May 15, 2012
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Resident [Any Field]
Are there any ACGME guidelines regarding who can supervise residents in performing procedures in which they do not yet have certified competency? For example, for CVC placement by a Medicine resident, does it have to be a Medicine attending? Can it be an EM attending? Can it be a Medicine resident who has certified competency? Can it be an NP or PA with certified competency?
 

Instatewaiter

But... there's a troponin
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Apr 28, 2006
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Attending Physician
Are there any ACGME guidelines regarding who can supervise residents in performing procedures in which they do not yet have certified competency? For example, for CVC placement by a Medicine resident, does it have to be a Medicine attending? Can it be an EM attending? Can it be a Medicine resident who has certified competency? Can it be an NP or PA with certified competency?
Yes
 
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Raryn

Infernal Internist / Enigmatic Endocrinologist
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Apr 25, 2008
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No real policies regarding that except the general one that on an inpatient medicine service you should only ever be supervised by an IM (or neurology) attending and IM residents (plus fellows as per the service). Assuming you have a medicine-trained attending leading your team (that you present to every day), your hospital policy determines who can supervise you doing procedures. It's perfectly normal for that to be anyone else who is allowed to do the procedure on their own, whether that's another resident or anything else you have listed.

In addition, your program and hospital determine the minimum # to achieve "competency" and be able to do it on your own. Five procedures is used as a general guideline for a minimum number of required procedures from the ABIM, but that general guideline only applies to procedures that are actually required by the ABIM (which last I looked was something like only venipuncture, arterial puncture, and pap smear). My program required anywhere from 3 (for paracentesis) to 10 (for intubation or central line) to be able to do various procedures solo.
 

IMreshopeful

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Jul 15, 2012
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Are there any ACGME guidelines regarding who can supervise residents in performing procedures in which they do not yet have certified competency? For example, for CVC placement by a Medicine resident, does it have to be a Medicine attending? Can it be an EM attending? Can it be a Medicine resident who has certified competency? Can it be an NP or PA with certified competency?
We typically required three of each procedure to be "signed off", but I wasn't really comfortable doing lines on my own until about my 10th (I did well over 50 in my residency). This is institution dependent. Also, we were absolutely allowed to be signed off and/or supervised by other services - one of my lines was signed off by a surgical attending, two of my LPs by an ED attending, etc.

Now I'm in fellowship and I'm expected to know how to do all of these things especially as part of my fellowship involves working in an ICU setting