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An Intervention to Improve Procedure Education for Internal Medicine Residents

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Abstract

Background

Internists commonly perform invasive procedures, but serious deficiencies exist in procedure training during residency.

Objective

Evaluate a comprehensive, inpatient procedure service rotation (MPS) to improve Internal Medicine residents’ comfort and self-perceived knowledge in performing lumbar puncture, abdominal paracentesis, thoracentesis, arthrocentesis, and central venous catheterization (CVC).

Design

The MPS comprised 1 faculty physician and 1–3 residents rotating for 2 weeks. It incorporated lectures, a textbook, instructional videos, supervised practice on mannequins, and inpatient procedures directly supervised by the faculty physician. We measured MPS impact using pre- and post-MPS rotation surveys, and surveyed all residents at academic year-end.

Measurements and Main Results

Thirty-nine categorical Internal Medicine residents completed the required rotation and surveys over the 2004–2005 academic year, performing 325 procedures. Post-MPS, the percentage of residents reporting comfort performing procedures rose 15–36% (p < .05 except for arthrocentesis, and CVC via internal jugular and femoral veins). The fraction desiring more training fell 26–51% (all p < .05). After the MPS rotation, self-rated knowledge increased in all surveyed aspects of the procedures. The year-end survey showed that improvements persisted. Comfort at year-end, for all procedures except abdominal paracentesis, was significantly higher among residents who rotated through the MPS than among those who had not. Self-reported compliance with recommended antiseptic measures was 75% for residents who completed the MPS, and 28% for those who had not (p < 0.001).

Conclusions

A comprehensive procedure service rotation of 2 weeks duration substantially improved residents’ comfort and self-perceived knowledge in performing invasive procedures. These benefits persisted at least to the end of the academic year.

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References

  1. Policies and procedures for certification. Philadelphia: American Board of Internal Medicine; 1998.

  2. Wigton RS, Alguire P. The declining number and variety of procedures done by general internists: a resurvey of members of the American College of Physicians. American College of Physicians Ann Intern Med. 2007;146(5):355–60.

    PubMed  Google Scholar 

  3. Wigton RS. Measuring procedural skills. Ann Intern Med. 1996;125(12):1003–04.

    PubMed  CAS  Google Scholar 

  4. Wickstrom GC, Kelley DK, Keyserling TC, Kolar MM, Dixon JG, Xie SX, et al. Confidence of academic general internists and family physicians to teach ambulatory procedures. J Gen Intern Med. 2000;15(6):353–60.

    Article  PubMed  CAS  Google Scholar 

  5. Hicks CM, Gonzalez R, Morton MT, Gibbons RV, Wigton RS, Anderson RJ. Procedural experience and comfort level in internal medicine trainees. J Gen Intern Med. 2000;15(10):716–22.

    Article  PubMed  CAS  Google Scholar 

  6. Sherertz RJ, Ely EW, Westbrook DM, Gledhill KS, Streed SA, Kiger B, et al. Education of physicians-in-training can decrease the risk for vascular catheter infection. Ann Intern Med. 2000;132(8):641–48.

    PubMed  CAS  Google Scholar 

  7. Huang GC, Smith CC, Gordon CE, Feller-Kopman DJ, Davis RB, Phillips RS, et al. Beyond the comfort zone: residents assess their comfort performing inpatient medical procedures. Am J Med. 2006;119(1):71.e17–71.e24.

    Article  Google Scholar 

  8. Wigton RS, Blank LL, Nicolas JA, Tape TG. Procedural skills training in internal medicine residencies. A survey of program directors. Ann Intern Med. 1989;111(11):932–38.

    PubMed  CAS  Google Scholar 

  9. Anastakis DJ, Regehr G, Reznick RK, Cusimano M, Murnaghan J, Brown M, et al. Assessment of technical skills transfer from the bench training model to the human model. Am J Surg. 1999;177(2):167–70.

    Article  PubMed  CAS  Google Scholar 

  10. Martin M, Scalabrini B, Rioux A, Xhignesse M. Training fourth-year medical students in critical invasive skills improves subsequent patient safety. Am Surg. 2003;69(5):437–40.

    PubMed  Google Scholar 

  11. Oxentenko AS, Ebbert JO, Ward LE, Pankratz VS, Wood KE. A multidimensional workshop using human cadavers to teach bedside procedures. Teach Learn Med. 2003;15(2):127–30.

