procedures after residency

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smartparts

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If I don't get signed off on a procedure during my residency training, are there ways to make it up after graduation? I'm not talking about the stuff everyone gets like IJ central lines, I'm looking for more oddball things like joint aspirations and subclavian lines. Also, does it matter? Once I graduate, am I allowed to do all that stuff at my discretion?
 
If I don't get signed off on a procedure during my residency training, are there ways to make it up after graduation? I'm not talking about the stuff everyone gets like IJ central lines, I'm looking for more oddball things like joint aspirations and subclavian lines. Also, does it matter? Once I graduate, am I allowed to do all that stuff at my discretion?

It will depend on the hospital. Most will require some verification that you performed enough of these procedures and were supervised/taught how to do them. If you aren't signed off and you have a complication, it will basically be indefensible.
 
It will depend on the hospital. Most will require some verification that you performed enough of these procedures and were supervised/taught how to do them. If you aren't signed off and you have a complication, it will basically be indefensible.

so is there a way to do it after residency (ie workshops, simulations, having colleagues who are signed off supervise me, etc)?
 
so is there a way to do it after residency (ie workshops, simulations, having colleagues who are signed off supervise me, etc)?

Yes there are ways to get "signed" off. Mostly the hospitals that will be granting you privileges need to be able to cover their assess and toss you under the bus if needed and this means you'll need to give them "something" even if it's just a weekend course with a certificate signed in crayon.

You can also get a colleague to "supervise" for a few and most places will say for basic procedures (read: non-OR things, bedside stuff) if your colleague witnesses five or ten and you're fine, that will probably be it.
 
The hospital (or hospitals) where you will work will ask you to apply for certain privileges when you first join - some of them are simple and routine (such as privilege to admit, privilege to round), others are for procedures (ie central line, A-line, intubation, bronchoscopy, thoracentesis, paracentesis, LP, etc), and others are more specialized (rigid bronch, perc trach, etc). What you are allowed to do will in part also depends on your employer's expectation - if no one in your group does central lines, and the malpractice insurance does not cover central lines, and your group does not expect you to do central lines ... most likely you will not be doing central lines (and thus asking for it will be moot)

Every hospital, in its bylaws, will have certain requirements in order to get privilege ... such as "must have done 10 PA cath successfully under supervision". So it is possible you get signed off during residency (ie residency only requires 5 PA caths) yet the hospital you join requires 10 - in which case you will need to do 5 more under supervision before you are privileged to do it independently. Hence why you are told in residency to log every procedures that you do, even if you are already "signed off" because you will never know what the expectations in the future are.

In almost all cases, the hospital bylaws will also have provisions for those in practice to acquire new skills (in particular when new technology comes around). In pulm, those out in practice > 10 years may not have been exposed to EBUS during training. So the requirement for privilege in doing something new (such as EBUS) may be different that someone just out of training
 
The hospital (or hospitals) where you will work will ask you to apply for certain privileges when you first join - some of them are simple and routine (such as privilege to admit, privilege to round), others are for procedures (ie central line, A-line, intubation, bronchoscopy, thoracentesis, paracentesis, LP, etc), and others are more specialized (rigid bronch, perc trach, etc). What you are allowed to do will in part also depends on your employer's expectation - if no one in your group does central lines, and the malpractice insurance does not cover central lines, and your group does not expect you to do central lines ... most likely you will not be doing central lines (and thus asking for it will be moot)

Every hospital, in its bylaws, will have certain requirements in order to get privilege ... such as "must have done 10 PA cath successfully under supervision". So it is possible you get signed off during residency (ie residency only requires 5 PA caths) yet the hospital you join requires 10 - in which case you will need to do 5 more under supervision before you are privileged to do it independently. Hence why you are told in residency to log every procedures that you do, even if you are already "signed off" because you will never know what the expectations in the future are.

In almost all cases, the hospital bylaws will also have provisions for those in practice to acquire new skills (in particular when new technology comes around). In pulm, those out in practice > 10 years may not have been exposed to EBUS during training. So the requirement for privilege in doing something new (such as EBUS) may be different that someone just out of training

that makes a lot of sense. thanks!
 
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