What is the Difference between Proctoring and Precepting

The issue of the differences between proctoring and preceptorships are still misunderstood in some organizations. So it is time to revisit this subject to make sure that we all have a good understanding of when to use proctoring and when a preceptorship would be indicated.

The Joint Commission, in their 2007 standards for the Medical Staff, introduced a new concept – that of Focused Professional Practice Evaluation (FPPE). The principle behind 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 during a practitioner’s introduction into the organization.

Many organizations use “proctoring” as a tool to confirm competence during the initial FPPE period. Proctoring may be performed concurrently (watching a provider perform a procedure, for example) or retrospectively (an evaluation typically carried out by review of the patient record).

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 provider asserts he/she already possesses are confirmed.

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

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

Role of the Proctor:

• Acts as a independent and unbiased monitor to evaluate, not teach, the technical and cognitive skills of another physician.
• Does not directly participate in patient care and has no physician/patient relationship with the patient being treated.
• 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.
• 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.

Clinical learning does not stop when a residency or fellowship is completed. Continued learning and skills acquisition is required if providers are to have a contemporary and relevant clinical practice. Clinical education/experience is a life-long process. A well organized and targeted preceptorship can assist providers with a skills refresher when specific clinical skills have not been recently performed or in obtaining supervised human subjects experience after didactic training has been completed. A well run and well documented program will ensure that privileging criteria is met prior to granting clinical privileges.

Make sure that your organization is clear on what is and is not expected of a proctor. And – if your organization determines that establishing a preceptorship program would be of value, it will be necessary to resource the preceptorship program in order to assure that it is well-defined and that one of the outcomes is documentation that confirms how a provider acquired new skills and/or knowledge.