A recent article summarizes a cross-sectional survey aimed at determining the processes in place to assess the procedural competency of academic emergency medicine attendings.[i] The survey was sent to the 39 ACGME-accredited Emergency Medicine programs in the U.S. and had a 27% response rate. The authors noted that only 25% of these programs had a process in place to assess the procedural skills of attendings at the time of initial hire. In addition, about half of the programs did not require a minimum number of procedures performed during the re-credentialing process for: dislocation reduction, intraosseous line placement, lateral canthotomy, lumbar puncture, paracentesis, thoracentesis, pericardiocentesis, transvenous cardiac pacing and tube thoracostomy. Additionally, 75% of programs did not have minimal annual requirement for procedures performed for re-credentialing in the following procedures: central line placement, cricothyroidotomy, endotracheal intubation and procedural sedation.
The results of this survey are quite startling since emergency life-saving procedures or bedside diagnostic procedures are commonly performed in the emergency department and considered essential for the effective practice of Emergency Medicine. We know that the maintenance of procedural competency is an essential part of good emergency medicine practice and that procedural skill decay happens.
There have been a number of studies that have demonstrated that simulation-based procedural training can improve physician mastery of different procedures: central line placement[ii], thoracentesis[iii], paracentesis[iv], lumbar puncture[v] and difficult airway management[vi]. If simulation-based training can improve the competency of resident and attending physicians, it seems logical that it can also be implemented by hospitals to demonstrate procedural competency in procedural skills maintenance. Just like inpatient physicians must maintain ACLS certification, which includes running a Mega Code session, every couple of years, why not have attending physicians demonstrate procedural skills competency on a simulator to maintain credentials for performing these skills in the Emergency Department, Hospital wards or in the ICU? It would probably make patient care safer and avoid procedure-related litigation claims for hospitals to require this.
References:
[i] Bell, E et al. Procedural Competency in Academic Emergency Medicine Attending Physicians: How Is Competency Maintained and Evaluated by Academic Institutions in the US? Cureus. 2021; 13(7): e16719.
[ii] Barsuk JH et al. Simulation-based mastery learning reduces complications during central venous catheter insertion in a medical intensive care unit. Critical Care Medicine. 2009, 37:2697-701.
[iii] Barsuk, JH et al. Simulation-Based Mastery Learning for Thoracentesis Skills Improves Patient Outcomes: A Randomized Trial. Acad Med. 2018 May;93(5):729-735
[iv] Barsuk, JH et al. Simulation-Based Education with Mastery Learning Improves Paracentesis Skills. J Grad Med Educ. 2012 Mar; 4(1): 23–27.
[v] Barsuk, JH et al. Simulation-based education with mastery learning improves residents’ lumbar puncture skills. Neurology. 2012 Jul 10; 79(2): 132–137
[vi] Komasawa N et al. Simulation-based Airway Management Training for Anesthesiologists – A Brief Review of its Essential Role in Skills Training for Clinical Competency. J Educ Perioper Med. 2017 Oct-Dec; 19(4): E612