Should procedural training be standardized during residency?

New research published in Current Problems in Diagnostic Radiology suggests procedural training should be standardized during residency and competence in specific procedures should be achieved at its completion.

At present, residents are not required to show competency in a standardized list of radiological procedures before the end of residency. The ACGME Diagnostic Radiology Milestones project—which details competency-based developmental outcome expectations and provides an outline for monitoring and measuring resident competence—is not yet implemented in practice.

“A clear definition of procedural competence is essential,” said lead author Christopher P. Ho, MD, Emory University School of Medicine in Atlanta, and colleagues. “For reference, the American Board of Surgery requires their candidates to have performed 750 operative procedures in 5 years as operating surgeon, including at least 150 operative procedures in the chief resident year. To our knowledge, there is no standard definition of procedural competence for invasive radiology procedures. However, the results of our survey suggest that there is general agreement among residents and faculty on what a definition of procedural competency should include.”

Researchers surveyed residents, fellows and clinical faculty in diagnostic radiology or nuclear medicine to gauge thoughts on the necessity of standardization of procedural training, which procedures should be evaluated on competency and the number of times a procedure must be performed to achieve said competency.

Results were received from 60 study participants. Nearly two-thirds of respondents (65 percent) believed procedural training should be standardized for residents. Thirty-two percent of residents and 61 percent of faculty feel the number of procedures and direct observation are equally important when evaluating procedural competence.

Residents and faculty agreed the most important procedures in which to achieve competency include CT-guided abdominal, thoracic and musculoskeletal procedures, minor fluoroscopic procedures and ultrasound-guided abdominal procedures.

“These results were not unexpected to us because they are some of the most common procedures performed at our institution and are also likely to be common skills needed by the practicing general radiologist,” the authors wrote. “In the evaluation of procedural competency, it makes sense to us that such procedures, rather than more subspecialized or complicated ones, be included.”

Faculty reported the procedures should be performed 11 to 20 times to achieve competency, while residents believed they should be performed only six to 10 times.

“Although this study was limited to a single institution, we have identified resident and faculty respondent agreement on procedural training, and our data provide a framework for starting to establish future guidelines for standardizing image-guided procedure training,” Ho et al. concluded. “Future studies could possibly be expanded to create a national consensus regarding the implementation of the ACGME Milestones Project.”