Skills Fade

Podcast – Skills Fade with Nathalie Pattyn at Tactical Trauma 24

Skills fade is a reality for all medical professionals. Emergency medicine requires constant practice, yet many clinicians find themselves in situations where their skills decline due to lack of exposure. At Tactical Trauma 24, Nathalie Pattyn shared insights into why this happens, how we should address it, and why it’s a systemic issue rather than an individual failure.


Listening time: 16.21

Understanding Skills Fade

Skills fade refers to the decline in clinical and procedural abilities due to lack of practice. It’s often mistaken for imposter syndrome, particularly among young emergency physicians, but it affects clinicians of all experience levels. Rare procedures, such as pediatric resuscitation, are especially vulnerable to skills degradation.

Medicine operates under different expectations compared to other high-stakes fields like aviation. Pilots must retrain after just three months of inactivity, while medical certifications often last for years. This unrealistic expectation leads to gaps in competency and confidence, leaving practitioners feeling unprepared when they return to active practice.

Personal Experience and Systemic Issues

Nathalie’s 15-month deployment to Antarctica highlighted the issue firsthand. She underwent extensive cross-specialty training before departure, yet after her return, she felt out of practice and vulnerable. With no formal re-entry process, she had to arrange supervised practice on her own. While some countries, such as the UK, provide guidelines for clinicians returning to work, many healthcare systems lack structured pathways. This leaves individuals struggling to assess and rebuild their competency alone.

Research shows that skills fade occurs within months, not years. The COVID-19 pandemic underscored this issue, with senior consultants losing their performance edge due to decreased case volume. Despite this, medicine continues to operate under outdated assumptions about how long clinicians can go without performing critical procedures before their proficiency suffers.

Distinguishing Between Skills Fade and Imposter Syndrome

Many clinicians fear they are losing their abilities, but how can they differentiate between real skills fade and mere loss of confidence? This is where structured assessments and retraining become crucial. Without clear guidelines, clinicians may either underestimate or overestimate their deficits, leading to patient safety risks or unnecessary anxiety. Addressing this on a systemic level could help remove the stigma and provide clear pathways for skill recovery.

Gender and personality may also influence self-awareness of skills fade. Some clinicians recognize their decline and seek retraining, while others may overestimate their abilities after a break. Without standardized processes, skill degradation remains a hidden risk.

The Difference Between Teaching and Training

Teaching and training are not the same. Teaching introduces concepts, while training reinforces them through repetition until they become second nature. Many experienced clinicians struggle to articulate procedural steps because they operate on an automatic level, making them less effective at training beginners. Medicine needs to integrate cognitive science principles to ensure clinicians not only learn but retain skills under pressure.

Ageing and Skill Retention

Aging affects psychomotor skills, reaction times, and visual perception. In surgical settings, data suggests that experienced consultants maintain an edge over trainees for a period, but beyond a certain point, age-related decline becomes a factor. The exact point at which this occurs varies by individual, making it difficult to create universal guidelines.

What Needs to Change?

A structured return-to-practice program should be implemented to support clinicians after extended absences. Recertification requirements should be shortened to ensure competency remains high. Medicine must shift from viewing skills fade as a personal issue to addressing it as a systemic responsibility. Implementing evidence-based training methods would reinforce long-term skill retention and ensure patient safety.

Final Thoughts

Skills fade is inevitable but manageable. Instead of placing the burden on individuals, healthcare systems must adopt structured solutions. High-risk fields like aviation prioritize continuous retraining—why doesn’t medicine? Addressing this issue could improve patient outcomes, boost clinician confidence, and create a safer, more competent workforce.


Key Learning Points


Podcast Transcription


Further Reading – Handbook of Mental Performance

Handbook of Mental Performance

This extensive overview of mental performance optimization techniques, written by Nathalie and Robin Houffa, offers both a state-of-the-art reference resource and a comprehensive tool for those engaged in managing and implementing mental performance programs and is free to read under a creative commons licence.

The book is written by a combination of academic and operational experts from a wide range of high-performance domains, including the military, space programs, academia, executive coaching, and elite athlete coaching, who complement scientific analyses and overviews of current knowledge with their own experience. Divided into three parts, the book begins by providing a broad conceptual framework through which to embed the latter technical content. Part two looks specifically at the interventions, knowledge, skills, and techniques needed to improve mental performance for both individuals and teams. The final section pulls together the theory of the previous parts, taking a more practical approach by covering implementation, methodological plans on how to appraise new techniques, lessons learned based on the practical experience of the authors, and considerations regarding the necessary learning environment for mental performance improvement.

