Training resident physicians in fiberoptic sigmoidoscopy. How many supervised examinations are required to achieve competence?

Procedural experience and comfort level in internal medicine trainees

“…Table 3 presents the percentage of trainees that either met or exceeded ABIM requirements or other published requirements. 1,12,13 Procedures for which there are no current ABIM requirements, with the exception of flexible sigmoidoscopy, 12,13 are not included in the table. For most of the procedures, postgraduate year 3 (PGY 3) residents met current recommendations.…”

“…For example, while the ABIM has no requirement, clinical observations have led to the recommendation that 10 to 30 flexible sigmoidoscopy procedures are required for competence. 1,12,13 To our knowledge, there is little data correlating procedural experience with competence in internal medicine trainees, and measuring competence in procedural skills is a difficult task. 14 A first step toward defining procedural requirements for residents during their training is to correlate procedural experience with self-reported comfort in performing a specific procedure.…”

Teaching Procedural Skills

“…For several procedures, experimental studies or, more commonly, a consensus process have determined the minimum number of times a trainee must perform a specific procedure to gain competence and to qualify for privileges. 13,26 This approach has been criticized by many because of its conflict with traditional hospital guidelines for granting privileges, its frequent reliance on consensus rather than experimentation to determine an adequate number of procedures to obtain privileges, and its tendency to place pri- 19 mary care physicians with a broad scope of practice at a disadvantage while creating advantages for subspecialists with a narrow practice scope. 27 An alternative method of ascertaining procedural competency is objective testing.…”

Redefining Emergency Medicine Procedures: Canadian Competence and Frequency Survey

“…The minimum frequency of performing or supervising a procedure to maintain competence was arbitrarily set by the investigators at three or more times per year, as suggested by the expert opinion panel and a review of the literature. 16,[54][55][56][57][58][59][60][61] A decision rule ( Fig. 2) was derived by the investigators as a tool to allow the assignment of each procedural skill to one of four training levels; 1) postgraduate certification (PG), 2) undergraduate certification (UG), 3) a skill where competency to perform was unnecessary but knowledge of the procedure was deemed important (PG knowledge only), or 4) an unnecessary skill with respect to clinical competency or acquisition of skill specific knowledge (unnecessary).…”

“…In this study, the minimum performance frequency of more than three per year was endorsed by the expert panel as the best estimate at the time of the study. Although models have been developed to predict the number of practice attempts required by a trainee to achieve clinical competence, 54 and various studies have been undertaken to define this value for specific procedures, 16,[55][56][57][58][59][60][61] the minimum frequency required to attain mastery may be specific to the procedure and to the individual learner. Published ''frequency of performance standards'' for procedural skill mastery or maintenance of competence were not found in the literature.…”