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Procedure-Dependent Relationship Between Procedural Volume and Self-Perceived Mastery: A Two-Year Analysis of a
Philippe Laitselart1, Pierre-Louis Conan2, Baudoin Verger1
1Department of Anesthesiology and Intensive Care Medicine, Percy National Military Teaching Hospital, 101, Avenue Henri Barbusse, 92140 Clamart, France.
Anaesthesia, Critical Care & Pain Medicine
|July 14, 2026
Summary
Procedural volume alone is not a reliable measure of physician mastery in emergency medicine. Training programs need multimodal assessments to ensure competence in critical procedures.
Area of Science:
- Emergency medicine training
- Physician competency assessment
- Austere environment medical skills
Background:
- Emergency procedures are vital for physicians in austere settings.
- Current training often uses minimum procedural numbers, assuming mastery through repetition.
- The link between procedural volume and self-perceived mastery can differ by skill.
Purpose of the Study:
- To evaluate the association between procedural volume and self-perceived mastery in military emergency medicine residents.
- To identify procedure-specific patterns in the exposure-mastery relationship.
Main Methods:
- Cross-sectional observational study of military general practice residents (2022-2024).
- Analysis of logbooks for procedures including endotracheal intubation (ETI) and focused assessment with sonography for trauma (FAST).
- Used receiver operating characteristic (ROC) analyses and mixed-effects logistic regression to model mastery probabilities.
Main Results:
- Procedural exposure and self-perceived mastery varied significantly across different emergency skills.
- ROC analyses indicated heterogeneous predictive accuracy, with FAST (0.91) outperforming ETI (0.66).
- Model-derived benchmarks for 90% mastery ranged from 3 procedures (tourniquet) to 26 (ETI), highlighting procedure-dependency.
Conclusions:
- Procedural volume is an insufficient metric for assessing physician self-perceived mastery.
- Volume-based training targets must be supplemented with structured, multimodal assessment methods.
- Recommendations apply to both military and civilian emergency medicine training programs.
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