Teaching Internal Medicine Residents to Perform Breast and Pelvic Exams: A Simulation Curriculum Module

Abstract

Introduction Internal medicine (IM) residents must be capable of performing ambulatory procedures required of a competent internist regardless of their career plans. Unfortunately, many IM residents may feel uncomfortable in the ambulatory setting and with ambulatory procedures as the bulk of residency training focuses on inpatient experiences. Methods The session described here is a 1.5-hour case-based, interactive module for residents of all training levels centered on key ambulatory procedures, featuring experienced faculty demonstrating said procedures on a realistic, full-body manikin patient care simulator followed by direct observation of resident competence by that faculty member. Four students per group is optimal. As clinician educators serve as facilitators, faculty training is limited to a walk-through of each session. The materials associated with this publication include the session protocol, cases, direct observation procedure checklists, preparticipation surveys, and postparticipation surveys. Results From July 2014 to June 2015, 66 residents of all training levels at Northwell Health-Lenox Hill Hospital in New York City, NY, completed this session. Upon completion, participant performance of breast and pelvic exams improved at every step of each procedure. Additionally, participant comfort, confidence, and intent to perform breast and pelvic exams increased. Discussion Given the success of this session, this educational experience was expanded to include modules on other key ambulatory procedures to promote the development of independent, competent, proficient, and professional IM practitioners who provide high-quality, patient-centered care while fulfilling the program requirements set forth by the ACGME.

Considering the Effects of the Dobbs Decision on Clinical Training and Practice and on the Lives of Medical Professionals

“…38 Additionally, gynecologic skills are important in many medical fields. 39 ACGME Family Medicine residency program requirements include direct experience with gynecologic care:…”

Tracheotomy care simulation training program for inpatient providers

“… 9 , 10 , 11 Better results have been demonstrated with instructor‐guided simulation, including programs on tracheotomy care education. 12 , 13 , 14 , 15 , 16 , 17 , 18 However, because instructor‐led simulation is time intensive and incorporating high‐fidelity mannequins can be costly, generalized use of these modalities is limited. This, coupled with the relative infrequency of airway complications, may contribute to the fact that knowledge, competence, and confidence with urgent and emergent airway and tracheotomy scenarios among non‐otolaryngology providers remains poor.…”

“…However, lecture‐style learning and review of written material in isolation can carry the limitation of reduced learner engagement and retention 9–11 . Better results have been demonstrated with instructor‐guided simulation, including programs on tracheotomy care education 12–18 . However, because instructor‐led simulation is time intensive and incorporating high‐fidelity mannequins can be costly, generalized use of these modalities is limited.…”