Apparently ACGME has changed the way that they define a resident's competentcy in various procedures such as central lines, paracentesis, thoracentesis, even pap smears. It used to be based on a number, but now they have put the ball in the court of the individual programs. The timing is convenient because the rules seems to have changed a few month before senior residents graduate.

I was wondering if people could comment on how their programs have handled this. Are graduating residents being grandfathered?

Apparently ACGME has changed the way that they define a resident's competentcy in various procedures such as central lines, paracentesis, thoracentesis, even pap smears. It used to be based on a number, but now they have put the ball in the court of the individual programs. The timing is convenient because the rules seems to have changed a few month before senior residents graduate.

I was wondering if people could comment on how their programs have handled this. Are graduating residents being grandfathered?

I thought this change was in place since 2005? ANyone know....aProgdirector??

They did this because so many residents weren't getting certain procedures. For instance, I SAW 1 paracentesis done by someone other than a radiologist. I'm qualified to call a radiologist to do one by u/s.

This is disappointing to me. I love general surgery, but ultimately chose IM (eventually Critical Care/Pulm) because I thought it would provide better opportunity for work/family balance. While on the interview trail for IM this year, I was disappointed to discover how variable programs were in their exposure to procedures. Many traditionally IM procedures are going to Interventional Radiology. I know that I'll get plenty of experience with lines/intubations during a Critical Care fellowship, but I'd like to use my hands as a resident, too!

I know that I'll get plenty of experience with lines/intubations during a Critical Care fellowship, but I'd like to use my hands as a resident, too!
You can get plenty of procedures, you just may not get all of the ones "required" by ABIM. Let your CC attendings know that you want procedures, hang out looking for them, stay late to "help" etc. I haved a friend who had nearly 1,000 lines and intubations by then end of his third year by doing this.

Awesome. Thank you!

You can get plenty of procedures, you just may not get all of the ones "required" by ABIM. Let your CC attendings know that you want procedures, hang out looking for them, stay late to "help" etc. I haved a friend who had nearly 1,000 lines and intubations by then end of his third year by doing this.

1,000!? One our pulm/cc fellows has over 2000 central lines... after working as a hospitalist / intensivist for ten years.

This is disappointing to me. I love general surgery, but ultimately chose IM (eventually Critical Care/Pulm) because I thought it would provide better opportunity for work/family balance. While on the interview trail for IM this year, I was disappointed to discover how variable programs were in their exposure to procedures. Many traditionally IM procedures are going to Interventional Radiology. I know that I'll get plenty of experience with lines/intubations during a Critical Care fellowship, but I'd like to use my hands as a resident, too!


gerigal, you will get plenty of procedures in pulm/cc. the question is, how many procedures in general im? not as many any more. then it seems like it would become a medicolegal problem- if you don't do many thoracenteses/paracenteses/intubations/lines, maybe you shouldn't do any.