Procedural experience and comfort level in internal medicine trainees.
BACKGROUND
The American Board of Internal Medicine (ABIM) has recommended a specific number of procedures be done as a minimum standard for ensuring competence in various medical procedures. These minimum standards were determined by consensus of an expert panel and may not reflect actual procedural comfort or competence.


OBJECTIVE
To estimate the minimum number of selected procedures at which a majority of internal medicine trainees become comfortable performing that procedure.


METHODS
Cross-sectional, self-administered survey.


METHODS
A military-based, a community-based, and 2 university-based programs.


METHODS
Two hundred thirty-two internal medicine residents.


METHODS
Survey questions included number of specific procedures performed, comfort level with performing specific procedures, and whether respondents desired further training in specific procedures. The comfort threshold for a given procedure was defined as the number of procedures at which two thirds or more of the respondents reported being comfortable or very comfortable performing that procedure.


RESULTS
For three of seven procedures selected, residents were comfortable performing the procedure at or below the number recommended by the ABIM as a minimum requirement. However, residents needed more procedures than recommended by the ABIM to feel comfortable with central venous line placement, knee joint aspiration, lumbar puncture, and thoracentesis. Using multivariate logistic regression analysis, variables independently associated with greater comfort performing selected procedures included increased number performed, more years of training, male gender, career goals, and for skin biopsy, training in the community-based program. Except for skin biopsy, comfort level was independent of training site. A significant number of advanced-year house officers in some programs had little experience in performing selected common ambulatory procedures.


CONCLUSIONS
Minimum standards for certifying internal medicine residents may need to be reexamined in light of house officer comfort level performing selected procedures.
Hicks
C M
CM
Division of General Internal Medicine, University of Colorado Health Sciences Center, Denver, USA.
Gonzalez
R
R
Morton
M T
MT
Gibbons
R V
RV
Wigton
R S
RS
Anderson
R J
RJ
D000328:Adult; D002568:Certification / Q000592:standards; D002983:Clinical Competence; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007388:Internal Medicine / Q000193:education* / Q000592:standards; D007396:Internship and Residency; D016015:Logistic Models; D008297:Male; D013044:Specialty Boards; D011795:Surveys and Questionnaires; D014481:United States