title: Procedural Experience and Confidence Among Graduating Medical Students.
abstract: OBJECTIVE
  Bedside procedures are a vital component of patient care-particularly for surgeons. Anecdotal evidence and previous studies from individual institutions reveal a lack of exposure to these interventions in medical school. Our objective was to ascertain medical students' experience and confidence in performing bedside procedures.
  
  
  METHODS
  Our study included a multi-institutional, anonymous, Health Insurance Portability and Accountability Act-compliant electronic survey. Using a 4-point Likert scale, students were asked how many times they had performed each of 18 common bedside procedures and their anticipated confidence in completing it independently. Statistical analysis included student t test, Chi-square test, analysis of means, linear regression, and Bonferroni correction for multiple comparisons.
  
  
  METHODS
  In total, participants included 2260 4th year medical students at 17 allopathic medical schools.
  
  
  RESULTS
  Overall, 644 students replied (28.5% response rate). Most respondents had never placed an arterial line (71%), central venous line (81%), chest tube (89%), intraosseous line (95%), injected a joint (63%), or had performed cardiopulmonary resuscitation (50%), a lumbar puncture (57%), paracentesis (66%), or thoracentesis (92%). Venipuncture, suturing, and Foley catheter placement were the only procedures which greater than 50% of students had performed more than 5 times. Significant correlation was observed (r = 0.7) between experience and confidence, with men being reported significantly higher experience and confidence than women (p < 0.0001). Students entering anesthesia and emergency medicine residencies reported significantly higher experience than those matriculating into other specialties (α = 0.003); students entering emergency medicine and surgery reported significantly higher confidence levels (α = 0.003).
  
  
  CONCLUSIONS
  The largest survey of its kind, the present study demonstrates that medical students are underexposed to essential bedside procedures and feel uncomfortable performing them-a trend that has worsened over 25 years. Students entering surgical specialties have significantly higher levels of confidence, although a corresponding difference in experience was not observed.
authors.affiliation: Department of Surgery, Duke University School of Medicine, Durham, North Carolina.
authors.forename: Justin
authors.initials: J
authors.lastname: Barr
authors.affiliation: Department of Neurologic Surgery, Mayo Clinic School of Graduate Medical Education, Rochester, Minnesota. Electronic address: Graffeo.Christopher@Mayo.edu.
authors.forename: Christopher S
authors.initials: CS
authors.lastname: Graffeo
mesh_terms: D000328:Adult; D002983:Clinical Competence; D004504:Education, Medical, Undergraduate; D005260:Female; D013502:General Surgery / Q000193:education*; D006801:Humans; D008297:Male; D020377:Self Efficacy; D013337:Students, Medical / Q000523:psychology*; D011795:Surveys and Questionnaires; D014481:United States
keywords: Medical Knowledge; Patient Care; Practice-Based Learning and Improvement; Professionalism; bedside procedures; clinical skills assessment; clinical training; medical education; simulation