Perceived core procedural skills for Nebraska family physicians.

We conducted a mail survey of 287 practicing family physicians, 22 family practice faculty, and 60 family practice residents in both rural and urban Nebraska concerning their perceptions of "core" procedures in family medicine and their perceived competency in performing them. Final response rate was 45%. There was general agreement concerning what constituted the core procedures in family medicine, although several newer procedures, such as flexible sigmoidoscopy, provoked more controversy. Rural physicians were more likely to classify intrauterine device insertion, endometrial biopsy, and cervical biopsy as core procedures than their urban counterparts. As expected, whether a physician performed a procedure related directly to his reported competence in performing it. However, there were discrepancies between perceived training during residency and current practice for control of nasal hemorrhage, aspiration of breast mass, flexible sigmoidoscopy, endometrial biopsy, and joint aspiration. Faculty programs for teaching procedural skills, standards for documenting competence, and systems for ongoing quality assurance should be further developed.