# procedures during residency

[nowwhat]

---

Members do not see this ad.

i was hoping to get some feedback about the number of procedures we should be seeing as residents to be adequately prepped for the real world. i know this will vary depending on academic and community programs as well as location. but how many intubations, crics, chest tubes, central lines, etc are you getting? how many does it take to be proficient?

also, for those that have finished residency are there certain procedures you wish you would have had more of prior to graduation?

 

[howelljolly]

From the ACGME guidelines available on the website:

N Numbers include both patient care and laboratory simulations
Adult medical resuscitation
Adult trauma resuscitation
ED Bedside ultrasound
Cardiac pacing
Central venous access
Chest tubes
Procedural sedation
Cricothyrotomy
Disclocation reduction
Intubations
Lumbar Puncture
Pediatric medical resuscitation
Pediatric trauma resuscitation
Pericardiocentesis
Vaginal delivery
45
35
*
06
20
10
15
03
10
35
15
15
10
03
10
* See Procedural Competency Guideline

 

[howelljolly]

I cant get it to format .... heres the link

http://www.acgme.org/acWebsite/RRC_110/110_guidelines.asp#res

 

[nowwhat]

i am familiar with these numbers.

however i really doubt most programs are able to get all their residents 10 chest tubes and 3 crics. correct me if i am wrong. i guess if you count cadavers you get around these requirements. i consider my residency a strong program and yet i know for a fact some of these procedures are lacking. i can only imagine that most other programs have similar challenges.

i would be curious to see if the attendings out there met these requirements coming out of residency. if not did you learn on the fly?

one last observation. i have noticed even amongst attendings a significant gap with respect to procedural competency. how do those of you who feel competent stay on top of things?

 

[kungfufishing]

chest tubes not that hard to get 10 of, crics probably on a cadaver/pig etc.

I work in a high acuity environment and do a lot of procedures. I like to.

i am familiar with these numbers.

however i really doubt most programs are able to get all their residents 10 chest tubes and 3 crics. correct me if i am wrong. i guess if you count cadavers you get around these requirements. i consider my residency a strong program and yet i know for a fact some of these procedures are lacking. i can only imagine that most other programs have similar challenges.

i would be curious to see if the attendings out there met these requirements coming out of residency. if not did you learn on the fly?

one last observation. i have noticed even amongst attendings a significant gap with respect to procedural competency. how do those of you who feel competent stay on top of things?

 

[BADMD]

i would be curious to see if the attendings out there met these requirements coming out of residency.

I met all of them, except for pacing and pericardiocentesis, without difficulty, if you count cadavers. Meeting the pacing requirements is actually pretty hard if you have in house cardiology and in house interventionalist cards. Same with pericardiocentesis; a pericardial window is so easy that a patient has to be all but dead to get anything else.

 

[deleted109597]

however i really doubt most programs are able to get all their residents 10 chest tubes and 3 crics. correct me if i am wrong. i guess if you count cadavers you get around these requirements. i consider my residency a strong program and yet i know for a fact some of these procedures are lacking. i can only imagine that most other programs have similar challenges.

Seriously? You doubt 10 chest tubes? Granted, I have a different background, but I've got 21 logged (and a bunch that I forgot), halfway through EM2. 10 of them were from this residency, so in theory I'll do another 10 before I graduate. Of course, once you get all of them, logging more sometimes is tedious. Most third years at my program don't even bother logging, as they're already complete for graduation (well, they were before 40 ultrasounds were added).
Crics and pericardiocentesis are hard to get on humans. A good pig lab will get your requirement though.

 

[Hercules]

10 Chest tubes really isn't very many. Most of our residents at UAB had them knocked out by the beginning of their 2nd year if not midway so we were usually grabbing juniors to do them for their logs. The crics and pericardiocenteses were mainly on pigs and simlab. I think one of our residents got 2 or 3 crics on patients, but most got one at best. Pacing I think technically counts even if done externally and also counts in simlabs.

The OP also asked about a procedural gap between attendings. I think some people are just better at certain procedures than others. I also think it helps to struggle with procedures a lot early on in your career and learn how to avoid each of those failures. Or maybe I'm just making myself feel better. Seriously though each time I missed a procedure I would ask attendings for tips, re-read Robins, etc. so that it wouldn't happen the next time.