Evaluating procedural skills

I have read with great interest the editorial about evaluation of procedural skills in family medicine training in the May 2006 issue of Canadian Family Physician.¹ The authors suggest 2 important goals regarding procedural skills training. The first is to ensure that core procedural skills are being taught and the second is to ensure that those skills are being formally evaluated.

I am a first-year resident in family medicine who plans to practise in an underserviced area and who has a strong interest in procedural skills. I agree that procedural skills should be an integral and structured part of family medicine training programs and that they cannot vary by preceptor or hospital, as happens now.

I have also noticed that some procedures (eg, circumcision, vasectomy) that were once a part of family medicine are fading away. I have had a hard time finding family physicians who still perform these procedures. It is even more difficult to find physicians willing to teach them. Specialists who perform these procedures daily are not eager to teach them to out-of-specialty residents. This is a substantial problem for those who want to provide comprehensive care in a rural setting.

With respect to the proposed formal examination of procedural skills, however, I believe that in-training observations and evaluations, as are done in surgical specialties, are a more realistic and efficient way of evaluating individual procedural skills. Objective-Structured Clinical Evaluations of procedural skills can only be done on models and do not facilitate realistic procedural skills evaluation.

It is essential that the College of Family Physicians of Canada introduce standard requirements for core procedures for residency training and reintroduce optional procedures (eg, sigmoidoscopy, endoscopy) to family medicine by formally recognizing them as part of family medicine’s scope of practice. Furthermore, redefined training requirements could be evaluated during training through a continuous log of procedures performed and concurrent evaluations by supervisors.