    Article  PubMed  Google Scholar 

  12. Velmahos GC, Toutouzas KG, Sillin LF, Chan L, Clark RE, Theodorou D, et al. Cognitive task analysis for teaching technical skills in an inanimate surgical skills laboratory. Am J Surg. 2004;187(1):114–19.

    Article  PubMed  Google Scholar 

  13. Kohis-Gatzoulis JA, Regehr G, Hutchinson C. Teaching cognitive skills improves learning in surgical skills courses: a blinded, prospective, randomized study. Can J Surg. 2004;47(4):277–83.

    Google Scholar 

  14. Ramakrishna G, Higano ST, McDonald FS, Schultz HJ. A curricular initiative for internal medicine residents to enhance proficiency in internal jugular central venous line placement. Mayo Clin Proc. 2005;80(2):212–18.

    Article  PubMed  Google Scholar 

  15. Proano L, Jagminas L, Homan CS, Reinert S. Evaluation of a teaching laboratory using a cadaver model for tube thoracostomy. J Emerg Med. 2002;23(1):89–95.

    Article  PubMed  Google Scholar 

  16. Centers for Disease Control and Prevention. Guidelines for the prevention of intravascular catheter-related infections. MMWR Morb Mortal Wkly Rep. 2002;51(RR-10):1–29.

    Google Scholar 

  17. Chen H, Lillemoe KD, Sonnenday CJ. (eds.) In: Manual of common bedside surgical procedures. 2nd ed. Philadelphia: Lippincott Williams & Wilkins; 2000.

  18. Wigton RS, Nicolas JA, Blank LL. Procedural skills of the general internist: a survey of 2500 physicians. Ann Intern Med. 1989;111(12):1023–34.

    PubMed  CAS  Google Scholar 

  19. Wigton RS. Training internists in procedural skills. Ann Intern Med. 1992;116(12 Pt 2):1091–93.

    PubMed  CAS  Google Scholar 

  20. Smith C, Gordon CE, Feller-Kopman D, Huang GC, Weingart SN, Davis RB, et al. Creation of an innovative inpatient medical procedure service and a method to evaluate house staff competency. J Gen Intern Med. 2004;19(5 Pt 2):510–13.

    Article  PubMed  Google Scholar 

  21. American Board of Internal Medicine. Internal Medicine Policies. Available at: http://www.abim.org/certification/policies/imss/im.aspx#procedures. Accessed January 8, 2008.

  22. Goldstein LB, Hey LA, Laney R. North Carolina stroke prevention and treatment facilities survey. Statewide availability of programs and services. Stroke. 2000;31(1):66–70.

    PubMed  CAS  Google Scholar 

  23. Fincher RM. Procedural competence of internal medicine residents: time to address the gap. J Gen Intern Med. 2000;15(6):432–33.

    Article  PubMed  CAS  Google Scholar 

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Acknowledgment

The authors are indebted to the following people for making it possible to perform this study: Drs. Lee Tai, Advocate Christ Medical Center, Oak Lawn, IL; Michael McFarlane, MetroHealth Medical Center, Cleveland, OH; Richard Christie, St. Vincent Charity Hospital, Cleveland, OH; and K. V. Gopalakrishna, Fairview Hospital, Cleveland, OH. There were no specific sources of financial support for this study.

Conflict of Interest Statement

None disclosed.

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Authors and Affiliations

  1. Department of Medicine, Case Western Reserve University at MetroHealth Medical Center, Cleveland, OH, USA

    Amanda Lenhard MD, Moayyed Moallem MD & Jeffrey Becker MD

  2. Departments of Medicine & Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada

    Ruth Ann Marrie MD, PhD & Allan Garland MD, MA

Authors
  1. Amanda Lenhard MD
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  2. Moayyed Moallem MD
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  3. Ruth Ann Marrie MD, PhD
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  4. Jeffrey Becker MD
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  5. Allan Garland MD, MA
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Corresponding author

Correspondence to Allan Garland MD, MA.

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Lenhard, A., Moallem, M., Marrie, R.A. et al. An Intervention to Improve Procedure Education for Internal Medicine Residents. J GEN INTERN MED 23, 288–293 (2008). https://doi.org/10.1007/s11606-008-0513-4

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  • DOI: https://doi.org/10.1007/s11606-008-0513-4

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