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Procedure competence versus number performed: a survey of graduate emergency medicine specialists in a developing nation
  1. Leana S Wen1,
  2. J Tobias Nagurney2,
  3. Heike I Geduld3,4,
  4. Angela P Wen5,
  5. Lee A Wallis3
  1. 1Harvard Affiliated Emergency Medicine Residency, Department of Emergency Medicine, Brigham and Women's Hospitals/Massachusetts General Hospital, Boston, Massachusetts, USA
  2. 2Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
  3. 3Division of Emergency Medicine, University of Cape Town, Cape Town, South Africa
  4. 4Stellenbosch University, Stellenbosch, South Africa
  5. 5Department of Biochemistry & Molecular Biology, University of Southern California, Los Angeles, California, USA
  1. Correspondence to Dr Leana S Wen, Harvard Affiliated Emergency Medicine Residency, Brigham and Women's Hospitals/Massachusetts General Hospital, 178 Marlborough St, #5, Boston, MA 02116, USA; wen.leana{at}


Background Emergency medicine (EM) training programmes are being conducted around the world but no study has assessed the procedural competence of developing nations' EM trainees.

Objectives To quantify the number of core procedures and resuscitations performed and describe the perceived procedural competency of graduates of Africa's first EM registrarship at the University of Cape Town/Stellenbosch University (UCT/SUN) in Cape Town, South Africa.

Methods All 30 graduates from the first four classes in the UCT/SUN EM programme (2007–10) were asked to complete a written, self-administered survey on the number of procedures needed for competency, the number of procedures performed during registrarship and the perceived competence in each procedure ranked on a five-point Likert scale. The procedures selected were the 10 core procedures and four types of resuscitations as defined by the US-based Residency Review Committee. Results were compiled and analysed using descriptive statistics.

Results Twenty-seven (90%) completed surveys. For most core procedures and all resuscitations, the number of procedures reported by respondents far exceeded the Residency Review Committee minimum. The three procedures not meeting the minimum were internal cardiac pacing, cricothyrotomy and periocardiocentesis. Respondents reported perceived competence in most procedures and all resuscitations.

Conclusions EM trainees in a South Africa registrarship report a high number of procedures performed for most procedures and all resuscitations. As medical education moves to the era of direct observation and other methods of assessment, more studies are needed to define and ensure procedural competence in trainees of nascent EM programmes.

  • International emergency medicine
  • South Africa
  • procedural competency
  • medical education
  • educational assessment
  • emergency care systems
  • emergency department
  • HIV
  • training
  • emergency ambulance systems
  • prehospital
  • education
  • emergency department management
  • trauma
  • non-accidental injury
  • major incident planning
  • military
  • paediatrics
  • paediatric resuscitation
  • paediatric injury
  • paediatric emergency med
  • paediatric orthopaedics

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  • An additional table is published online only. To view this file please visit the journal online (

  • Funding LSW received a travel grant from Partners Healthcare to conduct research.

  • Competing interests None.

  • Patient consent Obtained.

  • Ethics approval Partners Healthcare and the institution review boards of University of Cape Town and Stellenbosch University.

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

  • Data sharing statement We are glad to share our data with readers.

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