Our residency program kept a binder of all the "important" procedures that they expected a resident to learn and they would sign-off saying you were competent to perform the procedure independently. We could then show this list to the hospital we went to, in addition to a tally of the # of each procedure we did during residency. This was important if you wanted to get permission to do things like OB deliveries and circumcisions...not as important for something like a joint injection or skin biopsy. Even so, I know my new dept of fam med "shadows" our new attendings for their first several deliveries and circumcisions so they can also sign off on the new attending.