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EMORY FAMILY MEDICINE PROCEDURES CURRICULUM AND
PROCEDURAL COMPETENCY
Procedures offered. * Indicates competency required prior to
graduation. - # Indicates minimum required for competency evaluation.
OUTPATIENT PROCEDURES:
- Anoscopy*- 2
- Cervical Polypectomy- 2
- Chest X-ray interpretation*- 5 (Plus a score of 8 out of 10 in the CXR quiz)
- Colposcopy with endocervical curettage and biopsy- 5 (Plus a score of 8 out of
10 in the Colposcopy quiz)
-
Cryotherapy of the cervix-3
Endometrial biopsy*-3
Excision of thrombosed hemorrhoid-3
EKG interpretation*-5 (Plus a score of 16 out of 20 in the EKG quiz)
Eye fluorescein exam*-3
Flexible Nasopharyngolaryngoscopy (NPL)-3
Flexible Sigmoidoscopy and biopsy-5
Immobilization and stabilization of sprains and non displaced fractures*-3
Incision and Drainage of Abscesses*-3
Injection and aspiration of tendons, ligaments and muscles*-3
IUD insertion/removal- 4/1
Joint injection and aspiration – Knee, Subacromial/Shoulder, *-4 (4 total of
any of these major joints and 2 of each of the joints below)
-
Elbow, Wrist, Greater Trochanter, Carpal tunnel injections -2
Keloid injections/removal-3/3
Marsupialization of Bartholins cyst-3
Pap smear*-3
Radiofrequency and Cryocauterization procedures of skin*-3
Simple skin Laceration repair*-3
Skin surgery – Punch, Shave and Excisional biopsies*-4
Treadmill stress testing-4 (Plus a score of 10 out of 12 in the TST quiz)
Vasectomy-N/A
Wart, Nail and Foreign body removal*-3
Wet mount*-3
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INPATIENT PROCEDURES:
- Amniotomy/Artificial rupture of membranes-3
- Arterial line placement-5
- Central line placement-5
- Circumcision of newborn-5
- Endotracheal intubation/Mechanical ventilation-4
- Episiotomy repair-4
- Fetal scalp electrode/IUPC placement-3/3
- Foley catheter placement-3
- Interpretation of fetal monitor tracings-4
- Intravenous catheter placement-3
- Lumbar puncture-3
- Nasogastric tube placement-2
- Obstetric labor and delivery-40
- Paracentesis-5
- Thoracentesis-5
- Run codes-3
Procedure curriculum
This curriculum is intended to be Emory Family Medicine Resident’s guide to developing
knowledge of, demonstrating ability to and documenting competency in the above listed
procedures.
Goals:
1. Define requirements and expectations for procedural training during the residency.
2. Provide a structured educational experience so residents can develop thorough
knowledge and skills in performance of the listed procedures.
3. Define procedural competency in line with ACGME requirements.
4. Provide a structured format for residents to achieve competency in the required
procedures prior to graduation.
5. Document the number of procedures performed and indicate whether competency was
attained to aid in credentialing.
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Requirements and Expectations:
Residents should:
1. Read on or view performance of procedures prior to carrying out procedures with the
attending physician. There are multiple resources available to accomplish this including
Pfenninger and Fowler’s Procedures for Primary Care and NEJM training videos.
2. Know the indications, contraindications, risks and benefits of the procedure and be
able to explain this to the patient and/or relatives of the patient and obtain informed
consent.
3. Have knowledge of sterile techniques, management of complications, pain
management and interpretation of results and know when to seek
advice/consultation.
4. Adhere to Emory’s Universal protocol/Time out policy. See appendix 1.
5. Document all procedures performed and demonstrate competency to perform the
required procedures prior to completion of the 3 year residency program.
6. Note: Residents seeking to perform procedures in their own half day clinic schedule
(outside of procedure clinic) must have the approval of the faculty member precepting
them during that half day clinic prior to scheduling the appointment. These
appointments must be for 45 minutes.
Structured Educational Experience:
A half day of didactics is offered every 3 months in the form of a procedure workshop on
various procedures including Exercise Stress Test, Colposcopy, Flexible NPL to name a few.
