title: Beyond the comfort zone: residents assess their comfort performing inpatient medical procedures.
abstract: 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.
authors.affiliation: Department of Medicine, Beth Israel Deaconess Medical Center, and Harvard Medical School, Boston, Mass 02215, USA. ghuang@bidmc.harvard.edu
authors.forename: Grace C
authors.initials: GC
authors.lastname: Huang
authors.forename: C Christopher
authors.initials: CC
authors.lastname: Smith
authors.forename: Craig E
authors.initials: CE
authors.lastname: Gordon
authors.forename: David J
authors.initials: DJ
authors.lastname: Feller-Kopman
authors.forename: Roger B
authors.initials: RB
authors.lastname: Davis
authors.forename: Russell S
authors.initials: RS
authors.lastname: Phillips
authors.forename: Saul N
authors.initials: SN
authors.lastname: Weingart
mesh_terms: 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