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Rare procedures
  1. Geoff Hughes
  1. Correspondence to Professor Geoff Hughes, Emergency Department, Royal Adelaide Hospital, North Terrace, Adelaide, Australia; cchdhb{at}

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From a governance perspective, the professional processes that govern the safe performance of clinical procedures are covered under the umbrellas of medical registration, credentialing, audits, performance appraisal and supervised training with logbooks; however, if we analyse them carefully, it is soon clear that these structures leave a gap, as they do not adequately recognise the rare procedures that some clinicians will have to do only once in a blue moon or a career, whichever is longer.

What defines a routine clinical procedure, an occasional one and a rare one? What do these questions mean for major and minor procedures, for the practice of emergency medicine, for training programmes and for senior doctors learning a new skill?

The reason for asking these questions is because from time to time this journal is sent a case report that describes an author's need to perform a major but rare life/organ saving procedure. Authors will have several reasons for wanting to publish a report eg, for peer education, to solicit other people's experience of the problem (thus getting feedback in a rudimentary audit process) and perhaps, most importantly, as a catharsis and debrief for what may have been an extremely stressful experience, especially if there was a poor …

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  • Competing interests None.

  • Provenance and peer review Not commissioned; not externally peer reviewed.