Using receiver operating characteristic (ROC) analysis to establish the previous experience threshold for critical-procedure competency

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

“…2 It is highly unlikely that residents have achieved competency after performing so few emergency procedures and resuscitations. [6][7][8] The core curriculum in EM includes critical emergency procedural and resuscitation skills. In contrast to other specialties, we have often relied on other specialties to teach our residents procedural skills during off-service rotations.…”

“…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.…”

“…Many of our own colleagues have already begun to challenge traditional procedural techniques and training methods (e.g., the four-step Brofeldt cricothyrotomy technique, 3 thoracostomy, 8 and thoracotomy). 6,7 Maybe it is time to advance procedural skill training and certification using high-risk, standardized national procedural competency exams that might incorporate animal, cadaver, and virtual reality simulation laboratories. [5][6][7][8]10 I contend that we are now ready as a specialty to engage the ABEM in organizing a ''credible developmental research and field testing system on a national level, that could be extended to be a required part of the credentialing and evaluation system of the ABEM.''…”

“…6,7 Maybe it is time to advance procedural skill training and certification using high-risk, standardized national procedural competency exams that might incorporate animal, cadaver, and virtual reality simulation laboratories. [5][6][7][8]10 I contend that we are now ready as a specialty to engage the ABEM in organizing a ''credible developmental research and field testing system on a national level, that could be extended to be a required part of the credentialing and evaluation system of the ABEM.'' 2 With a more sophisticated educational approach, EM specialists can learn to perform procedures as well as or better than other specialists, 2-10 and the ABEM can go beyond what other specialty boards are doing to demonstrate competency.…”

“…2 With a more sophisticated educational approach, EM specialists can learn to perform procedures as well as or better than other specialists, 2-10 and the ABEM can go beyond what other specialty boards are doing to demonstrate competency. 2,[6][7][8] Emergency ultrasonography is yet another procedure where other specialists have defined their expertise expectations, and have demanded respect to perform ultrasonography once certified by their specialty board. As EM specialists, we must first define, then train ourselves in a similar fashion, and finally, allow ourselves to be tested to demonstrate our competency.…”