Physicians must be competent to perform the skills of their respective specialties before completing residency training. Educators struggle to understand just how many procedures are required of a trainee to become competent. Is there a minimum number? Does it differ by procedure for each trainee? How many is ‘enough’? And what should educators do if there are too few procedures to go around???

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Our accreditation systems are designed to ensure patient safety, as a societal responsibility. Residency program directors attest to their trainees’ competence before graduation — as a safeguard. I was a program director and I lost sleep worrying about this expectation of my role. Were my residents ready? What if my mistakes assessing them led to their mistakes with vulnerable patients?

The worry – how many procedures is enough? – was a tough one for me. Every trainee is different and they each require a unique set of training experiences to become competent. The BIG however: there are a limited number of cases for trainees to learn from in teaching hospitals.

There, I said it. There are only so many chest tubes, crics, and LPs to go around.

As medicine advances, there is a slow decrease in the number of necessary bedside and surgical procedures required to diagnosis and treat a variety of acute illnesses.

Thanks vaccines and CTAs, but where did all the LPs go?

The math is as follows: if X is the number of procedures required to train a class of residents per year, and Y is the total number of procedures available, your program is fine if Y > X.

But if X > Y… you need to think outside the box.

Medical education has fundamentally changed in the last several decades. There are more trainees. There *may* be more patients. And there are certainly more training programs and teaching hospitals, sponsored by health systems that were previously and decidedly non-teaching. This represents both a challenge and an opportunity for educators who need to be creative in their search for ‘enough’ procedures for their trainees.

My research collaborators and I have some potential solutions for teaching hospitals and program directors to consider, in our article, “More Learners, Finite Resources, and the Changing Landscape of Procedural Training at the Bedside” in Academic Medicine.

May 26, 2019

Co-Authors of original article: Linda Regan, MD – Johns Hopkins University, Jeremy Branzetti, MD – New York University, Laura Hopson, MD – University of Michigan