Use it or lose it: is de-skilling evidence-based?

'De-skilling' is a buzzword applied to the alleged attrition of skills through their infrequent practice. However, the belief that continuing competence in procedural medicine requires the consistent practice of a minimum number of procedures is based on anecdotal evidence. This not withstanding, accreditation or continuing practice requirements are imposed, often specifying a number of procedures that must be performed each year in order to retain the right to perform them. The following is a review of the literature into the evaluation of procedural skill competence as is related to use.     

The sound and the fury: was it all worth it?

The initial report of coronary heart disease (CHD) results from the trial of menopausal hormone therapy within the Women's Health Initiative precipitated substantial surprise and concern in the epidemiology research community over the apparent differences between the trial results and those of observational studies. What followed was 6 years of discussion and debate, frequently acrimonious, along with intense methodologic and substantive research attempting to reconcile or explain the apparent differences. The results have been an impressive improvement in methods to contrast and combine studies of differing designs, dramatic illustrations of some central epidemiologic principles, insights into likely mechanisms of CHD, and increasing clarity of the public health message about menopausal hormone therapy.