What is Proctoring in Healthcare?

Written by Researchbite | Updated on: February 17, 2023

What is Proctoring in Healthcare?

Read this article to find out what is proctoring in healthcare.

Introduction

It is crucial to maintain the integrity of this process to strike a balance between the requirement for flexibility in giving privileges to doctors and Advanced Practice Providers (APPs) and the need to guarantee that the patients receive excellent care from clinicians who are appropriately qualified. Although APPs might be more familiar with the notion, physicians occasionally go across circumstances where one or both of these approaches will be used. Proctoring takes place when clinical circumstances are being observed, whether they are genuine or fake. These requests must be made to the medical staff office first for more guidance when a doctor or APP needs a preceptorship for new or extra privileges (i.e., the desire to learn a new skill through training) that will occur with patients within the hospital. This is to check that all necessary approvals have been received and documents have been appropriately filled out.

Meaning Of Proctoring In Healthcare

A proctor accountable to and represents the medical staff objectively evaluates a physician's clinical competence. The treatments or procedures for which privileges are requested are proctored while being provided by new medical staff members seeking privileges or existing medical staff members asking for additional or extended privileges. Most of the time, a proctor serves as a monitor to assess another physician's technical and cognitive abilities. A proctor does not treat patients directly, has no physical relationship with them, and does not charge them fees. Sometimes, the terms proctorship and preceptorship are used synonymously. On the other hand, a preceptorship differs in that it is a training program in which a preceptor instructs another physician in new techniques while also taking primary responsibility for the patient's care.

There are three kinds of proctoring:

  • Prospective,
  • Concurrent,
  • Retrospective.

Before starting therapy, the proctor in prospective proctoring examines the patient in person or looks over their medical records. If the indications for a particular surgery are ambiguous or the technique is hazardous, this form of proctoring may be employed. Concurrent proctoring involves the proctor physically overseeing the applicant's work. This proctoring is typically utilized for invasive procedures so that the proctor may provide the medical personnel with an account from the patient's perspective to reassure them of the applicant's competency. Finally, retrospective proctoring entails the proctor reviewing patient records in the past. In most cases, the retrospective review is sufficient for noninvasive procedure proctoring.

The Role And Value Of Proctors

In the healthcare industry, proctoring refers to the impartial assessment of a provider's clinical competence by a proctor who serves in that capacity and is accountable to the medical staff. A crucial hurdle before providing rights is this peer-review mechanism. Proctoring recommendations for bylaws provisions were released by the American Academy of Family Physicians (AAFP). The article lists three proctoring methods: prospective, concurrent, and retrospective. The proctor will typically focus on and assess three main areas: clinical knowledge, equipment understanding, and proficiency with technique and procedure. Then, the department chair recommends to the executive medical committee whether to give clinical privileges, extend the proctoring term, or refuse clinical privileges based on the proctor's findings in a written report that includes a thorough evaluation of the applicant's performance.

  • Acts as a neutral third party to observe, not instruct, another doctor's technical and cognitive abilities.
  • Has no physician-patient interaction with the treated patient and does not actively participate in patient care.
  • Represents the hospital or governing body and is accountable to it for the accreditation of physicians requesting endoscopic privileges.
  • Receives no payment specifically for treating patients. As payment for the time invested in proctoring services, a proctor may or may not receive a fee from the hospital or regulating organization.

Proctoring Rules Of Conduct

Privileges for treatments and services should be determined by a doctor's proven current competence, documented training, and experience. Instead of the execution of a random selection of procedures, competence is assessed and validated based on the evaluation of performance in clinical conditions (i.e., proctoring). The best way to determine if a doctor is qualified to conduct an operation or offer a service safely and effectively is through direct observation by a qualified and experienced proctor. For invasive operations, concurrent proctoring should be employed, although retrospective proctoring could be sufficient for noninvasive procedures. Knowledge and Skills: Knowledge is a complicated and procedure-specific component of procedural skills, but specific broad guidelines regulate the growth of competency in carrying out the majority of operations. Clinical, procedural, and equipment knowledge are the available domains that must be learned before one may be considered competent. The proctor should evaluate the following areas.

