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Skills fade literature review

Published: December 2014

What were the key findings?

The literature review found that:

  • with respect to doctors and other health professionals, this isn’t a subject that has been extensively researched;
  • in the wider literature, though, there is substantial evidence that time out of practice does impact on an individual’s skills. Skills have been shown to decline over periods ranging from six to 18 months, according to a curve, with a steeper decline at the outset and a more gradual decline as time passes;
  • various factors, such as keeping in touch with peers and staying aware of developments, can mitigate skills fade. Further, the higher the level of learning and proficiency prior to any break from work, the higher the level of retained skill will be;
  • there is evidence that self-assessment of competence doesn’t necessarily match the findings of objective assessments;
  • no consensus exists as to what time period out of practice ought to result in an assessment of competence;
  • International practice for doctors varies. For instance in the Republic of Ireland and France there are no requirements placed on doctors to prove their fitness to continue to practise on returning after a break. In contrast, Australia and New Zealand have statutory requirements about proving fitness to continue to practise, particularly if the break is longer than three years.

Why did we commission this research?

Skills fade resulting from a career break is a potential risk to a doctors continuing fitness to practice. This literature review sought to identify what is currently known about this subject.

What did the research involve?

A literature review explored published research on the subject of how time out of practice affects skills, competence and performance. It covered literature on doctors, other health professionals and other skilled professions.

Executive Summary & Full report

Executive summary - Skills fade: a review of the evidence that clinical and professional skills fade during time out of practice, and of how skills fade may be measured or remediated (pdf)

Full report - Skills fade: a review of the evidence that clinical and professional skills fade during time out of practice, and of how skills fade may be measured or remediated (pdf)