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What skills, when and how often?
  1. Ruth Brown
  1. Correspondence to Dr Ruth Brown, Emergency Department, St Mary’s Hospital, Imperial College Healthcare NHS Trust, London W2 1NY, UK; Ruth.Brown{at}

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The practice of emergency medicine requires a wide range of knowledge, skills, behaviours and attributes. The breadth of casemix presenting to the average department encompasses all ages and acuities, and demands highly sophisticated critical thinking to determine diagnosis and optimal treatment, and a portfolio of procedural skills for immediate and time-dependent interventions. The Royal College of Emergency Medicine (RCEM) currently lists 61 practical procedural competences within the curriculum including some with many individual skills (airway protection, BLS and ALS),1 the 2015 ACEM curriculum framework lists 143 procedures, including multiple skills within (advanced cooling techniques).2

Gaining and maintaining mastery of these skills is challenging and likely to require significant refresher time for those skills infrequently used. The problem of skill decay is well known in medical and other professional groups, with the steepest rate of decline occurring immediately after training. Multiple factors including individual, organisational and original training efficacy impact on retention.3 Previous experience, complete mastery of the skill versus learning to novice level, and continued practise of similar skills may help to retain competence. Furthermore, the integration of new skills such as ultrasound into this skill set creates an additional burden of learning for senior clinicians.

For patients with critical illness or injury, retention of resuscitative skills is likely to lead to better patient outcomes. It is unclear as to the frequency of practice or the method of refresher practice that is required for these critical skills, the literature suggesting a range from more frequently than twice a month to yearly.4 There is also little evidence for the optimal method for refreshing previous training, with the most effective intervention depending on the …

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  • Contributors I have planned and completed this article alone.

  • Funding The author has not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Not required.

  • Provenance and peer review Commissioned; internally peer reviewed.

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