Skill progression models in emergency medicine training: a narrative review and the development of the OASIS framework

Document Type

Article

Publication Title

International Journal of Emergency Medicine

Abstract

Background: Emergency medicine (EM) requires mastery of diverse procedural skills in unpredictable, high-acuity settings. While established educational models—Dreyfus, Miller’s pyramid, Peyton’s four-step approach, and Entrustable Professional Activities (EPAs)—offer useful concepts, none provide an integrated, EM-specific, stage-linked supervision roadmap. Objective: To review existing models of procedural skill acquisition and supervision relevant to EM and present the OASIS framework (Observe, Assist, Supervised performance, Independent performance, Supervise others), which integrates educational theory with explicit supervision criteria. Methods: A narrative review of MEDLINE, CINAHL, and Web of Science (1990–2025) was conducted using terms related to EM, procedural training, supervision, entrustment, and educational frameworks. Eligible sources included theoretical/conceptual works, empirical studies, systematic/narrative reviews, and consensus/guideline documents. Reference list checks and grey literature were also included. Results & discussion: Fifty-two publications met inclusion criteria: theoretical/conceptual works (n = 15), reviews (n = 12), empirical EM/acute care studies (n = 17), and consensus/guidelines (n = 8). Common gaps included: absence of explicit supervision stages, variability in entrustment decisions, limited faculty procedural competence, and inadequate bridging from simulation to clinical autonomy. Peer-assisted learning was underutilized. The OASIS framework addresses these gaps by mapping procedural skill progression to five explicit supervision levels, each with defined learning goals, preparatory simulation steps, clinical application, and assessment checkpoints. It integrates deliberate practice, mastery learning, non-technical skill development, and a structured peer-assisted learning component. Compared to existing models, OASIS operationalizes supervision behaviors, reduces variability in entrustment, and standardizes progression toward safe autonomy. Conclusion: OASIS offers an evidence-informed, practical roadmap for procedural supervision in EM, aligning technical and non-technical competencies with graded autonomy. Implementation requires faculty calibration and simulation access, with future multi-centre research needed to evaluate its educational and patient safety impact.

DOI

10.1186/s12245-025-00994-1

Publication Date

12-1-2025

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