The Procedure Coordinator: A Resident-Driven Initiative to Increase Opportunity for Inpatient Procedures

Abstract

Background Training residents to become competent in common bedside procedures can be challenging. Some hospitals have attending physician-led procedure teams with oversight of all procedures to improve procedural training, but these teams require significant resources to establish and maintain. Objective We sought to improve resident procedural training by implementing a resident-run procedure team without routine attending involvement. Methods We created the role of a resident procedure coordinator (RPC). Interested residents on less time-intensive rotations voluntarily served as RPC. Medical providers in the hospital contacted the RPC through a designated pager when a bedside procedure was needed. A structured credentialing process, using direct observation and a procedure-specific checklist, was developed to determine residents' competence for completing procedures independently. Checklists were developed by the residency program and approved by institutional subspecialists. The service was implemented in June 2016 at an 850-bed academic medical center with 70 internal medicine and 32 medicine-pediatrics residents. The procedure service functioned without routine attending involvement. The impact was evaluated through resident procedure logs and surveys of residents and attending physicians. Results Compared with preimplementation procedure logs, there were substantial increases postimplementation in residentperformed procedures and the number of residents credentialed in paracenteses, thoracenteses, and lumbar punctures. Fifty-nine of 102 (58%) residents responded to the survey, with 42 (71%) reporting the initiative increased their ability to obtain procedural experience. Thirty-one of 36 (86%) attending respondents reported preferentially using the service. Conclusions The RPC model increased resident procedural training opportunities using a structured sign-off process and an operationalized service.

Characteristics and impact of bedside procedure services in the United States: A systematic review

“…No head‐to‐head data exist comparing complication rates of supervised versus unsupervised bedside procedures. However, in the study by Gorgone et al, 25 which involved mostly unsupervised procedures performed by residents (Model A), there were five instances of complications requiring transfer to a higher level of care 25 . Four of these, including one instance of arterial injury resulting from an attempted CVC placement, occurred when residents performed the procedure without supervision.…”

“… 6,13–16,18–20,22,25–28 There was one randomized controlled trial (RCT) 16 . The rest were observational studies, eight of them involving prospective data collection 6,14,18,22,25–28 . In general, the quality of the included studies was judged to be poor or fair (see Supporting Information).…”

“…“Core” procedures offered by all services that reported these data included paracentesis, thoracentesis, and lumbar puncture (Table 2). Of the 10 services that reported, seven (70%) also offered central venous catheter (CVC) placement 13,15,20,22,25–27 …”

“…16 The rest were observational studies, eight of them involving prospective data collection. 6,14,18,22,[25][26][27][28] In general, the quality of the included studies was judged to be poor or fair (see Supporting Information). There was excellent interobserver agreement on study quality, as indicated by a kappa score of 0.89.…”

Radiology Performed Fluoroscopy-Guided Lumbar Punctures Decrease Volume of Diagnostic Study Interpretation – Impact on Resident Training and Potential Solutions

“…In fact, the need to better prepare residents to perform bedside procedures is recognized by internal medicine training programs and solutions such as attending and resident run procedure teams have been established. [ 16 , 17 ] Simulation-based bedside LP training models have also been shown to increase procedural success in a prior study. [ 18 ] LP training simulators typically cost $2000–$2700 and are relatively inexpensive compared to their potential cost saving benefits.…”