To the Editor: Opportunities for Equitable Procedural Training

I would like to thank the authors of the recent article “The Art and Opportunity of Procedure Theft”¹ for highlighting the pervasive issue of procedure theft among medical trainees. Unstructured educational environments, scarce procedural opportunities, and hierarchical dynamics involved in procedural theft can undermine skill acquisition and propagate inequities that negatively impact patient safety. While I agree that responsibility lies primarily with program leadership rather than individual trainees, I believe there can be a data-informed system in place that helps operationalize and reinforce equitable procedural allocation. McGinness and Hancock describe several policy-based strategies to mitigate procedural theft, including turn-taking schedules, predefined procedural roles for shift schedules, and the use of designated procedural teachers.¹ While these approaches can reduce procedural theft, they rely on consistent real-time adherence. Data-informed systems that capture trainee goals, procedural outcomes, and near-miss learning events can complement these policies by identifying when and for whom such strategies fall short. I envision the process to start with trainees submitting brief, standardized procedural learning goals to supervisors, allowing procedural teachers to allocate opportunities beforehand. The goals can be incorporated into a procedural equity dashboard that displays real-time and longitudinal data on procedural exposure across trainees and groups.

Whether trainees share goals at the start of each shift or rotation, educators can longitudinally track if there have been mismatches between goals and outcomes. The dashboard can highlight patterns by day, shift, attending, or patient type, identifying subtle disparities that may not be as obvious. Supervisors can also be proactively alerted to balance experiences mid-rotation. Educators may choose how to define their equality metrics, adjusting for opportunity, level, complexity, and prior experience instead of solely focusing on raw procedure counts. Trainees may also have an option to submit post-shift feedback to the procedural teachers regarding missed procedural opportunities to allow educators to reflect on their policies, structural bottlenecks, existing inequalities, and team dynamics.

I commend McGinness and Hancock for their insight into procedural theft. Many trainees have experienced situations where opportunities were taken from them, yet most are reluctant to share these experiences, making it difficult to address the problem openly. While institutional policies can help combat procedural theft, I hope my data-driven approach can be used to create a fairer, more equitable system for procedural learning.