Background: Procedures, both inpatient and outpatient, are an essential part of the training for family medicine residents. Several residency programs struggle to provide the minimum number of procedures for residents to develop competency and comfort with the said procedures. Hospitalists do offer increased experience with procedures, although more recently, hospitalists are also referring most procedures to surgery, radiology, anesthesia, neurology or other specialists. Most graduates do not perform procedures in their practice owing to lack of adequate training during residency.
Purpose: Our goal was to increase the number of inpatient procedures performed by the residents during their training.
Description: We designed a process where our hospitalist teams (four non-teaching teams in our hospital system) can consult our family medicine resident service for any inpatient procedure. Our team was mostly consulted for paracentesis, thoracentesis and lumbar puncture; and less commonly, for central line placement and arterial line placement. Our residents underwent training in a procedure simulation lab at the beginning of every month. Our family medicine hospitalists led this training. Then, residents under the direct supervision of the family medicine hospitalist performed all the procedures for the consults received that month.Our inpatient procedure numbers have increased from two procedures a month to at least two procedures a week (an increase of 300%). Given the number of procedures that we are performing, all of our residents could easily get the minimum number of procedures to establish competency as outlined by the CAFM (Council of Academic Family Medicine). Our residents feel more confident to perform inpatient procedures and feel that they are more likely to continue to perform these procedures in their practice.
Conclusions: We have to be innovative in finding opportunities to improve the inpatient procedural training for residents. This practice innovation allows primary care residency programs functioning in a large hospital setting to meet the requirements for their resident procedural competencies.