Clinical Proctoring

AAFP Position

Clinical proctoring is an important peer assessment tool for physicians seeking privileges (i.e., applicant) in hospitals and health care organizations. Privileges for procedures and services should be based on training, experience and demonstrated competence. The American Academy of Family Physicians supports proctoring programs as an acceptable method for determining physician competence for credentialing privileges. Proctoring should be guided by the appropriate medical staff bylaws to ensure requirements are applied equitably to all medical staff members, regardless of specialty. The AAFP supports family physicians proctoring other family physicians whenever possible. The patient’s consent is required for the proctor to be present during the direct observation.

Definitions of Clinical Proctoring

Proctoring is an objective evaluation of a physician's clinical competence by an experienced physician (the proctor) who represents and is responsible to the hospital or credentialing body.¹ Medical staff members seeking new or expanded privileges are monitored and evaluated by a proctor while performing the service or procedure for which privileges are requested. As an observer, the proctor receives no fee from the patient and does not provide any services to the patient.^1,2 The terms proctorship and preceptorship are sometimes used interchangeably, but they are distinct. A preceptor teaches a physician new skills while retaining primary responsibility for patient care. A proctor observes and evaluates the skills of another physician and traditionally has no role in patient care.¹

Three common types of proctoring are prospective, concurrent and retrospective.³ In prospective proctoring, prior to treatment or performing a procedure, the proctor becomes familiar with details of the case, either by assessing the patient and/or reviewing their chart and then observing. This method of proctoring can be helpful for complex or high-risk procedures. In concurrent proctoring, the proctor observes the physician treating a patient or performing a procedure. This is often used for invasive procedures to verify competence. In retrospective proctoring, the proctor reviews patient charts after treatment, usually sufficient for noninvasive procedures. These types of proctoring are not mutually exclusive. In any request for privileging, a combination of all three may occur.

Proctoring Guidelines for Provisions of Bylaws

(1) Graduates of accredited family medicine residency programs should be granted core privileges without requiring proctoring.

(2) There should be a defined process for granting privileges beyond core competencies, including new procedures or technology.⁴ Proctorship may serve as evidence of demonstrated competence. The department should determine the requirements for competency, including the duration period and/or number of cases required for a proctorship.

(3) To the greatest degree possible, a proctor should be from the same specialty as the applicant. If applicable, each department should proctor its own members and recommend privileges without obtaining the approval or consent of other departments. An external proctor may be appointed if no suitable proctor is available within the same department or on the medical staff.

(4) The proctor should be impartial, unbiased and have the necessary training and experience in the service or procedure for which privileges are requested. For any service or procedure, a proctor should assess the applicant’s service or procedure-specific clinical knowledge, knowledge of equipment for the procedure and ability to assess and manage complications.⁵

(5) When a suitable proctor is not on staff, the medical staff should seek an external proctor or determine the proctor with the closest relevant experience to assess the applicant’s competency.4

(6) The hospital should pay the expenses incurred in obtaining any external proctor.

(7) Medical staff bylaws should specify requirements for its members to serve as proctors.

(8) The hospital should indemnify the proctor if unforeseen circumstances require an intervention by the proctor. 

(9) The proctor shall provide a confidential report using a standardized process to the governing body that determines privileges to assist in the decision to grant the requested privileges. The department’s decision should be based on the applicant's performance during the proctoring period.

(10) The proctoring report shall remain confidential, and there shall be clear access, appeal and retention policies.

References

1. Seto AH, Duffy PL, Don CW, et.al. SCAI Position Statement on Best Practices for Clinical Proctoring of New Technologies and Techniques. J Soc Cardiovasc Angiogr Interv. 2022;1(3):100036.
2. Heit M. Surgical proctoring for gynecologic surgery. Obstet Gynecol. 2014;123(2 Pt 1):349-352.
3. MedPro Group. Guideline. Credentialing and privileging. Accessed April 15, 2025. www.medpro.com/documents/10502/2837997/Guideline_Credentialing+and+Privileging.pdf
4. No authors. Committee Opinion No. 674: Guiding Principles for Privileging of Innovative Procedures in Gynecologic Surgery. Obstet Gynecol. 2016;128(3):e85-e88.
5. Miller M D. Education, training, and proficiency of procedural skills. Prim Care. 1997;24:231-241

(1995) (October 2025 COD)