Competence-based specialty training for doctors
With the transition to competence-based training of medical specialists in Norway, the focus has shifted to recognising that individuals have different learning curves. In skills training, doctors undergoing specialty training will need varying numbers of repetitions to achieve their competence goal. If we are to move away from asking 'How many procedures have you performed?', and instead ask 'What can you do?', we must also pave the way for individually tailored training volumes. Working time regulations, new and more complicated treatment modalities and, not least, patients' right to be involved in decision-making limit the possibilities for 'training' on patients. Prior to interacting with patients, it would be ideal if doctors undergoing specialty training had thoroughly practised basic skills to the point where they could almost perform them automatically – in other words, 'move the learning curve' away from the patient and into a simulated situation. The traditional 'See one, do one, teach one' approach is not unsafe for patients, but it is very resource-intensive and particularly difficult to implement in a time when learning opportunities have decreased. This is partly due to the rise in the number of doctors undergoing training. Additionally, treatment in Norwegian hospitals has become so specialised that what used to be suitable for 'beginners' now requires a much more advanced level of experience before patient care can be administered. Examples of this can be found in surgical departments, where the introduction of laparoscopy and robot-assisted surgery has resulted in significantly fewer learning opportunities for our future surgeons.
The learning opportunities available will also differ for each hospital. Situations that are rarely or never encountered in a particular hospital can, to some extent, be replaced by simulation, and the Norwegian Directorate of Health encourages more active use of simulation in training: 'Several specialties use simulation as a learning tool' (6). Simulation is also beneficial for situations that pose particular challenges and require additional training to instil confidence. It is also suitable for critical and time-sensitive scenarios.