The medicolegal aspects of proctoring

Virtually every medical staff ensures surgeons technical competency by requiring a proctoring process. However, rarely do medical staff bylaws specify the relationship between completion of proctoring and acquisition of medical staff privileges. For this reason surgeons failing to acquire privileges because of adverse proctor evaluations might be subject to National Practitioners Data Bank reporting. Few proctors understand what their responsibilities are should they witness malpractice being committed. In the State of California, case law has demonstrated that proctors are immune from liability should they allow substandard practices to continue and fail to intervene on the patient's behalf. Alternatively, if the proctor intervenes on a Good Samaritan basis they are most likely protected from malpractice liability. We recommend the implementation of two processes to avoid legal pitfalls: (1) Liability can be minimized if proctoring consents are obtained that clearly delineate the proctor's responsibilities during the operation. (2) Medical staff bylaws should clearly specify the temporal relationship between application of privileges, duration of proctoring process and final acquisition of clinical privileges.