Creation of an innovative inpatient medical procedure service and a method to evaluate house staff competency.
BACKGROUND
Training residents in medical procedures is an area of growing interest. Studies demonstrate that internal medicine residents are inadequately trained to perform common medical procedures, and program directors report residents do not master these essential skills. The American Board of Internal Medicine requires substantiation of competence in procedure skills for all internal medicine residents; however, for most procedures, standards of competence do not exist.


OBJECTIVE
1) Create a new and standardized approach to teaching, performing, and evaluating inpatient medical procedures; 2) Determine the number of procedures required until trainees develop competence, by assessing both clinical knowledge and psychomotor skills; 3) Improve patient safety.


METHODS
A Medical Procedure Service (MPS), consisting of select faculty who are experts at common inpatient procedures, was established to supervise residents performing medical procedures. Faculty monitor residents' psychomotor performance, while clinical knowledge is taught through a complementary, comprehensive curriculum. After the completion of each procedure, the trainee and supervising faculty member independently complete online questionnaires.


RESULTS
During this pilot program, 246 procedures were supervised, with a pooled major complication rate of 3.7%. 123 thoracenteses were supervised, with a pneumothorax rate of 3.3%; this compares favorably with a pooled analysis of the literature. 87% of surveyed house staff felt the procedure service helped in their education of medical procedures.


CONCLUSIONS
The "see one, do one, teach one" model of procedure education is dangerously inadequate. Through the development of a Medical Procedure Service, and an associated procedure curriculum and a mechanism of evaluation, we hope to reduce the rate of complications and errors related to medical procedures and to determine at what point competency is achieved for these procedures.
Smith
C Christopher
CC
Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA 02215, USA. csmith2@bidmc.harvard.edu
Gordon
Craig E
CE
Feller-Kopman
David
D
Huang
Grace C
GC
Weingart
Saul N
SN
Davis
Roger B
RB
Ernst
Armin
A
Aronson
Mark D
MD
D001900:Boston; D002983:Clinical Competence / Q000592:standards*; D003479:Curriculum; D004521:Educational Measurement / Q000379:methods*; D006801:Humans; D007297:Inpatients; D007388:Internal Medicine / Q000379:methods*; D008505:Medical Staff, Hospital / Q000193:education*; D019152:Paracentesis; D011597:Psychomotor Performance