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.

This general idea is certainly not novel. Professional athletes all receive ongoing coaching throughout their career. Why not us? Even for well-trained physicians in a busy practice, I believe that some periodic coaching would be valuable and professionally invigorating. This type of coaching can be used in many areas of emergency practice, not just procedures. Bedside manner, patient education, physical examination, decision making, charting, and communication with specialists could be coached as well.

Most physicians hate being tested. We hate taking the boards, we hate the nasty-grams from peer review/QA, and we hate responding to complaints. The beauty of coaching is that there is none of this. It is a stress-free way to be a better doctor without the finger pointing or multiple choice questions.

Pilots and physicians find themselves in remarkably similar situations. A deficiency in skill set or in decision making can lead to dreadful outcomes, and often there is precious little time to act. The “Miracle on the Hudson” is a great example of how the bold and expert actions of Capt. Chesley Sullenberger averted catastrophe. I’m sure he must credit his many years of experience and ongoing training with his success. However, the roughly 1,500 small plane crashes each year show that there is more work to be done with private pilots.

If coaching became part of our CME repertoire, I believe outcomes would improve and we would be happier in our work. This will require a paradigm shift in the way we think about continuing education and assessment of competency. All physicians should be open to learning something new every day and honing our procedural and decision-making skills. The pilots and the passengers will be better for it.

Be happy.

Dr. Baehren lives in Ottawa Hills, Ohio. He practices emergency medicine and is an assistant professor at the University of Toledo (Ohio) Medical Center. Your feedback is welcome at David.Baehren@utoledo.edu.