Beyond the comfort zone: residents assess their comfort performing inpatient medical procedures.
OBJECTIVE
Resident physicians learn to perform inpatient bedside procedures in a manner that is neither standardized nor rigorous. As a result, residents may be unskilled and uncomfortable performing procedures. This study characterizes residents' comfort performing medical procedures and identifies factors associated with lack of comfort.


METHODS
Study subjects were internal medicine resident physicians who performed one of four medical procedures (central line, lumbar puncture, paracentesis, or thoracentesis) on adult medical inpatients between July 1, 2003, and June 30, 2004.


METHODS
This prospective cohort study was conducted at a 556-bed Boston teaching hospital. Resident physicians evaluated their comfort with 9 aspects of 4 medical procedures, recording this information in an electronic log. We also abstracted operator characteristics and patient demographic data. We analyzed residents' comfort with each aspect of the procedure and defined "overall comfort" as comfort with each of the 9 aspects.


RESULTS
A majority of resident physicians reported lack of comfort with at least one aspect of the procedure. Residents reported lack of comfort with 37% of unsupervised procedures. They also reported lack of comfort with the prospect of managing complications in 35% of procedures. In the multivariable analysis, overall comfort was associated with the use of a dedicated medical procedure service (odds ratio [OR] 1.9, 95% confidence interval [CI] 1.1-3.4) and inversely associated with postgraduate year 1 status (OR 0.3, CI 0.1-0.5), first time performing the procedure (OR 0.4, CI 0.2-0.8), thoracenteses (OR 0.4, CI 0.2-0.8), and emergent procedures (OR 0.6, CI 0.3-1.0).


CONCLUSIONS
Many resident physicians are uncomfortable performing common bedside procedures. Experience and supervision mitigate some, but not all, discomfort.
Huang
Grace C
GC
Department of Medicine, Beth Israel Deaconess Medical Center, and Harvard Medical School, Boston, Mass 02215, USA. ghuang@bidmc.harvard.edu
Smith
C Christopher
CC
Gordon
Craig E
CE
Feller-Kopman
David J
DJ
Davis
Roger B
RB
Phillips
Russell S
RS
Weingart
Saul N
SN
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002405:Catheterization, Central Venous / Q000009:adverse effects; D002983:Clinical Competence; D005260:Female; D006784:Hospitals, Teaching; D006801:Humans; D007388:Internal Medicine / Q000193:education*; D007396:Internship and Residency; D008297:Male; D019300:Medical Errors; D008875:Middle Aged; D019152:Paracentesis / Q000009:adverse effects; D013129:Spinal Puncture / Q000009:adverse effects