Description
Attached is a list of procedures in which we would like you to develop
expertise. When you "graduate", facilities to which you apply will ask us
to confirm your abilities. Please note, NY State Department of Health
requires that you not perform any of these procedures on your own until you
have been given written privileges by the program director.
In order to be given written privileges by the program director, someone
supervising you must certify that he or she has directly supervised the
performance of the procedure and that you have demonstrated:
1. Knowledge of the indications and contraindications for the procedure.
2. Knowledge for the potential risks of the procedure and the ability to
explain these to the patient in terms that they could understand.
3. The ability to technically perform the procedure in an appropriate,
aseptic manner, with minimal discomfort to the patient.
4. Ability to deal with expected complications.
5. Ability to document the procedure appropriately.
The individual providing such certification must themselves have been
given the privilege of supervising you. They can then indicate that you
have satisfactorily demonstrated the above mentioned traits by printing
their name next to the date and sign their name where indicated.
Once an appropriate individual has certified that you have satisfactorily
completed a type of procedure, the program director will then, in writing,
give you clinical privileges. If you are asked to verify that you have
been given such clinical privileges (for example, by a nurse who may not
know you, or by a JCAHO surveyor), you should be prepared to show
documentation of you privileges.
There are three levels of privileges that you might be given:
1. That you can perform the procedure only under direct, in person,
supervision. In other words, what you have been doing thus far.
2. That you can perform the procedure under indirect supervision.
That means under the explicit written description of lines of
responsibilities for the care of patients on each type of
teaching service.
3. That you can perform the procedure under indirect supervision and
also supervise and certify other performing the procedure, once you
have become a PGY 2 or above.
Because these privileges are being granted under the broad auspices of
our training program, they are not intended to be equivalent to those
granted to attending physicians who exercise their privileges indecently.
For each procedure, the resident must demonstrate appropriate technical
ability and knowledge. Both of these factors must be evaluated.
Successful completion of the minimum criteria delineated for each procedure
qualifies the resident physician only for consideration of privileges for
that procedure. It does not guarantee that the program director will grant
privileges. The privileging is granted by the program director only when
the criteria for the procedure are met and the trainee's overall performance
and level of training make the granting of the privilege appropriate.
Informed Consent: Certain procedures require "informed consent". Informed
consent is not just the signing of a form. It is a process by which the
physician explains to the patient the indications, risks, benefits,
and alternatives to the procedure. It is very important to verify that
you have identified the correct individual for the procedure. And all
procedures which require consent also require double checking whether
the procedure is to be performed on the left or right, with a final
"time out" for review before starting the procedure.
Disciplinary Procedures: Inappropriate action, as defined as resident
physicians performing or supervising procedures outside the scope of their
individual privilege, will be reported to the program director and will
result in a triggering of a review and discipline protocol.
Emergency Policy: In the case of an emergency, any physician in
training (resident) to the extent within the scope of his or her level of
post-graduate education and experience, regardless of clinical privileges,
is permitted to do everything possible to save the life of a patient or
save the patient from serious harm. An emergency is defined as a
condition in which serious or permanent harm will result to a patient or
in which the life of a patient is in immediate danger and delay in
administering treatment would add to that danger.
Chaperones: The following is excerpted from the hospital policy on
chaperones:
All aspects of the history and physical examination should be done in a
courteous and professional manner. Clear, non-technical language should be
used to explain the purpose of the exam and to reduce patient anxiety.
This communication is essential, especially in situations where no
previous relationship exists between physician and patient.
a) Pelvic examinations by male staff members must be chaperoned by a
female staff member. The purpose of the exam should be explained in
clear, non-technical language.
b) Before performing a breast or rectal exam of a female patient by a
male physician, or a male genital/rectal exam by a female physician,
the patient must be asked if he/she desires a chaperone. If the
patient declines a chaperone, the examiner may proceed.
c) When barriers of language exist between the physician and patient, all
reasonable efforts must be made to obtain a translator. If a
translator can not be found, breast, rectal, and pelvic exams should
be deferred unless an overwhelming clinical indication exists. If
d) The rest of the general physical examination of patients is usually
obtained without the presence of a chaperone, but good judgment should
be employed. While chest and cardiac examinations may require some
breast manipulation, chaperones are not generally required for this
portion of the examination; however, the physician should explain
what is being examined (e.g., "Now I am listening to your heart...")
Verification of procedure site/correct procedure & patient: In order to
avoid medical errors, it is advised that one always verify the identity
of the patient and confirm that the procedure is indicated for the
identified patient. Moreover, for all procedures designated as requiring
written consent, there must also be written confirmation that the site
of the procedure has been verified (e.g., diagnostic thoracentesis of
left-sided pleural effusion; arthrocentisis of right-sided knee effusion.)
Ref: 1. "Procedures in Practice" 3rd ed. Edited by Nigel Scott.
2. "Procedural Skills for Internal Medicine" by Robert Wigton et al
~ Procedure number suggested by ABIM as minimum for competency
* Procedures identified with "*" require written consent & verification
of procedure site
Internet Links
University of Alberta
http://www.med.uottawa.ca/procedures/
Other Resources