Procedural Competency in Emergency Medicine: The Current Range of Resident Experience

Abstract

Abstract. Objectives:To evaluate the recorded range of procedures tracked by emergency medicine (EM) programs, and to determine whether differences in procedural experience occur in various types of residency or hospital settings. Methods: The program directors of 112 approved EM programs were asked to send actual procedure logs. The requested information included the average total number of a given procedure per graduating resident, for all procedures that were tracked. Data were categorized by program format, hospital type, and ED volume. To assess the global procedural experience among programs, a set of 22 ''index procedures'' were identified; all procedures the EM residency review committee (RRC-EM) required to be tracked were included in this set. The means per graduating resident for each index procedure were added together to generate a ''mean index procedure sum'' (MIPS) per graduating resident for each residency program. These MIPSs for a residency were then compared by program format, hospital type, and ED volume. A similar analysis was performed for all resuscitations, and a ''mean index resuscitation sum'' (MIRS) per graduating resident was generated. Results: An overall response rate of 82% was achieved; a number of programs had not graduated a residency class and were not included. Sixtyfive of 85 eligible programs (76%) provided procedural data. The average number of a given procedure per graduating resident (95% CI in parentheses) for selected procedures is as follows: oral intubation 65 (46 to 85), intubation unspecified 75 (62 to 87), nasal intubation 6 (4 to 9), cricothyroidotomy 2 (1 to 2), subclavian catheter 23 (16 to 30), chest tubes 17 (14 to 20), intraosseous line 2 (1 to 3), thoracotomy 3 (2 to 5), and vaginal deliveries 17 (13 to 21). The only statistically significant differences in subgroup comparisons were in diagnostic peritoneal lavage, trauma resuscitations, and pediatric medical resuscitations when compared by postgraduate year format, and intubation-unspecified and cricothyroidotomy when compared by hospital type. There was no statistically significant difference when MIPSs were compared by format, hospital type, or ED volume. Conclusions: To the authors' knowledge, this is the first study of the range of EM resident procedure experience across the spectrum of EM residency types and settings. Overall, there are few statistically significant differences in procedure experience among different program formats. Similar experiences are recorded in a variety of different hospital types or ED volumes. However, some programs report very limited EM resident experience with selected critical procedures. There is a large variation in the types and numbers of procedures recorded by EM programs. Key words: emergency medicine; procedure; resident physician. ACA-DEMIC EMERGENCY MEDICINE 1999; 6:728-735 D OCUMENTING proficiency in procedural skills is becoming increasingly important for all physician training programs, including emergency medicine (EM). The core content in EM 1 contains 8...

Definitively Defining the Specialty of Emergency Medicine: Issues of Procedural Competency

“…2 This is not happening in an alarming percentage of residency graduates. 4 I find it interesting that interventional radiologists and cardiologists perform rather invasive procedures, with few questioning their skills. These specialists may depend on the EM specialist or surgeon to resuscitate their patients in the event of a complication.…”

“…How can I say that? They are not getting the training, 4 and they are not being appropriately tested to ensure skill competency-reciting critical steps and content does not mean skill proficiency. [6][7][8] Once a uniformly high level of procedural competency is required of all ABEM-certified EPs, we will have achieved the next level of specialty definition so badly needed in EM.…”

“…At this point, the evidence suggests patients with a known reversible cause of cardiac arrest, such as pulmonary embolism, or coronary or valvular lesions amenable to angioplasty or surgery, are the best candidates for extracorporeal perfusion. 2,4,5 Based on other ischemia reperfusion models, it would seem that the earlier extracorporeal perfusion reperfusion can be instituted after the onset of global ischemia, the more successful this therapy will be in restoring normal cardiac function. This inverse relationship between time and benefit is analogous to reperfusion efforts in regional myocardial ischemia (acute myocardial infarction).…”

“…The same specialists may never have performed such procedures alone. 4 Let me go out on a limb and state there are ABEM-certified EPs who are not competent in performing many standard EM procedures and resuscitations. How can I say that?…”

High-Fidelity Simulation Enhances Pediatric Residents’ Retention, Knowledge, Procedural Proficiency, Group Resuscitation Performance, and Experience in Pediatric Resuscitation

“…[3][4][5] However, most residents fi nish training with inadequate knowledge and profi ciency with critical care skills. [5][6][7][8][9][10][11] Surveys of pediatric residents reveal that large percentages have never led a resuscitation event, and program directors perceive that many fail to achieve procedural competence. 6,11,12 The PALS course is insuffi cient in ensuring a resident's prolonged mastery of resuscitation skills.…”