Clinical Experience

  • Basic baseline knowledge
  • Guidelines for use and restrictions
  • Health and disease physiology
  • Anatomy
  • Practitioner's restrictions
  • Economics

Equipment Familiarity

  • Equipment's technical details
  • Particulars of the apparatus
  • Operating instructions for the apparatus
  • The equipment's safety features

Understanding of the Process

  • Procedure's physical properties
  • Techniques used in the process
  • The patient's preparation
  • Safety measures and possible problems
  • Restrictions of the process
  • Special techniques
  • Advanced methods

The proctor should be objective, possess verified training and experience, exhibit talents, and currently possess competency in the service or procedure being proctored. Unless there isn't a qualified proctor on the medical staff, the proctor should also be a member of the hospital's medical staff (as may occur in rural hospitals). The medical staff rules should provide that all medical staff members shall serve on occasion as proctors. The hospital should hire a proctor from another organization or training program if there isn't an appropriate proctor on the medical staff. The hospital is responsible for covering the costs associated with hiring that proctor. To report to the department chair or executive medical committee, the proctor must watch over and assess the candidate. The hospital shall agree in writing to hold the proctored physician harmless for any damages that may arise from adhering to the proctor's instructions if the proctor determines that intervening in the case is warranted. The hospital's insurance provider shall formally confirm this indemnity to the executive medical committee. The hospital should also consent to hold a proctor harmless for any losses brought on by a battery allegation.

Proctor Evaluation Requirement

Privilege lists may contain evaluation requirements, or the Department Chair or Credentials Committee may impose them. When defining qualifications, the Department Chair or Credentials Committee may choose to accept prior education and experience. The doctor requesting the privilege or operation is responsible for finding reviewer(s). However, reviewers must be approved by the Department Chair or Credentials Committee Chair, as described below. Partners or others with whom the physician shares calls are urged to serve as reviewers.

  1. Physician partners often complete observation for critical operations.
  2. A staff person with current credentials or a non-staff member who has been screened and given the go-ahead by the hospital to proctor the particular operation or procedures may both conduct proctoring.
  3. The app must provide a review plan if unique processes are required.

Qualifications For Proctors

  1. A Providence Health Care facility must now provide observers unlimited privileges in the same specialty. The reviewer must have exercised privileges at a Providence Health Care hospital over the previous year without any documented patient care issues unless the Credentials Chair or Chief Medical Executive (CME) gives express approval otherwise.
  2. Proctors must currently have full access to the hospital where the operation or procedures under evaluation are performed at Providence Health Care. The proctor cannot participate in an ongoing FPPE process unless expressly authorized by the Credentials Chair or Chief Medical Officer. And must have used the particular privilege at a hospital run by Providence Health Care within the previous year without any known patient care issues. It is optional for the proctor to have the same specialist credentials as the doctor being evaluated.

To the seeking physician, the minimum number of needed evaluated procedures will be notified. If it is decided that the opinions of many people should be utilized to assess the individual's competency, the Department, Credentials Committee, or MEC may demand the engagement of more than one reviewer. Review forms should be sent to Medical Staff Services as soon as feasible after each case to ensure that any issues with patient care performance are found as soon as possible. Medical Staff Services will let the department chairman or designated representative know if the reviewer raises any issues. Following the review, one of the following measures might be taken:

  • If performance is good, unrestricted rights may be provided.
  • Suppose the number of instances needs to be increased to decide on the practitioner's competency. In that case, the observation or proctoring requirements may be extended for an extra time frame and several cases.
  •  Suppose the department or MEC decides that the performance has fallen short of current standards or that awarding unlimited privileges might put patients in unnecessary danger. In that case, privileges may be refused or restricted.

Conclusion

Before a doctor or APP can start their preceptorship, they must first be granted privileges by the medical staff. Proctoring should be seen as a peer-reviewing tool, and some proctoring that happens in a simulation or as part of a formal course doesn't need to be approved by the medical staff. However, proctors often offer certifications and signatures attesting to proficiency, and these records are required when the medical staff requests the next step/level of practice.

References

  • https://www.providence.org/-/
  • https://www.healthstream.com/resource/blog/what-is-the-difference-between-proctoring-and-precepting

         

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