Trainee Access to Major Procedures in an Academic Emergency Department: Are We Doing Enough?

INTRODUCTION

The Australasian College for Emergency Medicine requires trainee competency in many procedures; however, real-world practicalities may not align with expectations. The objective of this study was to record the number of procedures performed by trainees in an academic emergency department (ED). Any gaps identified in exposure to procedures could help guide alternative forms of training.

METHOD: A prospective observational study was conducted in a tertiary ED in Perth, Western Australia, between 1 February 2024 and 31 January 2025. Data were collected on 14 procedures via self-reporting using a QR code linked to a Microsoft form. Procedure numbers, median per trainee, and range of procedures are reported. Full-time versus part-time rates were compared. Six-monthly sub-analyses were performed to account for changes in personnel mid-year.

RESULTS

Of 1413 procedures, 771 (54.6%) were performed by trainees. The median number performed was 10.5 (IQR = 6-23). There was no significant difference between those working full-time versus part-time (median = 15, IQR = 9-23 vs. median = 8, IQR = 4-16; p = 0.11). There was no significant difference between the two 6-month periods (median = 8.5, IQR = 4.3-13.8 vs. median = 9, IQR = 5.75-15, p = 0.51). Procedures commonly performed were sedation (207/405, 51.1%), intubation (121/193, 62.7%) and arterial lines (90/150, 60%).

CONCLUSIONS

Access to procedures is limited. Alternative forms of training should be incorporated into education programmes. A lack of exposure has wider implications for assessing competency in emergency medicine and should be considered in any future curriculum update.