Background: Internal Medicine physicians are increasingly involved in Perioperative care. Medicare claims data in colectomy & total hip arthroplasty patients shows >50% had a medicine consult (1) Surgeons, when surveyed, felt Internist’s role in preoperative risk stratification and medication management were vital (2).In one study, 82.2% of medical consultations came from surgical services commonly from orthopedics for preoperative evaluation and co-management. (3) A third of patients hospitalized surgical patients are now comanaged by medicine physicians. (4) Medical Consultations are associated with lower mortality rates, decreased time from admission to surgery (5), shorter length of stay and cost savings of $1400/admission. (6)
Purpose: The Accreditation Council for Graduate Medical Education (ACGME) & National Heart, Lung and Blood Institute (NHLBI) recognize the importance of learning perioperative medicine as a distinct skill. 7)(8). However, many Internal Medicine residents are unable to perform preoperative risk assessments, optimize surgical patients (9) A specific curriculum is not mandated, no entrustable professional activities (EPAs) or core competencies are specified by ACGME. (10). We felt that a structured dedicated perioperative educational event would help address these gaps.
Description: In our annual Citywide Perioperative Conference, we currently invite 7 programs annually consisting of about 170 residents in their 2nd year Internal Medicine programs on one Friday afternoon in Spring. Conference location is rotated amongst participating programs. The conference is organized by four hospitalists, one from each system (University Hospitals, MetroHealth, Cleveland Clinic, and UH Community Consortium)After lunch, the 4-hour session consists of 2hrs of didactics & 2hrs of case discussions in small groups led by faculty who receive printed guides to navigate. Core topics are cardiac risk stratification, Perioperative pain & medication management, evaluation of common postoperative medical issues. We are now beginning to gather post-conference feedback for continuous improvement in updated content and delivery. We have one speaker from Anesthesiology for Perioperative pain management didactics.We are convinced that we are filling knowledge gaps in Internal medicine Residency training curriculum.
Conclusions: While American College of Physicians through Annals Consult Guys and Society of Hospital Medicine through SHM Consults has online resources, we have an innovative, boots on the ground in person educational format. Enhanced Recovery After Surgery (ERAS), Multimodal Analgesia, Perioperative Brain health initiatives, Geriatric led Perioperative care teams are just some of the advances in Perioperative medicine. Our conference introduces basic foundational knowledge in perioperative medicine as a small step.We have a readily adoptable, sustainable format. We gladly welcome specific enquiries on formats, planning, logistics, timelines, for similarly interested clinician innovators who are keen on embarking on their own citywide Perioperative medicine journeys.We envision a future where in major Societies in Medicine, Surgery & Anesthesia come together in advancing a common goal of not only improving patient safety but achieving excellent functional outcomes in our patient’s perioperative journeys through educating our current trainees at the heights of their learning curves in residency.