Beyond the Comfort Zone: Residents Assess Their Comfort Performing Inpatient Medical Procedures

Huang, Grace C.; Smith, Christopher C.; Gordon, Craig E.; Feller‐Kopman, David; Davis, Roger B.; Phillips, Russell S.; Weingart, Saul N.

doi:10.1016/j.amjmed.2005.08.007

Cited by 119 publications

(146 citation statements)

References 11 publications

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“…Similar to those at other teaching hospitals, our residents informally acquire the skills to perform these procedures while assisting and being assisted by more experienced senior residents in a "see one, do one, teach one" apprenticeship model of learning. 4 To improve the training and performance of these bedside procedures, the Department of Medicine piloted a bedside procedure service to teach procedural skills and assist residents during these procedures. Use of the service, though voluntary, was actively encouraged at residents' monthly orientation meetings and regular conferences.…”

Section: Design and Settingmentioning

confidence: 99%

See 1 more Smart Citation

Impact of a bedside procedure service on general medicine inpatients: A firm‐based trial

Lucas

Asbury

Wang

et al. 2007

Journal of Hospital Medicine

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Section: Design and Settingmentioning

confidence: 99%

“…1,2 Unfortunately, many future inpatient physicians may lack the training 3 and confidence 4 to correct this problem. One proposed model for improving the teaching, performance, and evaluation of bedside procedures is a procedure service that is staffed by faculty who are experts at inpatient procedures.…”

mentioning

confidence: 99%

Impact of a bedside procedure service on general medicine inpatients: A firm‐based trial

Lucas

Asbury

Wang

et al. 2007

Journal of Hospital Medicine

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“…One intervention is the formation of medical procedure services (MPS), which provide formal procedural supervision by skilled attendings for trainees performing bedside procedures. [5][6][7][8] While medical procedure services improve resident comfort performing bedside procedures, 5,9,10 it remains unknown whether such services decrease risk of complications or improve procedural training opportunities.…”

Section: Introductionmentioning

confidence: 99%

The Impact of a Medical Procedure Service on Patient Safety, Procedure Quality and Resident Training Opportunities

Tukey

Wiener

2013

J GEN INTERN MED

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BACKGROUND: At some academic hospitals, medical procedure services are being developed to provide supervision for residents performing bedside procedures in hopes of improving patient safety and resident education. There is limited knowledge of the impact of such services on procedural complication rates and resident procedural training opportunities. OBJECTIVE: To determine the impact of a medical procedure service (MPS) on patient safety and resident procedural training opportunities. DESIGN: Retrospective cohort analysis comparing characteristics and outcomes of procedures performed by the MPS versus the primary medical service. PARTICIPANTS: Consecutive adults admitted to internal medicine services at a large academic hospital who underwent a bedside medical procedure (central venous catheterization, thoracentesis, paracentesis, lumbar puncture) between 1 July 2010 and 31 December 2011. MAIN MEASURES: The primary outcome was a composite rate of major complications. Secondary outcomes included resident participation in bedside procedures and use of "best practice" safety process measures. KEY RESULTS: We evaluated 1,707 bedside procedures (548 by the MPS, 1,159 by the primary services). There were no differences in the composite rate of major complications (1.6 % vs. 1.9 %, p=0.71) or resident participation in bedside procedures (57.0 % vs. 54.3 %, p=0.31) between the MPS and the primary services. Procedures performed by the MPS were more likely to be successfully completed (95.8 % vs. 92.8 %, p=0.02) and to use best practice safety process measures, including use of ultrasound guidance when appropriate (96.8 % vs. 90.0 %, p=0.0004), avoidance of femoral venous catheterization (89.5 vs. 82.7 %, p=0.02) and involvement of attending physicians (99.3 % vs. 57.0 %, p<0.0001). CONCLUSIONS: Although use of a MPS did not significantly affect the rate of major complications or resident opportunities for training in bedside procedures, it was associated with increased use of best practice safety process measures.KEY WORDS: bedside procedures; medical education; medical procedure services.

