An intervention to improve procedure education for internal medicine residents.
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).


METHODS
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.


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.
Lenhard
Amanda
A
Department of Medicine, Case Western Reserve University at MetroHealth Medical Center, Cleveland, OH, USA.
Moallem
Moayyed
M
Marrie
Ruth Ann
RA
Becker
Jeffrey
J
Garland
Allan
A
D000328:Adult; D002983:Clinical Competence; D003625:Data Collection; D004503:Education, Medical, Graduate / Q000379:methods*; D004521:Educational Measurement; D005260:Female; D006784:Hospitals, Teaching; D006801:Humans; D007388:Internal Medicine / Q000193:education* / Q000379:methods; D007396:Internship and Residency / Q000379:methods*; D007588:Job Satisfaction; D008297:Male; D020380:Needs Assessment; D011336:Probability; D011795:Surveys and Questionnaires; D014481:United States; D019037:Urban Health Services