Since the emergency medicine residency started at my hospital, I do fewer procedures than before. Usually I’m watching a resident and giving helpful hints. There are still enough times, however, that a resident needs help or nobody is with me, so I do enough procedures to maintain proficiency. I’ve never really thought that I needed to be “checked off” for procedures. At our recent Joint Commission survey, it was suggested that our program should consider periodically reviewing the skills of our core faculty to ensure ongoing competency.

I am responsible for quality issues in our department, so I pondered this for a while. After discussions with my director, Kris Brickman, we concluded that they might be on to something. Any regular reader of this column knows that I am no cheerleader for the Joint Commission, and I’m not starting here. We have too many hoops to jump through now, so I’m not suggesting that they make this a requirement. But I do believe there is some value to periodic skills review.

So we took advantage of our state-of-the-art simulation lab at the University of Toledo and reviewed airway management, central line placement, and lumbar puncture. The simulators are remarkably lifelike. They are not perfect, but we created an atmosphere for learning and assessment that served our purposes well.

The least valuable outcome of this was that we could check off proficiency for the entire core faculty and satisfy any inquiry at the next review by the Joint Commission. The great part of the experience was the give and take that occurred during the exercise. We talked about core teaching points, some tricks of the trade, and personal preferences. There was academic and clinical value for everyone. Ultimately, it is our residents (and their future patients) who will benefit the most.

After the exercise, my friend and colleague Jay Ryno gave me an article by Rick Durden from a magazine for pilots. Durden talks about a surgeon for whom he does flight review twice a year. These flight reviews have been shown to improve safety and prevent atrophy of skills. The surgeon sees so much value in the flight review that periodically he does the same type of thing in the OR. He asks another surgeon to watch him operate in order to critique his technique and judgment. The surgeon believes this experience keeps him at the top of his game. It’s like having a coach. There is no testing or merit badge to earn, just instruction and feedback.