Division of Pulmonary & Critical Care Medicine

Procedural skills encompass the areas of clinical care that require physical and practical skills of the clinician in order to accomplish a specific and well characterized technical task.  Procedural skill requirements vary according to the context in which procedures are performed and according to the complexity of the required procedure.  This curriculum (in concordance with ACGME recommendations) aims to present a structured curriculum that will evaluate the performance of procedures that are considered essential for our fellow’s scope of practice. We define procedural competency as an appropriate level of skill required to optimize the likelihood of a successful outcome.

Anticipated Learners: PGY 4,5,6 fellows in Pulmonary/ Critical Care, Nephrology/Critical Care, Infectious Disease/Critical Care, Emergency Medicine/Internal Medicine/Critical Care Medicine and Critical Care.

Curriculum Objectives:

1. To provide structured basic procedural skills training for critical care fellows
2. To ensure procedural proficiency criteria have been met
3. To provide a comprehensive procedural teaching curriculum

Fellow Educational Objectives:

1. Recognize Indicators for procedures
2. Describe the procedure in appropriate language for patients and caretakers
3. Acknowledge the impact of the procedure on patient and family
4. Competently perform all medical procedures required for the scope of practice
5. Perform procedures in a way that maximizes patient comfort

Curriculum Design:

Pre-Patient Training-Training done outside the clinical setting to provide instruction on the basic enabling skills of the procedure

• Simulation Center training (Pokes and Prods)
  • Instruction on the basic skills of the procedure
  • Opportunity to perform the procedure in a simulation environment

Training in the clinical situation

• Completed number of direct observations (DO) under faculty supervision with completion of direct observation forms

Designated Procedures (required DO form completion):

1. Central venous catheter (6)
   1. Internal Jugular (2)
   2. Subclavian (2)
   3. Femoral (2)
2. Arterial line placement (5)
3. Thoracentesis (5)
4. Paracentesis (5)
5. Endotracheal Intubation (5)

*Completion of DO forms is a requirement of the fellowship training process.  This does not necessarily translate into the fellow being able to perform procedures unsupervised.  This should be discussed with treating staff.

*Endotracheal Intubation will always require a staff presence.

Prepared By: Jayna Gardner-Gray MD

Reviewed by: Pulmonary and Critical Care Fellowship Program Director/Associate Program Directors; Chair, Division of Pulmonary and Critical Care

References:

1. Grantcharov T, Reznick R, Mclaughlin R S. Teahcing procedural skills. BMJ 2008;336:1129.
2. Ma IW, Sharma N, Brindle ME, Caird J, McLaughlin K. Measuring competence in central venous catheterization: a systematic-review. SpringerPlus. 2014;3:33. doi:10.1186/2193-1801-3-33.