Confidence of graduating internal medicine residents to perform ambulatory procedures

Abstract

OBJECTIVE:To evaluate the training of graduating internal medicine residents to perform 13 common ambulatory procedures, 3 inpatient procedures, and 3 screening examinations. DESIGN: Self-administered descriptive survey. SETTING:Internal medicine training programs associated with 9 medical schools in the eastern United States. ( N ϭ 128); response rate, 60%. PARTICIPANTS: Graduating residents MEASUREMENTS AND MAIN RESULTS:The total number of procedures performed during residency, importance for primary care physicians to perform these procedures, confidence to perform these procedures, and helpfulness of rotations for learning procedures were assessed. The majority of residents performed only 2 of 13 outpatient procedures 10 or more times during residency: simple spirometry and minor wound suturing. For all other procedures, the median number performed was 5 or fewer. The percentage of residents attributing high importance to a procedure was significantly greater than the percentage reporting high confidence for 8 of 13 ambulatory procedures; for all inpatient procedures, residents reported significantly higher confidence than importance. Continuity clinic and block ambulatory rotations were not considered helpful for learning ambulatory procedures. CONCLUSIONS:Though residents in this sample considered most ambulatory procedures important for primary care physicians, they performed them infrequently, if at all, during residency and did not consider their continuity clinic experience helpful for learning these skills. Training programs need to address this deficiency by modifying the curriculum to ensure that these skills are taught to residents who anticipate a career in primary care medicine.

Primary Care Resident Perceived Preparedness to Deliver Cross-cultural Care: An Examination of Training and Specialty Differences

“…First, the 60% response rate, although similar to rates from other recently published national resident surveys, [35][36][37] may limit the generalizability of findings to the larger resident physician population. Second, residents were asked to estimate quantitative values, such as the percentage of ethnic minority patients treated during residency, without verification through more objective measurement, such as chart review.…”

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

“…Even prior to this decision, the number and variety of procedures performed by internists already appeared to be decreasing, and many internal medicine residents were graduating without demonstrating competency in performing bedside procedures. 1,2,18,19 The ABIM's decision likely deprioritized obtaining proficiency in performing procedures even further, such that now only the most motivated residents seek to master this skill. Indeed, the fact that residents deferred half of all bedside procedures performed during weekdaysincluding many performed in the ICU (the traditional venue for mastering procedural skills)-to the MPS suggests that learning to perform these procedures may not be a top priority for housestaff, who undoubtedly have multiple competing demands on their time.…”

Use of an open access spirometry service by general practitioners

“…A similar failure to make optimal use of spirometry has been noted in other countries [10]. One problem is that trainees report a lack of confidence in their ability to interpret results [11].…”