Diagnostic assessment of procedural skills in first-year residents: identification of critical gaps through clinical simulation.
Abstract
Introduction: Entering a medical specialty program assumes that residents are proficient in basic diagnostic and therapeutic procedures, as outlined in the national graduate profile for general physicians. However, previous studies indicate a low self-perception of practical preparedness, attributed to limited hands-on exposure during undergraduate training. This study evaluated procedural skills in first-year residents through clinical simulation, aiming to identify educational gaps from the start of postgraduate training. Methods: A total of 83 residents from two cohorts (2024 and 2025), across eleven specialties, were assessed. Practical exams were conducted on four procedures: aseptic technique (n=83), interrupted suturing (n=48), lumbar puncture (n=35), and orotracheal intubation (n=34). Simulated evaluations were performed using checklists based on international standards and expert consensus. Performance was classified for diagnostic purposes as competent (≥70%), insufficient, or full score. Results: Competency rates were 88.0% for aseptic technique, 95.8% for suturing, 73.5% for orotracheal intubation, and 65.7% for lumbar puncture. Notable differences emerged between procedures, with greater difficulty observed in more complex or less frequently practiced techniques. Lumbar puncture had the highest rate of insufficient performance. Conclusion: Clinical simulation enabled objective assessment of incoming residents' procedural competencies, revealing discrepancies between perceived preparedness and actual performance. This diagnostic approach provides evidence-based baseline data to design targeted interventions, with lumbar puncture requiring priority attention (34.3% insufficient performance). The strategy may potentially contribute to enhancing clinical safety and optimizes resource allocation for postgraduate training.
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