Table 1.

Three-step procedure credentialing policy.

Step 1: Pass written multiple-choice test with a score of 80% or higher. Step 2: Pass formal hands-on simulated procedure. All learners must obtain formal hands-on training by an instructor for each individual procedure. The learner is tasked to memorize the provided checklist for each individual procedure and perform at least 80% of the steps for the procedure correctly without missing a single critical action. Learners typically schedule this test 1-10 days after their formal training. Once passed, this grants them permission to perform this individual procedure under supervision. All subsequent successfully performed procedures must be logged. Step 3: Provide documentation for the pre-determined minimum number of successfully completed procedures with signatures from all supervising providers. Once completed, the learner can independently perform that procedure as well as supervise other step 2 level providers in completing that individual procedure. See procedure requirements below allowing for autonomous performance. Minimum number of successfully performed procedures required for autonomous practice Lumbar puncture—5 Endotracheal intubation—10 Central venous access:  Internal jugular—8  Subclavian—8  Femoral—5 Chest tube (tube thoracostomy) —10 Arterial line—5 Cricothyrotomy—5 Intraosseous access (IO)—5 Paracentesis—5 Thoracentesis—5 Transvenous pacing—–5