title: Supervising the supervisors--procedural training and supervision in internal medicine residency.
abstract: BACKGROUND
  At teaching hospitals, bedside procedures (paracentesis, thoracentesis, lumbar puncture, arthrocentesis and central venous catheter insertion) are performed by junior residents and supervised by senior peers. Residents' perceptions about supervision or how often peer supervision produces unsafe clinical situations are unknown.
  
  
  OBJECTIVE
  To examine the experience and practice patterns of residents performing bedside procedures.
  
  
  METHODS
  Cross-sectional e-mail survey of 653 internal medicine (IM) residents at seven California teaching hospitals.
  
  
  METHODS
  Surveys asked questions in three areas: (1) resident experience performing procedures: numbers of procedures performed and whether they received other (e.g., simulator) training; (2) resident comfort performing and supervising procedures; (3) resident reports of their current level of supervision doing procedures, experience with complications as well as perceptions of factors that may have contributed to complications.
  
  
  RESULTS
  Three hundred sixty-seven (56%) of the residents responded. Most PGY1 residents had performed fewer than five of any of the procedures, but most PGY-3 residents had performed at least ten by the end of their training. Resident comfort for each procedure increased with the number of procedures performed (p < 0.001). Although residents reported that peer supervision happened often, they also reported high rates of supervising a procedure before feeling comfortable with proper technique. The majority of residents (64%) reported at least one complication and did not feel supervision would have prevented complications, even though many reported complications represented technique- or preparation-related problems.
  
  
  CONCLUSIONS
  Residents report low levels of comfort and experience with procedures, and frequently report supervising prior to feeling comfortable. Our findings suggest a need to examine best practices for procedural supervision of trainees.
authors.affiliation: Department of Medicine, Division of Hospital Medicine, University of California San Francisco, San Francisco, CA 94143, USA. Michelle.Mourad@ucsf.edu
authors.forename: Michelle
authors.initials: M
authors.lastname: Mourad
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Kohlwes
authors.forename: Judith
authors.initials: J
authors.lastname: Maselli
authors.forename: Andrew D
authors.initials: AD
authors.lastname: Auerbach
mesh_terms: D002140:California; D002405:Catheterization, Central Venous; D016001:Confidence Intervals; D003430:Cross-Sectional Studies; D003479:Curriculum; D004503:Education, Medical, Graduate / Q000379:methods / Q000706:statistics & numerical data*; D005180:Faculty, Medical / Q000706:statistics & numerical data*; D005260:Female; D019538:Health Care Surveys; D006784:Hospitals, Teaching / Q000706:statistics & numerical data*; D006801:Humans; D007388:Internal Medicine / Q000706:statistics & numerical data*; D007396:Internship and Residency / Q000706:statistics & numerical data*; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D016017:Odds Ratio; D019152:Paracentesis; D010865:Pilot Projects; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D015397:Program Evaluation