Educational Impact of a Teaching Procedure Service Versus Standard Procedural Training on Internal Medicine Interns

Background:

Academic medical centers face new challenges in providing access to safe and efficient inpatient procedures while balancing house staff autonomy and education. Internal medicine residents at many medical centers perform invasive bedside procedures without a standardized approach to training, supervision, or assessment. We sought to evaluate the impact of a 2‐week hospilalist procedure service (HPS) rotation on interns' self‐perceived procedure ability and knowledge as compared with the standard curriculum.

Methods:

We randomly selected 16 of the 57 internal medicine interns in our program to participate in a 2‐week procedure service rotation. The rotation included didactic lectures, required reading, instructional videos, step‐by‐step instruction, and performance of paracentesis, thoracentesis, and lumbar puncture, directly supervised by a trained attending hospitalist. All interns in the program were surveyed at the beginning and the end of the academic year to evaluate self‐reported knowledge and ability to (1) independently perform specific bedside procedures; (2) supervise others in conducting procedures; and (3) use bedside ultrasounds for procedures, comparing interns who completed the rotation versus those who did not.

Results:

Ninety‐four percent of HPS interns and 71% of controls completed both surveys. Baseline knowledge and experience was not significantly different between the intervention and the control group. Over the course of the year, interns rotating on the HPS performed significantly higher numbers of paracentesis (9 vs. 4; P < 0.001), thoraoentesis (6 vs. 2; P < 0.001), and lumbar puncture (4 vs. 3; P < 0.001) than did their non‐HPS peers Interns who completed the rotation were more likely to rate their ability to perform all of the assessed procedures as “high to very high” (P < 0.05 for all procedures), as well as the ability to supervise others and use ultrasounds to perform bedside procedures (P < 0.05 for all procedures and for ultrasound use). For central lines, a procedure not performed or taught by the HPS, there were no significant differences in intern self‐rated ability to perform or supervise between the 2 groups. HPS interns were more likely to rate self‐perceived knowledge as very good or excellent in all surveyed aspects of procedure performance, including indications and contraindications, landmarks, procedure‐specific US use, evidence‐based procedure technique, troubleshooting, and management of complications (P < 0.05 for all).

Conclusions:

A 2‐week hospitalist‐supervised procedure service rotation substantially improved residents' experience, self‐perceived ability, and knowledge in performing invasive bedside procedures. These benefits persisted to at least the end of the academic year. Standardized procedure service rotations are a viable solution for residency programs looking to improve the quantity and quality of procedure‐based education.

Author Disclosure:

M. Mourad, none; D. Sliwka, none.