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More Learners, Finite Resources, and the Changing Landscape of Procedural Training at the Bedside

Gisondi, Michael, A., MD; Regan, Linda, MD; Branzetti, Jeremy, MD; Hopson, Laura, R., MD

doi: 10.1097/ACM.0000000000002062

There is growing competition for nonoperative, procedural training in teaching hospitals, due to an increased number of individuals seeking to learn procedures from a finite number of appropriate teaching cases. Procedural training is required by students, postgraduate learners, and practicing providers who must maintain their skills. These learner groups are growing in size as the number of medical schools increases and advance practice providers expand their skills to include complex procedures. These various learner needs occur against a background of advancing therapeutic techniques that improve patient care but also act to reduce the overall numbers of procedures available to learners. This article is a brief review of these and other challenges that are arising for program directors, medical school leaders, and hospital administrators who must act to ensure that all of their providers acquire and maintain competency in a wide array of procedural skills. The authors conclude their review with several recommendations to better address procedural training in this new era of learner competition. These include a call for innovative clinical rotations deliberately designed to improve procedural training, access to training opportunities at new clinical sites acquired in health system expansions, targeted faculty development for those who teach procedures, reporting of competition for bedside procedures by trainees, more frequent review of resident procedure and case logs, and the creation of an institutional oversight committee for procedural training.

M.A. Gisondi is associate professor and vice chair of education, Department of Emergency Medicine, Stanford University School of Medicine, Stanford, California; ORCID:

L. Regan is associate professor, vice chair of education, and residency director, Department of Emergency Medicine, Johns Hopkins Medical Institutions, Baltimore, Maryland; ORCID:

J. Branzetti is assistant professor and residency director, Department of Emergency Medicine, New York University School of Medicine, New York, New York; ORCID:

L.R. Hopson is associate professor and residency director, Department of Emergency Medicine, University of Michigan School of Medicine, Ann Arbor, Michigan; ORCID:

Funding/Support: None reported.

Other disclosures: None reported.

Ethical approval: Reported as not applicable.

Correspondence should be addressed to Michael A. Gisondi, MD, Department of Emergency Medicine, Stanford University, 900 Welch Rd., Suite 350, Palo Alto, CA 94304; telephone: (650) 721-4023; e-mail:; Twitter: @MikeGisondi.

© 2018 by the Association of American Medical Colleges