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. 2008 Mar;23(3):288-93.
doi: 10.1007/s11606-008-0513-4. Epub 2008 Jan 23.

An intervention to improve procedure education for internal medicine residents

Amanda Lenhard  1 , Moayyed Moallem, Ruth Ann Marrie, Jeffrey Becker, Allan Garland
Affiliations

An intervention to improve procedure education for internal medicine residents

Amanda Lenhard et al. J Gen Intern Med. 2008 Mar.

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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Figures

Figure 1
Figure 1
Percentages of residents that completed the Medical Procedure Service rotation who reported being comfortable performing invasive procedures in 3 surveys. *p < .05 compared to Pre-MPS survey; #p < .05 compared to post-MPS survey. MPS medical procedure service, LP lumbar puncture, PC abdominal paracentesis, TC thoracentesis, SC CVC subclavian vein central venous catheterization, IJ CVC internal jugular vein central venous catheterization, FEM CVC femoral vein central venous catheterization, AC arthrocentesis.
Figure 2
Figure 2
Percentages of residents that completed the Medical Procedure Service rotation who reported a desire for more education and training regarding invasive procedures in 3 surveys. *p < .05 compared to pre-MPS survey; #p < .05 compared to post-MPS survey. MPS medical procedure service, LP lumbar puncture, PC abdominal paracentesis, TC thoracentesis, CVC vein central venous catheterization, AC arthrocentesis.
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