Skill retention is of particular concern in the military and emergency services domains where training is frequently followed by a period of non-use of these skills. Consequently, there is a significant body of research and literature, in these domains, examining the various factors affecting the decline in knowledge and skills (this has been termed ‘skill decay’ or ‘skill fade’). Skill decay is a complex problem. While skills do decline over time, the greatest decline occurs immediately after skill acquisition, with subsequent decline becoming more and more gradual.
There are also various factors that modulate the degree of skill decay:
- Learning context (factors which are modifiable to enhance learning)
- instructional strategies
- degree of overlearning (learning beyond the point of initial mastery)
- retention interval (the interval between the learning and the use of the skill)
- conditions of retrieval (the degree of similarity between the learning and performance contexts)
- interventions for preventing decay of skills
- Task type (inherent characteristics of the task which are not modifiable by the trainer)
- physical versus cognitive
- closed-loop versus open-loop (closed-loop tasks involve discrete responses and have a defined beginning and end; open-loop tasks do not have a defined end, are dynamic and are likely to be complex)
- natural versus artificial
- speed-based versus accuracy
- simple versus complex
- individual versus team-based
- Task context
- Individual differences in the trainee
- personality (conscientiousness, openness to experience)
There is still a lot that is not known about the interplay of the above factors, particularly with respect to ‘complex’ skills, because most studies involve ‘simple’ tasks. Physical, closed-loop, natural, speed-based and complex tasks appear to be less susceptible to skill decay than cognitive, open-loop, artificial, accuracy and simple tasks.
Very little is known about the impact that a period of absence from practice has on a GP’s competence, performance and skills. However, it would not be unreasonable to assume that what is known about skill decay can be applied to the medical context. With respect to performance and skills, there are two aspects that have to be considered: if the GP’s skills have deteriorated, and what changes have occurred to practice during the period of absence.
For a GP re-entering practice, the two broad areas affecting the retention of skills are individual factors and the length of absence. Clearly, the longer a GP is absent from practice, the greater the likelihood that knowledge and skills will decline to a degree that is significant. Concurrently, changes to practice will occur and the amount of change that a GP will have to contend with will also be dependent on the length of absence. Individual factors include the age of the GP: the older a GP is, the more difficult it will be for them to re-enter practice.
Overseas experience, with respect to doctors, suggests that two or three years’ absence from practice requires some form of assessment and retraining prior to full return. Currently, however, in Australia, there is no formal program to assist GPs re-entering practice. The responsibility rests with the individual GP to ensure that they are safe to return to practice and that they have the required knowledge and skills for the scope of practice to which they are returning. It is important for the GP to identify as early as practicable what issues might arise, or might have arisen, as a result of absence and to put the necessary processes into place for upskilling or reskilling as early as possible. For example, a GP planning to be absent from practice for a significant period of time should be concurrently identifying what measures will be required to facilitate a successful re-entry. Similarly, a GP who is already absent from practice should be thinking about a re-entry plan from the moment that there is intent to re-enter. At the same time, consideration should be given as to whether a mentor and/or supervisor might be required to assist with planning for re-entry, as well as with the transition back into practice.