Must a proctor be from the same specialty as the practitioner being observed?

In most cases, it is useful but not required to have a specialty-to-specialty match. There are many observations regarding clinical practice that doctors from a wide range of specialties can accurately make. Did the observed practitioner exhibit adequate history and physical skills, compose a differential diagnosis, demonstrate good bedside manner, compose a thoughtful therapeutic plan? General competence is fairly recognizable to good physicians. In addition, if proctoring is targeted to a specific clinical concern, there may be a range of specialists that would be knowledgeable in the relevant subject matter. For example, if concerns arise regarding the ability of a surgeon or intensivist to appropriately manage electrolyte abnormalities, colleagues in a range of unrelated specialties could have the capability to assess good electrolyte management from bad. Such colleagues might include a nephrologist or a strong hospital-based internist.

There are circumstances where it is critical to utilize a proctor of the same specialty. Many procedural and technical skills are specialty specific. If the question is whether a neurosurgeon is using proper technique to prevent dural tears, the assessment probably needs to come from another neurosurgeon. If the proctoring has been triggered by a very specific competency concern that is highly specialty specific, then a comparable specialist should be utilized.

Proctoring for focused professional practice evaluation (FPPE) to confirm competency often does not need this kind of specialty match. When a practitioner first joins a medical staff and is extended clinical privileges, he or she has completed a careful vetting process and is presumed competent in the privileges granted. At this point, FPPE is required by accreditation organizations not because competency is suspect, but rather as a safeguard by providing firsthand assessment confirming that competency. In this circumstance, the rigor of specialty to-specialty proctoring is often not necessary.

For example, many medical staffs will allow an anesthesiologist to proctor a surgeon and provide feedback. This is convenient because the anesthesiologist is already in the operating room. The anesthesiologist is certainly capable of reporting whether the surgeon used good sterile technique, appeared confident and knowledgeable in his work, interacted well with the surgical team, performed the proper time-outs, and so forth. The anesthesiologist can take note of prolonged surgical times, breaks in the use of required or typically utilized protocols, clumsiness with instruments or problematic indecision, or other indications that competence may be inadequate. If such observations are made, additional proctoring can be performed by a like specialist.

Source: Proctoring, FPPE, and Practitioner Competency Assessment