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Procedural Competence Among Faculty in Academic Health Centers: Challenges and Future Directions

Vaisman, Alon MD; Cram, Peter MD, MBA

doi: 10.1097/ACM.0000000000001327

Increasingly, faculty are taking on more direct responsibilities in patient care because of reductions in resident work hours, increasing admissions, and an endless push for efficiency. Furthermore, the rise of different career tracks in academia (i.e., patient care, research, education, or administration) and a drive for efficiency and subspecialization have placed additional strains on academic health centers. Combined, these factors have led to faculty increasingly being placed in the position of supervising bedside procedures that they may have not performed in years or with tools they have never trained with at all. Despite these challenges, procedural retraining for faculty remains nonstandardized across most academic health centers. The resulting lack of procedural competence among faculty creates a number of challenges for the different parties involved.

In this Perspective, the authors discuss the nature of the current problem of faculty procedural competence and the challenges it poses for faculty and academic health centers, medicolegal ramifications, and the challenges it poses to the faculty–trainee relationship. The authors then suggest several strategies to delineate and resolve this problem. To delineate the problem, they suggest single-center surveys to address the current paucity of data. To resolve the problem, they suggest the consideration of some modest, low-cost interventions such as having backup systems in place for procedure supervision (e.g., procedural service teams or interventional radiologists) and providing faculty with opportunities to retrain.

A. Vaisman is a licensed physician in internal medicine and current trainee in adult infectious diseases, Division of General Internal Medicine and Geriatrics, University Health Network, and Department of Medicine, University of Toronto, Toronto, Ontario, Canada.

P. Cram is director, Division of General Internal Medicine and Geriatrics, University Health Network and Sinai Health System, and professor of medicine, University of Toronto, Toronto, Ontario, Canada.

Funding/Support: P. Cram is supported by a K24 award from the National Institute of Arthritis and Musculoskeletal and Skin Diseases at the National Institutes of Health (AR062133).

Other disclosures: None reported.

Ethical approval: Reported as not applicable.

Correspondence should be addressed to Alon Vaisman, Division of General Internal Medicine, University Health Network, 200 Elizabeth St., 14EN-220, Toronto, ON, M5G 2C4; telephone: (416) 340-4059; e-mail:

© 2017 by the Association of American Medical Colleges