Defining competency-based evaluation objectives in family medicine: Procedure skills

Stephen Wetmore; Tom Laughlin; Kathrine Lawrence; Michel Donoff; Tim Allen; Carlos Brailovsky; Tom Crichton; Cheri Bethune

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Table 1.

The general key features for procedure skills

KEY FEATURE	SKILL DIMENSION	4 PRINCIPLES	CanMEDS ROLE
To decide whether you are going to do a procedure consider
• The indications and contraindications to the procedure	Clinical reasoning	Skilled clinician	Medical expert
• Your own skills and readiness to do the procedure (eg, your level of fatigue and any personal distractions)	Clinical reasoning Professionalism	Skilled clinician	Medical expert Professional
• The context of the procedure, including the patient involved, the complexity of the task, the time needed, the need for assistance, and the location	Clinical reasoning Selectivity	Skilled clinician	Medical expert
Before deciding to go ahead with the procedure
• Discuss the procedure with the patient, including a description of the procedure and possible outcomes, both positive and negative, as part of obtaining consent	Communication skills Clinical reasoning	Skilled clinician	Medical expert Communicator
• Prepare for the procedure by ensuring appropriate equipment is ready	Clinical reasoning	Skilled clinician	Medical expert
• Mentally rehearse the following: -The anatomic landmarks necessary for procedure performance -The technical steps necessary in sequential fashion, including any preliminary examination -The potential complications and their management	Clinical reasoning	Skilled clinician	Medical expert
During performance of the procedure
• Keep the patient informed to reduce anxiety	Patient-centred approach	Doctor-patient relationship	Medical expert Communicator
• Ensure patient comfort and safety always	Patient-centred approach	Doctor-patient relationship	Medical expert Professional
When the procedure is not going as expected, reevaluate the situation, stop, or seek assistance as required	Clinical reasoning Professionalism	Skilled clinician	Medical expert Collaborator
Develop a plan with your patient for aftercare and follow-up after completion of a procedure	Patient-centred approach	Doctor-patient relationship	Medical expert Professional