Curated Milestones Evaluation Exhibit

Invasive Bedside Procedural Checklist

Joshua D. Lenchus, DO
University of Miami Miller School of Medicine

Program Size: More than 101 residents
Academic Setting: University-Based
Clinical Setting: Procedures


This critical skills checklist is used to assess the technical skill of the operator while under supervision. The checklist items blended infection prevention measures and evidence-based best practices to form a template for our achievement of expert consensus during development. A small group of local multidisciplinary experts reviewed the items to determine relevance in describing the procedure for a novice. While the submission is for a single procedure, all invasive bedside procedures can follow the same outline, divided into pre-procedure, procedure, and post-procedure sections. Note that the pre- and post- components are generally universal regardless of procedure. Further, the checklist is intended to serve as a foundation-setting tool, hence the general instructions rather than those more prescriptive. The tool has the advantage of marrying objective data gleaned from the individual checklist items with subjective assessments conducted by the operator and supervisor at the conclusion of the procedure. Additionally, in deference to the link between multiple attempts and subsequent complications, a section is included for such at the bottom. For the supervisor, completing this tool in real-time is simple and easy to accomplish, yielding valuable point-of-care information to the operator and training programs. Supervisory faculty are mentored and proctored in an effort to ensure consistent scoring and the descriptive anchors are elaborated in greater detail. Further, initial scoring by new faculty is overseen by more experienced ones to foster consistency. Our work using this checklist has led to the definition of competence as a patient-outcome based measure (JGME, Dec 2013).

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Expert consensus was coupled with evidence-based measures (e.g., IHI bundle for central line-associated bloodstream infections) to create this critical skills checklist. All of the items must be completely performed and the subjective assessments at the bottom must rank highly as this is used as the basis of determining one's procedural competence.

Lessons Learned

The implementation of this tool at other sites requires a supervisor who will critically evaluate the operator with respect to completion of each task as well as assess him/her on the subjective scale. Note that all of the measures must align for competency determination, but a single outlier will prevent such.

Faculty Development and Training

A brief overview of how to properly assess the operator. This can be accomplished by email, conference call, or live demonstration. Then, a spot check of its use is in order to ensure standard evaluations are occurring.

How Used to Inform Decisions about a Learner's Milestone

Absolutely - procedural competency is a heretofore esoteric concept without tangible and evidence-based determination. The implementation of this tool speaks directly toward the support of milestone achievement in this realm.

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