I wanted to share my residency procedure logs to provide some more perspective to this discussion. First, this isn't nor should not be representative. But I think it can be helpful for a few reasons in support of the potential of our specialty. Note that I attended a really good unopposed program and was within that was on one end of those proactively seeking out additional training and with a clear reason why (global health, rural medicine goals). I largely stopped logging office procedures (excisions, injections) after intern year, this does not include procedures during 2 elective away months, and also did not log many others fully which became high volume or once I met our internal privileging requirements (such as with ultrasound, vent management, ekg, chest xray, etc).
Some points I want to make
1) Family medicine is diverse, and we should not extend the limitations of your experiences to our colleagues or our specialty as a whole
2) Procedure numbers are helpful, but also critical and harder to capture is true independence, back up or not, can you assess the need for the procedure or alternatives, can you perform the procedure in a complicated patient or emergent setting, have you managed procedure related complications that can arise or are competent to do so if needed
3) Procedures cross train so low numbers in a single specific procedure can still give rise to competency, e.g. assisting open urology cases prepared me for bladder complications in a difficult c-section, etc. Paras, thoras, LPs, have their own specifics, but generally inserting needles and removing fluid is a skill that cross-trains
4) You have to supplement doing the procedure with preparation before and after, reading and reviewing thoroughly, do the procedure or op note yourself and from scratch (not templates) to both have the opportunity and cement the learning
5) Yes, I really did 3 ex-laps as the primary surgeon, we had great teachers, it was my final year, one was for a strangulated hernia, and 2 gastric perforations. Can I handle anything I find? No but I can get in and out of an abdomen safely. Useful for my post-partum tubals as well.
6) Some of what I experienced 3 years ago is no longer possible now, old attendings retiring, more outpatient requirements, hospital rule changes, so I'm grateful for the moment in time I had
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