Determining core versus noncore privileges
For organizations moving toward the development of a criteria-based core privileging system, determining whether a certain procedure or privilege is core or special/noncore can be problematic. Core are those procedures or privileges that any well-trained physician within a particular specialty or subspecialty should be competent to perform upon completion of postgraduate training.
Several factors should be considered when trying to identify specific privileges or special procedures that fall outside the core and therefore would be deemed special or noncore. These factors recognize the need for additional education, training, or recent experience to safely perform the procedure. Factors to consider include the following:
- Knowledge. Does this procedure/privilege require additional education/training gained either within a postgraduate training program or via hands-on continuing medical education (CME)?
- Skill. Is a higher level of skill involved, or does the procedure require routine occurrence to maintain that particular skill?
- Judgment. Does the procedure require a higher level of judgment to perform than those procedures that are typically delineated within the core?
- Risk. Is it a high-risk procedure?
- Ability to manage complications. Is additional training/clinical skill/technique needed if complications arise?
- Technique. Is the clinical technique a new approach?
- Equipment. Was the technology or equipment recently introduced, and therefore, does it require additional training/clinical skill/judgment?
Typically, answering these questions requires clinical expertise from your physician leaders because these privileges and procedures may not be part of all postgraduate training programs. If the answer to more than one of these questions is “yes,” there should be further research and discussion with the department chair or their designee as to whether the procedure should be special or outside the core.
When a new technology or procedure first arrives on the scene, it may be by nature a noncore privilege due to its unfamiliarity. In many cases, as a new technology or procedure becomes increasingly commonplace, it will often transition into the core list. A good example of this is laparoscopic cholecystectomy for general surgeons. When it first was introduced in the late 1980s and early 1990s in the United States, it would have been a special privilege but today, it is considered a core privilege.