations to ensure competency of ALS providers in clinical skills. ALS providers in Gauteng are open to clinical skill refresher training, and they may unintentionally refresh their skills by changing their work environment or engaging in discussions with other healthcare professionals. To address this issue, it is recommended that stakeholders, including the HPCSA, ALS provider employers, and EMS institutions, collaborate to ensure the ongoing competency of ALS providers in clinical skill performance. This collaboration could involve establishing training facilities and implementing mechanisms to hold ALS providers accountable for skill maintenance. Additionally, the development of a digital clinical skill diary is advocated. Such a tool would enable ALS providers to track the
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frequency of their clinical skill performance and empower them to proactively address potential skill decay due to infrequent practice.