EdibleEgg

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There are a few threads about Family Medicine procedures on this forum. The link below is a "consenus statement" on procedural training from the STFM. Kent has noted several times that procedural practice is very regional, but would some of you guys comment on this? Are you meeting these recs in your program now? Do you plan to use these procedures in your practice?




Nothnagle M, Sicilia JM, Forman S, Fish J, Ellert W, Gebhard R, Kelly BF, Pfenninger J, Tuggy M, Rodney WM. Required Procedural Training in Family Medicine Residency: A Consensus Statement. Fam Med 2008; 40: 248-252. http://stfm.org/fmhub/fm2008/toc.cfm?xmlFileName=fammedvol40issue4.xml
 

Peeshee

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Definitely interesting to see which procedures are required. I think we have exposure to all procedures but that does not equal proficiency. They do not specify how many numbers of each procedure are needed. I think it takes a lot of practice to become proficient in a procedure, such as a central line. I do not really see family medicine drs. in practice doing central lines, even though they probably did them during residency. Another example is colonoscopy/endoscopy - family medicine residents do them, but gastroenterologists have focused on this specific area and have much more practice.

I think that residency should be tailored to your interests, especially in terms of procedures. I understand that it's all about exposing us to everything, but how realistic is it for us to know everything? That's why I think we should focus in on our interests and not be forced to do all procedures.

Just curious for those in family medicine residencies or who have already finished, how many central lines did you do? how many LP's did you do? how many colonoscopies/endoscopies?
 
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EdibleEgg

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I appreciate your response. Procedural medicine is something that seems extremely important to most fourth year students who declare FM, but it seems less important to residents. I'm not exactly sure why that happens. It may be that people do focus more on what they are interested in. It may be that there are a people who weren't really interested in FM who feel stuck in FM and are just interested in getting by. In my case, I was interested, but my residency program did not provide all of the opportunities I wanted.

As far as the article goes, I think they don't include numbers because numbers don't equal proficiency. I'll agree that it takes practice to become proficient in a procedure, but how much is the real question. If you ask gastroenterologists, the minimum number of colons needed is one less than the lowest number a GI fellow does in fellowship or one more than an FP can do in residency.

I am one family doc that does cental lines, actually quite a few. I'm not doing colonoscopy at the moment, but I plan to resume once I stop locum tenens and settle down. If you plan on doing any hospital medicine, then it is a valuable skill. If it doesn't hurt your pride a little when the surgery PA comes over to put in a central line for you, then something is wrong (that's not a shot at PA's by the way).

I agree that you should be allowed to tailor your training to your interests. That's one of the great things about family medicine. However, I think the point of the article is that there is a minimum set of knowledge that every FP should have, and there is a minimum amount training that should at least be offered by residency programs.

Thanks for your thoughts. There's a lot of gloom and doom surrounding primary care. I don't buy into most of it, but I have seen FP's neutered procedurely. Yes, it hurts that much.


I was very aggresive, and these were my numbers:
lines ~50
endoscopies ~150
LP ~ 5 (just didn't have the opportunity)