Procedural Competence Among Academic Emergency Medicine Attending Physicians: A Survey of Skill Maintenance Strategies

Objectives: To evaluate how academic emergency departments (EDs) support procedural skill maintenance for faculty physicians, particularly in environments where learners often perform procedures. We aimed to characterize training strategies, barriers to participation, and the inclusion of high-acuity, low-occurrence (HALO) procedures. Methods: We conducted a cross-sectional survey of department chairs, vice chairs, and chair emeriti attending the 2025 Association of Academic Chairs of Emergency Medicine (AACEM) retreat. The survey assessed institutional approaches to procedural training, frequency of offerings, training modalities, inclusion of HALO procedures, and perceived barriers. Descriptive statistics and chi-square tests were used to analyze differences in training frequency and procedural coverage. Results: Of 81 academic departments represented, 49 responded (60.5%). Most (87.8%) offered procedural training, yet only 32.6% required participation. Hands-on training was most common (93%), followed by in-person (79%) and virtual (16%) sessions. While 100% of departments covered point-of-care ultrasound and 93% airway management, fewer addressed HALO procedures: only 27.9% covered all HALO categories (e.g., surgical airway, thoracostomy, pericardiocentesis). Time constraints and clinical schedules were the most-commonly reported barriers to participation. Conclusions: Procedural skill maintenance for EM attendings varies widely across academic EDs. Despite the specialty's procedural intensity, most academic departments lack comprehensive, mandatory training, particularly for infrequent but critical procedures. Findings highlight variability in departmental approaches and the need to further explore best practices for procedural skill maintenance.