Nationally, medical students receive variable procedural training during medical school. Some get great hands-on experience with procedures and others hardly any. Recently, much of the responsibility for teaching procedures in the medical school curriculum has fallen on the shoulders of emergency physicians (for better or worse).
But a question arises: What IS the minimum required procedural competency for the average medical student, independent of specialty career choice?
The Association of American Medical Colleges (AAMC) published in their 1999 Medical School Objectives Project that the basic procedure list is:
IV placement- Arterial blood gas sampling
- Thoracentesis
- Lumbar puncture
- Nasogastric tube insertion
- Foley catheter placement
- Suturing
Then in 2005, the AAMC published a Clinical Skills Curriculum for medical schools, which provides an extensive laundry list of "recommended" skills in the curriculum. Because the importance of each skill isn't weighted, it's hard to tell what are the most important skills. To give you a sense of the >100 skills listed, skills included suturing, chest tube placement, pap smear, endotracheal intubation, suprapubic cystostomy, and ear wax removal. Yes, that's right - ear wax removal!
So, what do you think are the most important skills to come out with after medical school? This was the question asked in a single-site study* of EM faculty and end-of-year PGY1 residents from all specialties. Both groups were given 31 procedures to rank as "no need to know", "convenient to know", and "must know". Interestingly, there was a moderate disconnect between faculty and resident perception of what procedures should be learned during medical school.
The majority of faculty thought that 14 procedures were "must know":
- CPR
- Bag valve mask airway
- IV placement
- Phlebotomy
- ACLS resuscitation
- Arterial blood gas
- ECG interpretation
- Oral and nasal airway
- Local anesthesia
- ECG procurement
- Throat culture
- Nasogastric tube placement
- Laceration repair
- Foley placement (female) - Not sure why male foleys didn't make the list.
- CPR
- Bag valve mask airway
- ACLS resuscitation
- ECG interpretation
- Local anesthesia
- Laceration repair
- Intubation
- Central line placement
- Lumbar puncture
- Abscess incision and drainage
- Arterial line placement
What's the next step?
This study should be expanded to other clinical sites where nurses, physician assistants, nurse practitioners, respiratory therapists, and other ancillary staff are more and less involved with performing procedures. This may significantly affect whether the residents rank procedures as "must know".
Anyone up for doing a multicenter survey?
* Fitch MT, Kearns S, Manthey DE. Faculty physicians and new physicians disagree about which procedures are essential to learn in medical school. Med Teach. 2009 Apr;31(4):342-7.
