How often have you performed a lateral canthotomy? By the end of training, ACEM expects you to be able to independently perform the procedure. What about incision and drainage of a haemorrhoid? ACEM expects the same and this came up as a recent fellowship written examination question; it took a lot of candidates by surprise. Are you an expert in finger thoracotomy? What about setting up a transport ventilator? Or external cardiac pacing?

Did you know the ACEM curriculum has published a procedures list with levels of competence explained for each level of training? This list is well worth revising when coming up to exams.

Being able to perform procedures is one of the great drawcards of emergency medicine. They are fun, exciting and rewarding. However gaining experience and developing proficiency and competence is a real challenge throughout training as many of the life or limb saving procedures are infrequently performed.

Here are a few ways to learn.

• Roberts and Hedges’ is the ACEM prescribed textbook. The information is great, but it is a big, heavy book. There are a few (illegal) PDF copies floating around.

• Some of our FACEM colleagues in NSW are in the process of creating an app with a reference to emergency medicine procedures. They use the ACEM procedures list and outline the key points for each procedure. Check it out at https://emergencyprocedures.medapps.com.au. Hopefully it is developed into a smart-phone app soon as it is a wonderful resource

• Are you an EMRAP subscriber? The EMRAP-HD Videos on procedures are brilliant.

• Our ED and education department have a number of part-task trainers that can be used to simulate procedures. If you want to practice a particular procedure or skill then let one of the education team know so we can arrange a session

• Do you have lots of money? The procedures course through Alfred Health is a two-day cadaveric workshop that will ‘teach you how to confidently perform a wide range of basic and complex resuscitative procedures’ https://emergencyeducation.org.au/program/the-procedures-course/

• Keep your eyes open on the shop floor for opportunities to observe or perform procedures. Perform as many DOPs as possible and learn from the many FACEMS and years of experience.