Background: Several institutions have implemented a medical procedure service (MPS) to improve timeliness of bedside procedures and standardize performance and training of procedures by internal medicine (IM) residents (1-2). A critical barrier to starting an MPS has been a lack of experienced proceduralists (3). In 2011, our IM residency program created an MPS led by [...]

Background: Procedural complications are a common source of adverse events in hospitalized patients(1, 2). In academic centers, bedside procedures have traditionally been performed by trainees, often without experienced proceduralist supervision, or referred to interventional radiology or consultant services, often with an associated delay in procedure performance. Many trainees report discomfort with their skill in performing [...]

Background: Several institutions have implemented a medical procedure service (MPS) to improve timeliness of bedside procedures and standardize performance and training of procedures by internal medicine (IM) residents (1-2). A critical barrier to starting an MPS has been a lack of experienced proceduralists (3). In 2011, our IM residency program created an MPS led by [...]

Background: Simulation-based procedural training has been shown to improve provider competency and confidence in number of medical specialties, including hospital medicine. To the present, simulation training has largely focused on medical students and residents. Attending hospitalists are a prime target for simulation-based procedural training. Despite recent studies showing patient safety and cost-effectiveness of procedures performed [...]

Background: Internal medicine residency contains procedural training, including guidance in paracentesis, thoracentesis, lumbar puncture, arthrocentesis, and central line placement. As a result, most hospitalists are able to perform these bedside procedures. However, national trends confirm that these procedures are increasingly referred to interventional radiology, and these referrals are associated with higher direct hospital costs.1 Enhancing [...]

Background: New internal medicine interns are expected to be familiar with bedside procedures such as paracentesis. Medical students frequently have inadequate dedicated time to learn bedside procedures and are taught in a fragmented manner. As a result, new interns lack familiarity with these procedures. As such, we assessed whether a comprehensive module for paracentesis would [...]

Background: The American Board of Internal Medicine suggests residents participate in a minimum of five abdominal paracentesis (AP), central venous catheter (CVC) placements, and lumbar punctures to ensure “adequate knowledge and understanding” of procedures performed by practicing internists. Competency in these procedures is poorly defined and difficult to assess. To address the need for well-supervised, [...]

Background: Nearly half of incorrect procedures occur outside the operating room, and failure to conduct a robust time-out is a frequent root cause. Mannequin-based simulation (MBS) has been shown to improve self-confidence and performance of time-outs, but is expensive, time-consuming, and difficult to scale up effectively for large groups of medical learners. Screen-based simulation (SBS) [...]

Background: Lumbar puncture and paracentesis are core competencies in internal medicine, but residents frequently report discomfort performing these procedures unsupervised. Simulation-based training (SBT) has previously been shown to improve resident performance of lumbar punctures on patients, but outcomes after paracentesis SBT have only been assessed on simulators. We hypothesized that SBT would improve internal medicine [...]

Background: The latest guidelines on parapneumonic effusion (PPE) management1 recommend immediate evaluation of PPE with ultrasound. Recognizing that bedside procedure services (BPSs) staffed with procedural hospitalists (proceduralists) are becoming the first point of ultrasound contact for many patients admitted with PPE our study sought to demonstrate that proceduralists can reliably agree with radiologists (viewed as [...]