Training future hospitalists with simulators: A needed step toward accessible, expertly performed bedside procedures

Lucas, Brian; Asbury, J; Franco‐Sadud, Ricardo

doi:10.1002/jhm.602

Cited by 11 publications

(12 citation statements)

References 15 publications

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“…While simulation can improve procedural skills, such curricula are designed to supplement-not replace-hands-on training. [20][21][22][23] The implication is that the percentage of practicing internal medicine physicians who are not proficient at performing or supervising bedside procedures is likely to increase. Hence, the demand for specialized procedure services will likely expand in the future as hospitals struggle to ensure that procedures can still be performed 24 h per day.…”

Section: Discussionmentioning

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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Section: Discussionmentioning

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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“…In July 2007, the ABIM repealed the numeric procedural requirements for many of these procedures, instead requiring residents only to be able to ‘recognize indications, contraindications and manage complications’ of selected bedside procedures ( 10 ). In addition, duty hour restrictions, availability of other specialties such as interventional radiology ( 11 ), and lack of motivation may all play a part in the overall decline of procedural certification in residents. Research has demonstrated the positive impact of a specialized medical procedure service (MPS) in the training of procedural skills to internal medicine residents.…”

mentioning

confidence: 99%

Potential impact of a bedside procedure service on training procedurally competent hospitalists in a community-based residency program

Montuno

Hunt

Lee

2016

Journal of Community Hospital Internal Medicine Perspectives

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BackgroundThe Society of Hospital Medicine has delineated procedures as one of the core competencies for hospitalists. Little is known about whether exposure to a medical procedure service (MPS) impacts the procedural certification rate in internal medicine trainees in a community hospital training program.ObjectiveTo determine whether or not exposure to an MPS would impact both the number of procedures performed and the rate of resultant certifications in a community hospital internal medicine training program.DesignRetrospective review.MethodsFive cohorts of resident physicians and their procedure data were analyzed comparing months where residents were unexposed to the intervention (pre-MPS) to months where residents were exposed to the intervention (post-MPS). We calculated the average number of procedures performed per month for pre- versus post-MPS periods. For procedural certification, we compared two proportions: the number of certifications over the number of 6-month pre-MPS periods and the number of certifications over the number of 6-month post-MPS periods.Setting/subjectsThe study was conducted at a community-based academic medical center. Subjects included all internal medicine residents.ResultsWe found a statistically significant difference between the groups, with pre-MPS groups performing 4.3 procedures per month compared with post-MPS groups performing 6.7 procedures per month (p=0.0010). For certification rates, we found statistically significant differences in several categories – overall, paracentesis, femoral central lines, and jugular central lines.ConclusionsThis study demonstrated that resident exposure to an MPS statistically significantly increased the total number of procedures performed. This study also showed that overall certification rates were statistically significantly different between the pre- and post-MPS groups for several procedures.

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“…Simulators allow the assurance of safe manual skills, including proper needle insertion techniques and disposal of sharp objects. 3,79 If simulators are not available, however, then patient-based training and assessments can still be performed under direct observation. Safe performance of ultrasound-guided procedures during patient-based assessments (without preceding simulator-based assessments) is sufficient to certify manual competence.…”

Section: Initial Certification Assessments Should Ideally Begin On Simentioning

confidence: 99%

Credentialing of Hospitalists in Ultrasound‐Guided Bedside Procedures: A Position Statement of the Society of Hospital Medicine

Lucas

Tierney

Jensen

et al. 2018

Journal of Hospital Medicine

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Ultrasound guidance is used increasingly to perform the following 6 bedside procedures that are core competencies of hospitalists: abdominal paracentesis, arterial catheter placement, arthrocentesis, central venous catheter placement, lumbar puncture, and thoracentesis. Yet most hospitalists have not been certified to perform these procedures, whether using ultrasound guidance or not, by specialty boards or other institutions extramural to their own hospitals. Instead, hospital privileging committees often ask hospitalist group leaders to make ad hoc intramural certification assessments as part of credentialing. Given variation in training and experience, such assessments are not straightforward "sign offs." We thus convened a panel of experts to conduct a systematic review to provide recommendations for credentialing hospitalist physicians in ultrasound guidance of these 6 bedside procedures. Pathways for initial and ongoing credentialing are proposed. A guiding principle of both is that certification assessments for basic competence are best made through direct observation of performance on actual patients.

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Training future hospitalists with simulators: A needed step toward accessible, expertly performed bedside procedures

Cited by 11 publications

References 15 publications

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

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

Potential impact of a bedside procedure service on training procedurally competent hospitalists in a community-based residency program

Credentialing of Hospitalists in Ultrasound‐Guided Bedside Procedures: A Position Statement of the Society of Hospital Medicine

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