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1.7 Surgical and Procedural Skills

1.7 Surgical and Procedural Skills			Core Rotation	Elective Rotation	Academic Program	Special Interest Elective
The family physician is a skilled clinician
The resident will be able to:
1.7.1	S	Perform the following core integumentary procedures:
1.7.1.1	S	Abscess incision and drainage	FM, AEM, PEM	UC	X
1.7.1.2	S	Wound debridement	FM, AEM, PEM, GS	UC	X
1.7.1.3	S	Insertion of sutures (simple, mattress, subcuticular)	FM, AEM, PEM	UC	X
1.7.1.4	S	Laceration repair (suturing, gluing)	FM, AEM, PEM	UC	X
1.7.1.5	S	Skin biopsy (shave, punch, excisional)	FM, AEM, PEM	UC	X
1.7.1.6	S	Excision of dermal lesions (e.g. papilloma, nevus, cyst)	FM, AEM, PEM	UC	X
1.7.1.7	S	Cryotherapy of skin lesions	FM, AEM, PEM	UC	X
1.7.1.8	S	Electrocautery of skin lesions	FM, AEM, PEM	UC	X
1.7.1.9	S	Skin scraping for fungus determination	FM, AEM, PEM	UC	X
1.7.1.10	S	Use of Wood's lamp	FM, AEM, PEM	UC	X
1.7.1.11	S	Release subungual hematoma	FM, AEM, PEM	UC	X
1.7.1.12	S	Drainage acute paronychia	FM, AEM, PEM	UC	X
1.7.1.13	S	Surgical management of ingrown toenail	FM, AEM, PEM	UC	X
1.7.1.14	S	Removal of foreign body (fish hook, splinter, or glass)	FM, AEM, PEM	UC	X
1.7.1.15	S	Pare skin callus	FM, AEM, PEM	UC	X
1.7.2	S	Perform the following local anesthetic procedures:
1.7.2.1	S	Infiltration of local anesthetic	FM, AEM, PEM	UC	X
1.7.2.2	S	Digital block in finger or toe	FM, AEM, PEM	UC	X
1.7.3	S	Perform the following eye procedures:
1.7.3.1	S	Instillation of fluorescein	FM, AEM, PEM	UC	X
1.7.3.2	S	Slit lamp examination	AEM, PEM	UC	X
1.7.3.3	S	Removal of corneal or conjunctival foreign body	FM, AEM, PEM	UC	X
1.7.3.4	S	Application of eye patch	FM, AEM, PEM	UC	X
1.7.3.5	S	Perform the following ear procedures:
1.7.3.6	S	Removal of cerumen	FM, AEM, PEM	UC	X
1.7.3.7	S	Removal of foreign body	FM, AEM, PEM	UC	X
1.7.4	S	Perform the following nose and throat procedures:
1.7.4.1	S	Removal of foreign body	FM, AEM, PEM	UC	X
1.7.4.2	S	Cautery for anterior epistaxis	FM, AEM, PEM	UC	X
1.7.4.3	S	Anterior nasal packing	FM, AEM, PEM	UC	X
1.7.5	S	Perform the following gastrointestinal procedures:
1.7.5.1	S	Nasogastric tube insertion	FM, AEM, PEM, IM	UC, FMH	X
1.7.5.2	S	Fecal occult blood testing	FM, AEM, PEM, IM	UC, FMH	X
1.7.5.3	S	Anoscopy / Protoscopy	FM, AEM, PEM	UC	X
1.7.5.4	S	Incise and drain thrombosed external hemorrhoid	FM, AEM, PEM, GS	UC	X
1.7.6	S	Perform the following genitourinary procedures:
1.7.6.1	S	Placement of transurethral catheter	AEM, PEM, IM, GS	UC, FMH	X
1.7.6.2	S	Cryotherapy or chemical therapy of genital warts	FM, AEM, PEM	UC	X
1.7.6.3	S	Aspiration of breast cyst	FM, AEM, PEM, GS	UC, WH	X
1.7.6.4	S	Pap smear	FM, AEM, PEM, OBG	UC, WH	X
1.7.6.5	S	Diaphragm fitting and insertion	FM, OBG	WH	X
1.7.6.6	S	Insertion of intrauterine device	FM, OBG	WH	X
1.7.6.7	S	Endometrial aspiration biopsy	FM, OBG	WH	X
1.7.7	S	Perform the following obstetrical procedures:
1.7.7.1	S	Normal vaginal delivery	FM, OBG		X
1.7.7.2	S	Episiotomy and repair	FM, OBG		X
1.7.7.3	S	Artificial rupture of membranes	FM, OBG		X
1.7.8	S	Perform the following musculoskeletal procedures:
1.7.8.1	S	Splinting of injured extremities	FM, AEM, PEM	UC	X
1.7.8.2	S	Application of sling - upper extremity	FM, AEM, PEM	UC	X
1.7.8.3	S	Reduction of dislocated finger	FM, AEM, PEM	UC	X
1.7.8.4	S	Reduction of dislocated radial head (pulled elbow)	FM, AEM, PEM	UC	X
1.7.8.5	S	Reduction of dislocated shoulder	FM, AEM, PEM	UC	X
1.7.8.6	S	Application of forearm cast	FM, AEM, PEM	UC	X
1.7.8.7	S	Application of scaphoid cast	FM, AEM, PEM	UC	X
1.7.8.8	S	Application of ulnar gutter splint	FM, AEM, PEM	UC	X
1.7.8.9	S	Application of below-knee cast	FM, AEM, PEM	UC	X
1.7.8.10	S	Aspiration and injection of knee joint	FM, AEM, PEM	UC, SM, RH	X
1.7.8.11	S	Aspiration and injection of shoulder joint	FM, AEM, PEM	UC, SM, RH	X
1.7.8.12	S	Injection of lateral epicondyle (tennis elbow)	FM, AEM, PEM	UC, SM, RH	X
1.7.8.13	S	Aspiration and injection of bursa (e.g. patellar, subacromial)	FM, AEM, PEM	UC, SM, RH	X
1.7.9	S	Perform the following resuscitation procedures:
1.7.9.1	S	Oral airway insertion	FM, AEM, PEM, IM, GS	UC, FMH, ICU	X
1.7.9.2	S	Bag and mask ventilation	FM, AEM, PEM, IM, GS	UC, FMH, ICU	X
1.7.9.3	S	Endotracheal intubation	FM, AEM, PEM, IM, GS	UC, FMH, ICU	X
1.7.9.4	S	Cardiac defibrillation	FM, AEM, PEM, IM, GS	UC, FMH, ICU	X
1.7.10	S	Perform the following injections and cannulations:
1.7.10.1	S	Intramuscular injection	FM, AEM, PEM, IM, GS	UC, FMH	X
1.7.10.2	S	Subcutaneous injection	FM, AEM, PEM, IM, GS	UC, FMH	X
1.7.10.3	S	Intradermal injection	FM, AEM, PEM, IM, GS	UC, FMH	X
1.7.10.4	S	Venipuncture	FM, AEM, PEM	UC, FMH	X
1.7.10.5	S	Peripheral intravenous line (adult/child/infant)	FM, AEM, PEM, IM, GS	UC, FMH, ICU	X
1.7.10.6	S	Adult lumbar puncture	FM, AEM, PEM, IM, GS	UC, FMH, ICU	X