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“…Education in CVC insertion is needed because many internal medicine residents are uncomfortable performing this procedure. 2 CVC insertion also carries the risk of potentially life-threatening complications including infection, pneumothorax, arterial puncture, deep vein thrombosis, and bleeding. Education and training may also contribute to improved patient care because increased physician experience with CVC insertion reduces complication risk.…”

mentioning

confidence: 99%

Use of simulation‐based mastery learning to improve the quality of central venous catheter placement in a medical intensive care unit

McGaghie

Cohen

Balachandran

et al. 2009

Journal of Hospital Medicine

351

272

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Disclosure: The authors have no financial or other potential conflicts of interest.BACKGROUND: Central venous catheter (CVC) insertions are performed frequently by internal medicine residents.Complications, including arterial puncture and pneumothorax, decrease when operators use fewer needle passes to insert the CVC. In this study, we evaluated the effect of simulation-based mastery learning on CVC insertion skill. DESIGN:This was a cohort study of internal jugular (IJ) and subclavian (SC) CVC insertions by 41 internal medicine residents rotating through the medical intensive care unit (MICU) over a five-month period. Thirteen traditionallytrained residents were surveyed about the number of needle passes, complications, and procedural self-confidence on CVCs inserted in the MICU. Concurrently, 28 residents completed simulation-based training in IJ and SC CVC insertions. Simulator-trained residents were expected to perform CVC insertions to mastery standards on a central line simulator. Simulator-trained residents then rotated through the MICU and were surveyed regarding CVC placement. The impact of simulation training was assessed by comparing group survey results. Central venous catheter (CVC) insertions are commonly performed at the bedside in medical intensive care unit (MICU) settings. Internal medicine residents are required to demonstrate knowledge regarding CVC indications, complications, and sterile technique, 1 and often perform the procedure during training. Education in CVC insertion is needed because many internal medicine residents are uncomfortable performing this procedure. 2 CVC insertion also carries the risk of potentially life-threatening complications including infection, pneumothorax, arterial puncture, deep vein thrombosis, and bleeding. Education and training may also contribute to improved patient care because increased physician experience with CVC insertion reduces complication risk. 3,4 Similarly, a higher number of needle passes or attempts during CVC insertion correlates with mechanical complications such as pneumothorax or arterial punctures. 4-8 Pneumothorax rates for internal jugular (IJ) CVCs have been reported to range from 0% to 0.2% and for subclavian (SC) CVCs from 1.5% to 3.1%. 4,5 The arterial puncture rate for IJ CVCs ranges from 5.0% to 9.4% and for SC CVCs from 3.1% to 4.9%. 4,5 Proper use of ultrasound to assist with IJ CVC insertion has been shown to decrease these mechanical complications. 4,5 However, studies of ultrasound use with SC CVC insertion have mixed results. 4 Simulation-based training has been used in medical education to increase knowledge, provide opportunities for deliberate and safe practice, and shape the development of RESULTS: Journal of Hospital Medicine Vol 4 No 7 September 2009 397clinical skills. 9,10 We previously used simulation-based mastery learning to improve the thoracentesis and advanced cardiac life support (ACLS) skills of internal medicine residents. 11,12 Although a few small studies have linked simulation-based interventions to imp...

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Beyond the Comfort Zone: Residents Assess Their Comfort Performing Inpatient Medical Procedures

Cited by 119 publications

References 11 publications

Impact of a bedside procedure service on general medicine inpatients: A firm‐based trial

Impact of a bedside procedure service on general medicine inpatients: A firm‐based trial

The Impact of a Medical Procedure Service on Patient Safety, Procedure Quality and Resident Training Opportunities

Use of simulation‐based mastery learning to improve the quality of central venous catheter placement in a medical intensive care unit

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