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Proctoring versus precepting

Medical Staff Leader Connection, October 25, 2006

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The Joint Commission, in their 2007 standards for the Medical Staff, have introduced a new concept - that of Focused Professional Practice Evaluation (FPPE).  Although the requirements related to this concept do not go into effect for survey purposes until January 1, 2008, many medical staff organizations are beginning the planning process to implement the requirements associated with this new standard.  The principle behind the introduction of the requirements associated with FPPE is that when new applicants are granted privileges, an organization has information that suggests competence.  It is the organization's responsibility to confirm competence.

The Joint Commission provides some "tools" that medical staff organizations can use to implement provisions related to FPPE.  One of the tools mentioned for confirmation of competency is proctoring.  Some medical staff organizations already use proctoring to confirm competence.  For many medical staff organizations, however, the introduction of proctoring will be new.

It is important to understand what proctoring is - and what it is not.  There are two terms that are sometimes used by medical staff organizations interchangeably.  However, they have very different meanings.

Proctoring is the process through which skills and/or knowledge that a practitioner asserts he/she already possesses are confirmed.

Precepting is the process through which a practitioner gains experience and/or training on new skills and knowledge.  Therefore, precepting would not be an appropriate method to use to confirm competency. 

The American Society for Gastrointestinal Endoscopy published a paper in 1999 on Proctoring for Hospital Endoscopy Privileges which has a good definition of the role of a proctor:

Role of the Proctor:

1. Acts as a independent and unbiased monitor to evaluate, not teach, the technical and cognitive skills of another physician.
2. Does not directly participate in patient care and has no physician/patient relationship with the patient being treated.
3. Represents the hospital and or governing body and is responsible to the hospital or governing body in connection with credentialing of physicians seeking endoscopic privileges.
4. Does not receive a fee directly related to patient care.  A proctor may or may not receive a fee from the hospital or governing body as compensation for time spent in proctoring services.

This same paper goes on to describe a preceptor as follows:  A preceptor is an instructor or teacher.  When teaching an endoscopic practice to a trainee, a physician is responsible for the actions of that trainee as well as himself/herself.

Make sure that your organization is clear on what is and is not expected of a proctor as well as someone who acts as a preceptor (if your organization is involved in teaching new skills via preceptorships).

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