Although basic technical proficiency for these tests can be reached after only a few attempts, competency involves much more than just technical ability, Wigton emphasized. Paradoxically, gauging competency for technically difficult procedures, such as colonoscopy, may be easier. The American Board of Internal Medicine continually grapples with the problem of identifying the procedures in which physicians should be proficient and in how to determine competency in doing those procedures, said John Norcini, PhD, executive vice president of the Board. Consensus building requires a merging of views from specialists and generalists that results in somewhat meaningless averages. Database development requires extensive and complicated data collection and is virtually impossible to do for every procedure needed, he added.
Most programs require residents to do more than the minimum.
Some medical groups, such as the American Society for Gastrointestinal Endoscopy, no longer suggest using a minimum number of procedures to define competence. Instead, competency is determined by success rates in each procedure. Acceptable rates are determined individually for each procedure, depending on its invasiveness and level of risk. To compensate, the two new internists just hired to join LaCombe's practice are being required to spend their last year in residency learning certain diagnostic procedures. But the trend in some managed care settings is to require all primary care physicians to handle more diagnostic procedures.