Introduction
The Accreditation Council of Graduate Medical Education (ACGME) and
American Board of Thoracic Surgery mandate operative proficiency through
tabulation of key procedures throughout residency, aimed at ensuring a
level of surgical competency prior to graduation 1–3.
The impetus being that through familiarization of the cadence of
procedures as well as the necessary skill set, the trainee will be able
to perform these procedures safely and independently by the end of
training. While the operating room (OR) is a controlled environment with
faculty supervision, procedures carried out at the bedside can have
significantly less oversight 4. These procedures
including chest tube placement, central line cannulation have intrinsic
risk and can be morbid or mortal if done improperly. However, there are
no current number of procedures that a trainee needs to perform and no
clear-cut guidelines exist for assessing bedside procedure
competency4–7. There is limited instruction from
faculty on these procedures, often resulting in instruction from senior
residents instead 8,9. While this follows the see one,
do one, teach one mantra integral to surgery, it can lead to high
variability in procedural competence and no clear delineation of
privileges in trainees.
Our institution had no set mechanism for the delineation of bedside
procedures for our residents. Given the overall potential for harm and
with a directive from the local Graduate Medical Education (GME) office
we developed a training and credentialing program for our resident. The
course was designed and implemented by a small working group of
attending physicians, advanced practice providers (APP) and residents.
More so as, integrated teams continue to change the landscape of
surgical training, it is important to recognize that other
practitioners; nurse practitioners, physician assistants and physicians
in other sub-specialties play a critical role in the education and
training of residents. This can be especially pointed in the realm of
bedside procedures. Thus, in developing the curriculum a multifaceted
approach to the curriculum was used. The goal of this study was to
evaluate the development and execution of a high-risk bedside procedures
credentialing program for trainees by surveying resident on their
previous experiences, attitudes and knowledge on each procedure.