Faculty Procedural Supervision and Expertise: An Endangered Species

Editor’s Note: This post is one of two pieces on the topic of procedural competency. Check back next week for the other piece. A few days ago I was working with a new resident and she came to me for help with a procedure. She had a patient with a severe headache and fever and she wanted to do a spinal tap. We had previously discussed the differential diagnosis and the possibility of meningitis. Now it was clear the resident was not at all confident in her ability to do the procedure and that I might have to do it. I took a deep breath. Although there had been a time when I was confident about doing a spinal tap, that was long ago. I had not done one myself in over a year though I had supervised a few. I watched as the resident prepared her supplies, positioned the patient, anesthetized and cleaned the area, and inserted her needle. Unfortunately she was not able to get any spinal fluid and after two attempts, she asked if I could try. I put on sterile gloves with some trepidation and explained to the patient that I would be taking over the procedure. “My head hurts,” she said. “Please help me.” “Yes,” I said. “I understand that this has been the most severe headache you have ever had and that the CT scan you received was normal. Now we have to make sure you don’t have an infection,” I said. “That is why you need the spinal tap.” “Will you be able to do it?” she said. “I can’t go through this another time.” “I have done many of these,” I s...
Source: Academic Medicine Blog - Category: Universities & Medical Training Authors: Tags: Featured From the Editor Editor in Chief faculty procedural competency resident Source Type: blogs