One half day every 3 months, residents on a rotational basis will be trained in certain
procedures at the Emory Simulation Laboratory.
Procedural Competency:
ACGME defines procedural competency as “Demonstrating appropriate manual technique and
dexterity in performing the procedure; showing appropriate confidence and proficiency with all
technical aspects of the procedure, demonstrating awareness of the indications,
contraindications and complications of the procedure.”
Format for attainment of Competency:
1. Residents will receive several evaluations in their performance of procedures. This will
include immediate feedback by the supervising attending, the procedure will be
documented in the Emory Family Medicine Residency Procedural Passport or New
Innovations with supervising attending evaluating the performance of the procedure in
the “Comments” section
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2. After a specified minimum number of a particular procedure has been performed,
residents seeking to be deemed “competent” and capable of performing the procedure
independently will inform a supervising attending.
3. A supervising attending must then observe the resident perform the procedure without
assistance and the resident questioned on various aspects of the procedure including
indications, contraindications and complications.
4. If the procedure is performed adequately and the resident correctly addresses the
attending physicians questions, that resident can then be signed off as competent to
perform that particular procedure.
Documentation:
All procedures performed must be documented by the resident in the Procedural log book
(passport) or New Innovations. If the resident has been deemed to be competent in a particular
procedure, the attending physician must document “Competent” in the comments section- see
format for attainment of competency. The attending physician should complete an evaluation
form on every procedure performed by the resident. See Appendices 2 to 4.
NB: In other to be deemed competent in the following procedures: Colposcopy, Exercise stress
test and EKG and CXR interpretation, you will need to pass a Quiz in addition to meeting the
other minimum requirements of that particular procedure.
Oguchi Andrew Nwosu, MD, FAAFP.
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Appendix 1
Universal Protocol for Preventing Wrong Site/Procedure/Person Procedure and
Performance of Time Out
Background: As part of Emory Healthcare’s comprehensive program to ensure patients receive safe and
effective care in accordance to the Joint Commission’s Universal Protocol, the organization has
established a standardized program involving a system of multiple, coordinated processes designed to
reduce the likelihood of wrong site, wrong procedure and wrong person surgery/procedure. Specifically,
the program addresses:
1. Conduction of a pre-operative/pre-procedure verification process
2. Site Marking
3. Time Out/Call-to-Order performed immediately prior to starting the procedure.
Note: Certain minor procedures such as venipuncture, peripheral IV placement, NG tube or urinary
catheter insertion are not within the scope of the protocol, other procedures such as closed fracture
reduction, suturing of superficial lacerations, incision/drainage of a skin abscess, joint
injections/aspiration are excluded from the protocol. Also, where the patient’s clinical condition
requires immediate performance of an invasive procedure related to a life-threatening emergency,
requirements of the Universal Protocol are limited to a one-time verification of patient identity using
two patient identifiers, such as name, date of birth and/or medical record number.
Conduction of a pre-operative/pre-procedure verification process
1. Active verification of the correct person, correct procedure and correct site.
2. Ensure that all relevant information like H & P, consents, labs results and x-rays as well as
equipment needed for procedure are available and accurately match the patient.
Site Marking
1. Site marked before procedure performed with patient involved, if possible.
2. Marking methods includes: left/right distinction; the surface; multiple structures and levels.
Time-Out/Call-to-Order performed immediately prior to starting the procedure
1. Perform a time out just prior to the start of the procedure
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2. The Time Out should be standardized; it is initiated by a nurse or designee; it involves
immediate members of the procedure team and other active participants.
3. In the ambulatory setting, elements included in the Time-Out include verification of patient
identity, correct site, correct procedure and documentation of written or verbal consent for
procedure.
4. All other activities are halted during the time-out to focus on confirmation of the correct
patient, procedure, site and other clinical elements.
Note: Where discrepancies are noted the nurse or designee will stop the procedure until the
discrepancy is resolved to the satisfaction of the team before the procedure can commence
All members of the team are highly encouraged to “speak up” to stop the procedure if any element of
the checklist is not validated.