Pairing an overview of all available neurological, cognitive, and psychological interventions aimed at improving mental performance with a review of their implementation, this is a go-to guide for practitioners involved in managing mental performance and program managers looking at the implementation of a mental performance policy across a wide range of domains. It will also be of interest for courses on performance psychology and human performance in both an academic and professional environment.


The Guest – Dr Nathalie Pattyn

Nathalie Pattyn, MD, MPsy, PhD, received a degree in medicine from the Université Libre de Bruxelles (magna cum laude, 2001), a Master in Clinical Psychology from the Vrije Universiteit Brussel (cum laude, 2004), a PhD in Psychological Sciences from the Vrije Universiteit Brussel (2007) and a PhD in Social and Military Sciences from the Royal Military Academy (2007).

She also holds a postgraduate degree in Aerospace Medicine; a postgraduate degree in Emergency Medicine; a postgraduate degree in General Practice ; a postgraduate degree in Disaster Medicine ;and a Master in Global and Remote Healthcare.

She completed her Junior Officer Course with the Belgian Defense College in 2005, and her Staff Officer Course in 2008. She has a mixed clinical, research and operational background, having been deployed as a medical officer in various Middle Eastern and African countries, and having completed missions in Antarctica for a total duration of more than two years.

Her longest deployment was 15 months to the Halley VI Research Station in Antarctica, where she worked as the station physician while setting up a new biomedical research laboratory for the European Space Agency. She is currently still working as an emergency physician and a flight surgeon.

Her research interests include the psychophysiological measures of performance in elite populations; and Human Factors approach to isolated and confined environments, ranging from space to submarines.

In 2010, she founded a research unit within the Royal Military Academy, dedicated to the multidisciplinary study of human performance in operational environments. This led her to be the project manager for designing a tailored Human Performance Program for the tier one unit of the SOF community in Belgium.

She is currently an Associate Professor in Physiopathology at the Vrije Universiteit Brussel and in Human Performance at the Royal Military Academy.


Tactical Trauma 2024

Huge thanks to Fredrik Granholm and all at Tactical Trauma 24 for their very warm welcome and for letting us record this series of podcasts. This is a fantastic conference, and we would highly recommend you check it out when they advertise their next event.

Where to listen

You can listen to our podcast in numerous ways, ensuring you never miss an episode no matter where you are or what device you’re using. For the traditionalists, Apple Podcasts and Google Podcasts offer easy access with seamless integration across all your Apple or Android devices. Spotify and Amazon Music are perfect for those who like to mix their tunes with their talks, providing a rich listening experience. If you prefer a more curated approach, platforms like Podchaser and TuneIn specialize in personalising content to your tastes. For those on the go, Overcast and Pocket Casts offer mobile-friendly features that enhance audio quality and manage playlists effortlessly. Lastly, don’t overlook YouTube for those who appreciate a visual element with their audio content. Choose any of these platforms and enjoy our podcast in a way that suits you best!


Cite this article as: Iain Beardsell, "Podcast – Skills Fade with Nathalie Pattyn at Tactical Trauma 24," in St.Emlyn's, February 5, 2025, https://www.stemlynsblog.org/podcast-skills-fade/.

1 thought on “Podcast – Skills Fade with Nathalie Pattyn at Tactical Trauma 24”

  1. Thank you for addressing this important issue in our continuing professional development. The construct of skill fade is likely to be multi-faceted. There are both subjective and objective components. It may be an internal experience or be externally visible. There are cognitive, affective and psychomotor components. Our own insights will vary. What defines skill-fade is also likely to be related to personality factors, peer expectations, as well as institutional standards. An important question is at what point does skill-fade become clinically significant? This is quantifiable if we compare outcomes high volume cardiac medical or surgical centres with low-volume ones. However, in EM there are few procedures that a practitioner can come even close to volume as our specialised colleagues. Measuring outcomes with these numbers is not statistically meaningful. This makes determining the ideal volume or frequency of any chosen intervention difficult.

Thanks so much for following. Viva la #FOAMed

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