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Procedural experience and comfort level in internal medicine trainees

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Abstract

BACKGROUND: The American Board of Internal Medicine (ABIM) has recommended a specific number of procedures be done as a minimum standard for ensuring competence in various medical procedures. These minimum standards were determined by consensus of an expert panel and may not reflect actual procedural comfort or competence.

OBJECTIVE: To estimate the minimum number of selected procedures at which a majority of internal medicine trainees become comfortable performing that procedure.

DESIGN: Cross-sectional, self-administered survey.

SETTING: A military-based, a community-based, and 2 university-based programs.

PARTICIPANTS: Two hundred thirty-two internal medicine residents.

MEASUREMENTS: Survey questions included number of specific procedures performed, comfort level with performing specific procedures, and whether respondents desired further training in specific procedures. The comfort threshold for a given procedure was defined as the number of procedures at which two thirds or more of the respondents reported being comfortable or very comfortable performing that procedure.

RESULTS: For three of seven procedures selected, residents were comfortable performing the procedure at or below the number recommended by the ABIM as a minimum requirement. However, residents needed more procedures than recommended by the ABIM to feel comfortable with central venous line placement, knee joint aspiration, lumbar puncture, and thoracentesis. Using multivariate logistic regression analysis, variables independently associated with greater comfort performing selected procedures included increased number performed, more years of training, male gender, career goals, and for skin biopsy, training in the community-based program. Except for skin biopsy, comfort level was independent of training site. A significant number of advanced-year house officers in some programs had little experience in performing selected common ambulatory procedures.

CONCLUSION: Minimum standards for certifying internal medicine residents may need to be reexamined in light of house officer comfort level performing selected procedures.

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Author information

Authors and Affiliations

  1. the Division of General Internal Medicine, University of Colorado Health Sciences Center, Denver, Colo

    Christopher M. Hicks MD, Ralph Gonzales MD &  Robert J. Anderson MD

  2. Department of Internal Medicine, Exempla St. Joseph’s Hospital, Denver, Colo

    Michael T. Morton MD

  3. Department of Medicine, Madigan Army Medical Center, Tacoma, Wash

    Robert V. Gibbons MD

  4. Section of General Internal Medicine, University of Nebraska Medical Center, Omaha, Neb

    Robert S. Wigton MD

Authors
  1. Christopher M. Hicks MD
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  2. Ralph Gonzales MD
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  3. Michael T. Morton MD
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  4. Robert V. Gibbons MD
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  5. Robert S. Wigton MD
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  6. Robert J. Anderson MD
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Corresponding author

Correspondence to Robert J. Anderson MD.

Additional information

Dr. Ralph Gonzales is supported in part by a Robert Wood Johnson Minority Medical Faculty Development grant (#2532434).

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Hicks, C.M., Gonzales, R., Morton, M.T. et al. Procedural experience and comfort level in internal medicine trainees. J GEN INTERN MED 15, 716–722 (2000). https://doi.org/10.1046/j.1525-1497.2000.91104.x

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  • DOI: https://doi.org/10.1046/j.1525-1497.2000.91104.x

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