Asking for help: internal medicine residents' use of a medical procedure service.
BACKGROUND
Little is known about the professional help-seeking behavior of residents as they perform procedures in the hospital.


OBJECTIVE
To determine when residents seek formal supervision to perform inpatient medical procedures.


METHODS
We conducted a prospective cohort study of resident physicians' use of formal supervision through a medical procedure service (MPS) for placing central venous catheters (CVCs) and performing thoracenteses. We compared resident, procedure, and patient characteristics among MPS and non-MPS procedures. We performed bivariable and multivariable analyses to examine factors associated with use of the MPS. We also performed a subgroup analysis of non-MPS procedures to assess the influence of resident, procedure, and patient characteristics on the choice of informal supervision.


METHODS
Boston teaching hospital.


METHODS
Sixty-nine internal medicine residents.


METHODS
Use of an elective MPS for formal faculty supervision.


RESULTS
Among 191 procedures performed, 79 (41%) used the MPS. Residents were more likely to seek faculty supervision via the MPS among patients with 3 or more comorbidities (odds ratio [OR], 2.1; 95% confidence interval [CI], 1.2-3.5). They were less likely to seek MPS supervision when procedures were performed urgently or emergently (OR, 0.4; 95% CI, 0.2-0.8). There were few differences in the characteristics of unsupervised and informally supervised procedures.


CONCLUSIONS
Resident physicians appear to seek formal assistance appropriately for procedures they perform on sicker patients. Additional research is needed to understand whether overconfidence or poor access to attending physicians is responsible for their failure to seek consultation with urgent and emergent cases.
Huang
Grace C
GC
Division of Primary Care and General Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA. ghuang@bidmc.harvard.edu
Smith
C Christopher
CC
York
Meghan
M
Weingart
Saul N
SN
D000368:Aged; D002405:Catheterization, Central Venous / Q000592:standards*; D002983:Clinical Competence; D004503:Education, Medical, Graduate / Q000379:methods*; D005260:Female; D006801:Humans; D007388:Internal Medicine / Q000193:education*; D007396:Internship and Residency; D016015:Logistic Models; D008297:Male; D008611:Mentors; D019152:Paracentesis / Q000592:standards*; D011446:Prospective Studies