An intervention to improve procedure education for internal medicine residents

J Gen Intern Med. 2008 Mar;23(3):288-93. doi: 10.1007/s11606-008-0513-4. Epub 2008 Jan 23.


Background: Internists commonly perform invasive procedures, but serious deficiencies exist in procedure training during residency.

Objective: Evaluate a comprehensive, inpatient procedure service rotation (MPS) to improve Internal Medicine residents' comfort and self-perceived knowledge in performing lumbar puncture, abdominal paracentesis, thoracentesis, arthrocentesis, and central venous catheterization (CVC).

Design: The MPS comprised 1 faculty physician and 1-3 residents rotating for 2 weeks. It incorporated lectures, a textbook, instructional videos, supervised practice on mannequins, and inpatient procedures directly supervised by the faculty physician. We measured MPS impact using pre- and post-MPS rotation surveys, and surveyed all residents at academic year-end.

Measurements and main results: Thirty-nine categorical Internal Medicine residents completed the required rotation and surveys over the 2004-2005 academic year, performing 325 procedures. Post-MPS, the percentage of residents reporting comfort performing procedures rose 15-36% (p < .05 except for arthrocentesis, and CVC via internal jugular and femoral veins). The fraction desiring more training fell 26-51% (all p < .05). After the MPS rotation, self-rated knowledge increased in all surveyed aspects of the procedures. The year-end survey showed that improvements persisted. Comfort at year-end, for all procedures except abdominal paracentesis, was significantly higher among residents who rotated through the MPS than among those who had not. Self-reported compliance with recommended antiseptic measures was 75% for residents who completed the MPS, and 28% for those who had not (p < 0.001).

Conclusions: A comprehensive procedure service rotation of 2 weeks duration substantially improved residents' comfort and self-perceived knowledge in performing invasive procedures. These benefits persisted at least to the end of the academic year.

MeSH terms

  • Adult
  • Clinical Competence*
  • Data Collection
  • Education, Medical, Graduate / methods*
  • Educational Measurement
  • Female
  • Hospitals, Teaching
  • Humans
  • Internal Medicine / education*
  • Internal Medicine / methods
  • Internship and Residency / methods*
  • Job Satisfaction
  • Male
  • Needs Assessment
  • Probability
  • Surveys and Questionnaires
  • United States
  • Urban Health Services