The resident will be able to:
1.7.2	S	Perform the following enhanced procedures:
1.7.2.1	S	Excision of skin carcinoma	FM, GS		X
1.7.2.2	S	Removal of whole toenail	FM, GS		X
1.7.2.3	S	Removal of corneal rust ring	FM, AEM, PEM	UC	X
1.7.2.4	S	Posterior nasal packing	AEM, PEM	UC	X
1.7.2.5	S	Needle thoracentesis	FM, IM, GS	FMH, ICU	X
1.7.2.6	S	Placement of chest tube	FM, AEM, PEM	FMH, ICU	X
1.7.2.7	S	Vacuum extraction	FM, OBG		X
1.7.2.8	S	Fracture hematoma block	FM, AEM, PEM	UC	X
1.7.2.9	S	Reduction of Colles fracture	FM, AEM, PEM	UC	X
1.7.2.10	S	Reduction of Boxer fracture	FM, AEM, PEM	UC	X
1.7.2.11	S	Reduction of other simple fractures	FM, AEM, PEM	UC	X
1.7.2.12	S	Application of full leg cast	FM, AEM, PEM	UC	X
1.7.2.13	S	Cardioversion	FM, AEM, PEM, IM, GS	UC, FMH, ICU	X
1.7.2.14	S	Child lumbar puncture	PEM		X

Family medicine is a community-based discipline
The resident will be able to:
1.7.3	K	Describe how the characteristics of the practice can affect the need for specific procedural skills	FM		X

The family physician is a resource to a defined practice population
The resident will be able to:
1.7.4	K	Identify useful resources to have in the practice to aid the performance of procedures	FM		X

The patient-physician relationship is central to the role of the family physician
The resident will be able to:
1.7.5	A	Describe and recognize the importance of potential psychological symptoms (e.g. fear, anxiety) that patients may have when having a procedure performed and strategies to assist patients with these symptoms	FM, AEM, PEM, IM, GS	UC, FMH, ICU	X

References
Wetmore SJ, Rivet C, Tepper J, Tatemichi S,Donoff M, Rainsberry PN. Defining core procedure skills for Canadian family medicine training. Can Fam Physician 2005;51:1364-1365.
Standards for Accreditation of Residency Training Programs. The College of Family Physicians of Canada. 2006.