Redefining emergency medicine procedures: Canadian competence and frequency survey.
OBJECTIVE
To redefine the Royal College of Physicians and Surgeons (RCPS) procedural skills list for Canadian emergency medicine (EM) residents through a national survey of EM specialists to determine procedural performance frequency and self-assessment of competence.


METHODS
The survey instrument was developed in three phases: 1) an EM program directors survey identified inappropriate or dated procedures, endorsing 127 skills; 2) a search of EM literature added 98 skills; and 3) an expert panel designed the survey instrument and finalized a list of 150 skills. The survey instrument measured the frequency of procedure performance or supervision, self-reported competence (yes/no), and endorsement of one of four training levels for each skill: undergraduate (UG), postgraduate (PG), knowledge only, or unnecessary (i.e., too infrequently performed to maintain competence).


RESULTS
All 289 Canadian EM specialists were surveyed by mail; 231 (80%) responded, 221 completed surveys, and 10 were inactive. More than 60% reported competence in 125 (83%) procedures, and 55 procedures were performed at least three times a year. The mean competence score was 121 (SD +/- 17.7, median = 122) procedures. Competence score correlation with patient volume was r = 0.16 (p = 0.02) and with hours worked was r = 0.19 (p = 0.01). Competence score was not associated with year or route (residency vs grandfather) of certification. Each procedure was assigned to a training level using response consensus and decision rules (UG: 1%; PG: 82%; unnecessary: 17%).


CONCLUSIONS
A survey of EM clinicians reporting competence and frequency of skill performance defined 127 procedural skills appropriate for Canadian RCPS postgraduate training and EM certification.
Farion
K
K
Division of Emergency Medicine, Department of Medicine, University of Ottawa, The Ottawa Hospital and Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada.
Morrison
L J
LJ
D001291:Attitude of Health Personnel; D002170:Canada; D002568:Certification / Q000592:standards; D002983:Clinical Competence / Q000592:standards*; D003661:Decision Support Techniques; D004503:Education, Medical, Graduate / Q000592:standards*; D004504:Education, Medical, Undergraduate / Q000592:standards*; D004635:Emergency Medicine / Q000193:education* / Q000592:standards* / Q000706:statistics & numerical data; D004638:Emergency Treatment / Q000592:standards* / Q000706:statistics & numerical data; D006801:Humans; D007396:Internship and Residency / Q000592:standards; D020380:Needs Assessment; D008486:Physician Executives / Q000523:psychology; D010818:Practice Patterns, Physicians' / Q000592:standards* / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires; D016526:Workload