Skills and procedures in emergency medicine: room for controversy

To examine patterns of consensus and divergence of opinion about whether, and under what conditions, residency-trained emergency physicians use certain skills and perform procedures, directors of 35 emergency medicine, 28 surgery and 30 internal medicine residency programs were surveyed. The directors reacted to a list of 30 skills modified from the condition/skills list compiled by the Certification Task Force of the American College of Emergency Physicians representing a consensus on the core-knowledge for emergency medicine, as determined by both practicing and university-based emergency physicians. The responses indicate a wide variation of opinion about which skills are within the realm of residency-trained emergency physicians, and under what circumstances a procedure should be performed. The skills of greatest concern among emergency medicine directors include axillary and intravenous lidocaine blocks, bronchoscopy, burr holes, closed reduction of dislocated hips, Swan-Ganz catheterization, and cardiopulmonary by-pass. In contrast, slightly more than one third of the procedures on the modified list were clearly agreed upon by over 80% of the directors as procedures performed by trained emergency physicians.