What are the 14 "must know" procedures for new clinicians?

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Results of a recent survey indicate that teaching physicians and new doctors have different ideas of which procedures are necessary to learn before graduation from medical school—particularly when it comes to the minimally invasive activities.

Michael T. Fitch, MD, PhD, and his colleagues at Wake Forest School of Medicine asked 51 members of the medical school's faculty and 184 new physicians who had recently completed internships to rate throat culture, spinal tap, and 29 other basic clinical procedures in terms of how important they are to know in the first year after medical school.

Of the 14 procedures faculty physicians rated as “must know,” only six garnered the same rating from the newer members of the profession. The new doctors countered with an additional five procedures that they considered essential.

The procedures identified as most important by the new doctors were more invasive than those named by their more experienced counterparts. For example, the new physicians championed spinal taps, incisions and drainage, intubation, and central line insertion. The greatest divergence of opinion usually involved minimally invasive procedures, as evidenced by the new physicians disagreeing with the notion that knowing how to draw blood is important. Dr. Fitch and colleagues say this could be due to the fact that this task is often performed by non-physician staff, therefore making it non-essential knowledge for interns.

“Like a lot of clinical education in most medical schools, the third and fourth years are learning-by-doing—taking care of real patients,” pointed out Dr. Fitch in a statement describing the study results. “So, the procedures the patients need end up being the ones students learn."

Wake Forest University's medical school has changed its curriculum to include all 19 procedures named as “must knows” by the two groups of survey respondents, and students are required to track electronically any time they observe, participate in, or perform these acts. “The training that our current medical students are receiving has been enhanced by the results of this study,” affirmed Dr. Fitch, an assistant professor of emergency medicine at the school. “That is going to lead to better patient care.”

Full survey results appear in the peer-reviewed publication Medical Teacher (subscription required).

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