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Appendix 2
Evaluation of Procedure
Learner Name:________________________________________________ Patient’s MR #__________
Status: Resident: PGY 1_____ 2_____ 3_____
Date: ____________ Patient Age:_____
Consent Done ___Yes No___
Indication for Procedure_____________________________
Time out done____ Yes ____No
Appropriate: Yes ___ No___
Procedure: (check all that apply)
Colposcopy______
Punch/Shave/Excision biopsy______
Endo Bx______ IUD insertion______
I & D Abcess______
NPL ______
Joint Injection______ ___
Other___________________
What # Procedure is this for the learner _____
Satisfactory
(1)Inspection
(2)Anatomy Identification
(3)Pathology Identification
(4)Biopsy/Procedure
Technique
(5)Knowledge of Bleeding
Control Methods
(6)Therapeutic Plan Based
on Results
Needs Improvement
N/A
__________
__________
__________
__________
__________
__________
__________
__________
__________
__________
__________
__________
__________
__________
__________
__________
__________
__________
Duration of Procedure:_______Minutes
Complications: None ______ Yes(List) ______________________________________________
Patient Discomfort:
0
1
2
3
4
5 (Unbearable)(Circle one)
Has minimum number for competency evaluation been attained? _____Yes
_____No
(if no skip next question)
Was this procedure performed well enough to count as a competent exam?
Yes_____
No_____ If “No”, why not?______________________________________________
Attending Faculty: Name ____________________________________
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Appendix 3
Evaluation of TMST
Learner Name:_____________________________________________
Patient’s MR#____________
Status: Resident:
PGY 1_____2_____3_____
Date__________
Age:________
Consent Done _____Yes
_____No
Correct Indication for Procedure______Yes
_____No
Time out done_____Yes _____No
What number TMST is this for the learner? _______
What Protocol?_____Bruce
Criteria
Patient Examined
Procedure Explained
Knows criteria for
stopping test
Knows criteria suggestive
and diagnostic of ischemia
Was attentive to
monitor and EKG’s
Was attentive to
patient
Appropriate stopping
point
Appropriate interpretation
Appropriate recommendation
_____Modified Bruce
_____McNaughton
_____Other
Satisfactory
Needs Improvement
__________
__________
_________________
_________________
__________
_________________
__________
_________________
__________
_________________
__________
_________________
__________
__________
__________
_________________
_________________
_________________
Complications:
None________ Yes(List)_____________________________________
Has minimum number for competency evaluation been attained?_____Yes
_____No
(if no, skip next question)
Patient discomfort: 0 1 2 3 4 5 (Unbearable) (Circle one)
Was this TMST performed well enough to count as a competent (independent) procedure?
Yes_____
No_____ If “No”, why not?_______________________________________
Attending Faculty: Name_________________________________________
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Appendix 4
Evaluation of Rectosigmoidoscopy
Learner: Name______________________________________________
Status: Resident: PGY 1_____2_____3_____
Date__________
Patient: Age______
Consent Done_____Yes
Patient’s MR#_____________
_____No
Indications for Procedure______________________________________________________
Appropriate: Yes_____
No_____
Procedure: (Check all that apply)
Anoscopy_____
Rigid Sigmoidoscopy_____
RRS: 30 cm____
60 cm_____
What # FFS is this for the learner?_____
Insertion
Satisfactory
__________
Needs Improvement
_________________
Negotiation of Sigmoid curve
__________
_________________
Anatomy Identification
__________
_________________
Pathology Identification
__________
_________________
Appropriate Insertion
Cessation
__________
_________________
Visualization During Withdrawl __________
Therapeutic Plan Based
on Results
__________
_________________
_________________
Insertion Depth Obtained: _______cms
Duration of Procedure: _________ minutes
Complications: None______ Yes(List) ___________________________________________
Patient Discomfort:
0 1 2 3 4 5 (Unbearable) (Circle one)
Was this endocopy performed well enough to count as a competent exam?
Yes_____
No_____ If “No”, why not? _________________________________________________
Attending Faculty: Name_________________________________________________________________
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