Not Like They Used To: The Decline of Procedural Competency in Medical Training

Excellent article. I finished at Northwestern Medical school in 1977 at the age of 23. I knew I was going to take a residency in Family Medicine in order to practice in a small town in Wisconsin, At Northwestern I had 2 excellent pediatric rotations, and learned to insert umbilical catheters, obtain blood gasses for analysis, perform LPs at all ages, perform bladder taps. Unfortunately some of the methods at the Children's Hospital on Fullerton were less than comfortable. I was required to present a case of growth restriction regarding a 9 month old boy who was admitted to the hospital. I was asked the height of the father and the mother, although I was not present during the intake, and no mention of those was listed in the chart. The two expert attendings made it clear that I should be able to present those facts. They did not ask the pediatric resident in attendance; he did the intake. It felt kind of unfair but I took it in stride. I had informed that the process was called the Hot Seat and every student of pediatrics in that required rotation was treated the same. A year later the practice was stopped after a student went back to his dorm room and killed himself by shooting a shotgun stuck under his jaw.

I continue to practice family medicine in a rural setting. I stopped delivering babies after 35 years in practice. I see some pediatrics but spend most of my taking care of the majority of nursing home residents in the county. I perform of lot of definitive surgical treatment for skin cancer, treat a lot of wounds, especially below the knees of very ill patients, and provide the majority of Transitional Care Management for residents of the county. I have never been sued for medical malpractice. I learn more about my work everyday. I especially like the Harvard Geriatric Medicine course. I do a lot of evidence based medication deprescribing.

Matthew Grade, MD