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Skill Fade - myth or reality?

We’ve all heard the phrase ‘skill fade’, and no doubt joked about it from time to time while we’ve talked about training and putting what we’ve learned into practice on a day to day basis. It’s something that everyone experiences in multiple areas. But what does it really mean, particularly from a medical perspective?

Definition: Skill Fade is defined as the decay of ability or adeptness over a period of non-use.

Typically, we do our medical training updates once every 5 years. In a perfect world, we don’t need to use anything we’ve learned in between because the ideal scenario is that everyone stays healthy and uninjured! Depending on your workplace, you may have to deal with some minor medical incidents, or if you’re unlucky, you might have a more major event requiring medevac and/or carrying out CPR.

If your refresher training is recent, it’s likely that you’ll remember roughly what to do. You also have the guidance provided in the Ship Captain’s Medical Guide and shoreside support such as Telemedicine. But if it’s a while since your latest update, and you haven’t used your skills and knowledge regularly, it could be a lot more daunting.

In emergency care, several studies have identified that the rate of skill fade is consistent across several medical disciplines, with skill fade starting to occur from around eight weeks with peak decline at six months. That leaves a whole lot of time before your next medical training when it’s up to you to keep your knowledge and skills up to date.

We’ve put together a few points to help you mitigate the effects of skills fade and keep yourselves a bit more worry free when it comes to maintaining your medical knowledge and skills in between training courses.

  1. Understanding Skill Fade - Figure 1 shows a curve where the skill decline is greater in the first few months, then becomes more gradual over time - the curve starts close to the required competence but the critical cross over happens relatively quickly. You might experience this with a break from a specific skill that leads to you becoming ‘rusty’. But in medical terms, you won’t be using the skills daily. So an understanding of the starting point of our skills through reflection and feedback can help us to understand the impact of this lack of day to day use. So for instance, setting up procedures onboard can help to safely achieve the desired outcome. 
  2. Continuous Professional Development (CPD) - Keeping up to date with developments through conversations with peers and professional groups can be a great way to refresh knowledge and stay current. It may not help directly with practical skills, but having that background information can be vital. So sign up to newsletters and blogs, keep reading and talk through incidents and procedures with colleagues. 
  3. Make the most of your training. - It stands to reason that the higher the level of proficiency at training, the greater the level of retention even if the skills aren’t regularly used. Figure 1 varies for everyone, but relates specifically to medical professionals with years of training behind them. So for those of you who do medical training as just a small part of your role, the skill fade could mean you drop below the minimum level more quickly. So make the most of your training courses. Ask questions. Think about incidents and potential for accidents in your environment and talk them through. Plan drills onboard. Use your instructor's experience. Develop checklists and Mantras. Suggest refresher training in between the required 5 years.
  4. Self assessment may not be reliable.  - There is value in some form of objective assessment especially where skills have only been trained and practiced to a minimum level. The Johari window (figure 2) provides a useful insight into our own blind spots when we’re trying to assess our own competence.
  5. First time Faff!  - The first time you have to manage a medical situation is likely to feel awkward, and like you’re out of your depth. Even putting on a pair of gloves can be unbelievably tricky if your hands are sweating! Take time to review and reflect on what happened and your response. Learn from any experience, however small, talk it through and share with your colleagues. 

But it’s not all bad news!


At Red Square Medical, we offer a whole host of resources to help mitigate the effects of skill fade. Here’s a few examples and if you have something different in mind, please ask and we’ll do all we can to help.

1. Sign up for our free monthly educational resource,
Salt Water Solutions. Each month we’ll email out a short training update for you to use and share.


2. Sign up to our monthly newsletter,
Worse Things Happen at Sea. Covers a host of topics including important updates to regulations and new developments in the maritime medical world.


3. Check out our
Blog Spot! You’ll find literally hundreds of useful blogs covering a wide range of subjects from mindfulness to lightning burns and medical conditions to managing trauma. 


4. Ask us about
Onboard Training. Did you know that we can come to your vessel to train the whole crew, using your kit and with scenarios relevant to your environment. There’s no better way to train as a team and it’s a really valuable way to refresh skills without formal assessment.


by Rachel Smith 08 May, 2024
At Red Square Medical, we’re keen to support those who have a passion for maritime medicine. While we can’t provide placements for everyone, occasionally a request pops up at just the right time and we can provide some experience and insight into our unique and specialised world. Last year we were contacted by Jordan Lin, a medical student with a love of the ocean. This is his story… When I was a boy, my dad and I used to go fishing with a local fisherman off the Norfolk coast. I absolutely loved being on the sea and so for quite a long time, I wanted to be a fisherman. When I got a bit older I kind of forgot about this and think I may have been slightly put off by watching the TV series ‘World’s Deadliest Catch’! But I have always loved being on the water and spent a lot of time sailing dinghies; I was also a swimming teacher for children back in high school and college. Later, I decided to study medicine and I’m now a final year medical student at the University of Bristol where I completed an intercalated degree; a Masters in Health Sciences Research. I’m now looking forward to starting work as a qualified Doctor in August. Though having spent 6 years training, my next 2 years will be spent working for the required two foundation training years that must be completed before being able to work independently as a Doctor in the UK. At university, I joined the VITA network which is a group dedicated to developing a health and public health approach at the heart of any response to human trafficking and exploitation. I became the blog coordinator for the organisation and you can read the blogs, including those that I have written, here: https://vita-network.com/blog/ In my spare time, I have been involved with the Bristol University Hot Air Ballooning Society and trained through the society to get my Balloon pilots licence. So, I often spend weekends during the summer flying in a leisurely fashion over Bristol and the surrounding area!
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