Journal of General Internal Medicine

, Volume 15, Issue 6, pp 361–365 | Cite as

Confidence of graduating internal medicine residents to perform ambulatory procedures

  • Glenda C. Wickstrom
  • Maria M. Kolar
  • Thomas C. Keyserling
  • David K. Kelley
  • Sharon X. Xie
  • Bryan A. Bognar
  • Carmen L. Lewis
  • Connie T. DuPre
Original Articles

Abstract

OBJECTIVE: To evaluate the training of graduating internal medicine residents to perform 13 common ambulatory procedures, 3 inpatient procedures, and 3 screening examinations.

DESIGN: Self-administered descriptive survey.

SETTING: Internal medicine training programs associated with 9 medical schools in the eastern United States.

PARTICIPANTS: Graduating residents (N=128); response rate, 60%.

MEASUREMENTS AND MAIN RESULTS: The total number of procedures performed during residency, importance for primary care physicians to perform these procedures, confidence to perform these procedures, and helpfulness of rotations for learning procedures were assessed. The majority of residents performed only 2 of 13 outpatient procedures 10 or more times during residency; simple spirometry and minor wound suturing. For all other procedures, the median number performed was 5 or fewer. The percentage of residents attributing high importance to a procedure was significantly greater than the percentage reporting high confidence for 8 of 13 ambulatory procedures; for all inpatient procedures, residents reported significantly higher confidence than importance. Continuity clinic and block ambulatory rotations were not considered helpful for learning ambulatory procedures.

CONCLUSIONS: Though residents in this sample considered most ambulatory procedures important for primary care physicians, they performed them infrequently, if at all, during residency and did not consider their continuity clinic experience helpful for learning these skills. Training programs need to address this deficiency by modifying the curriculum to ensure that these skills are taught to residents who anticipate a career in primary care medicine.

Key words

residents confidence training ambulatory procedures 

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References

  1. 1.
    American College of Physicians Task Force on Physician Supply. The role of the future general internist defined. Ann Intern Med. 1994;121(8):616–22.Google Scholar
  2. 2.
    Byyny RL. Challenges in the education of the general internist. Arch Intern Med. 1988;148:369–72.PubMedCrossRefGoogle Scholar
  3. 3.
    Schroeder S, Showstack J, Gerbert B. Residency training in internal medicine: time for a change? Ann Intern Med. 1986;104:554–61.PubMedGoogle Scholar
  4. 4.
    Wigton RS. Training internists in procedural skills. Ann Intern Med. 1992;116(12 pt 2):1091–3.PubMedGoogle Scholar
  5. 5.
    American Medical Association. Graduate Medical Education Directory. Chicago, Ill: AMA; 1994–1995.Google Scholar
  6. 6.
    American Medical Association. Graduate Medical Education Directory. Chicago, Ill: AMA; 1998–1999.Google Scholar
  7. 7.
    Burke W, Baron RB, Lemon M, Losh D, Novack A. Training generalist physicians: structural elements of the curriculum. J Gen Intern Med. 1994;9(suppl 1):S23-S30.PubMedCrossRefGoogle Scholar
  8. 8.
    Cohen JJ. Roles of various organizations in internal medicine curriculum reform. Ann Intern Med. 1992;116(12 pt 2):1111–5.PubMedGoogle Scholar
  9. 9.
    Federated Council of Internal Medicine Task Force. Philadelphia, PA: American College of Physicians; Graduate Education in Internal Medicine—A Resource Document. Philadelphia, PA: American College of Physicians; 1996.Google Scholar
  10. 10.
    Reuben DB, McCue JD, Gerbert B. The residency-practice training mismatch—a primary care education dilemma. Arch Intern Med. 1988;148:914–9.PubMedCrossRefGoogle Scholar
  11. 11.
    Wigton RS, Blank LL, Nicolas JA, Tape T. Procedural skills training in internal medicine residencies. a survey of program directors. Ann Intern Med. 1989;111:932–8.PubMedGoogle Scholar
  12. 12.
    Wigton RS, Nicolas JA, Blank LL. Procedural skills of the general internist—a survey of 2500 physicians. Ann Intern Med. 1989;111(12):1023–34.PubMedGoogle Scholar
  13. 13.
    Mandel JH, Rich EC, Luxenberg MG, Spilane MT, Kern DC, Parrino TA. Preparation for practice in internal medicine—a study of ten years of residency graduates. Arch Intern Med. 1988;148:853–6.PubMedCrossRefGoogle Scholar
  14. 14.
    Wigton RS, Steinmann WC. Procedural skills training in the internal medicine residency. J Med Educ. 1984;59:392–400.PubMedGoogle Scholar
  15. 15.
    Wigton RS. A method for selecting which procedural skills should be learned by internal medicine residents. J Med Educ. 1981;56:512–7.PubMedGoogle Scholar
  16. 16.
    American Board of Internal Medicine. Policies and Procedures for Certification. Philadelphia, PA: American Board of Internal Medicine; 1995.Google Scholar
  17. 17.
    Association of American Medical Colleges. Summary of key findings from the Internal Medicine Residency Training Survey. Washington, DC: Association of American Medical Colleges; 1996–1997.Google Scholar
  18. 18.
    Ende J, Davidoff F. What is a curriculum? Ann Intern Med. 1992;116(12, pt 2):1055–7.PubMedGoogle Scholar
  19. 19.
    Halperin A, Kaufman A. Ambulatory medical education: a reconsideration of sites and teachers. J Gen Intern Med. 1990;5(suppl):S35-S44.PubMedCrossRefGoogle Scholar
  20. 20.
    Wickstrom GC, Kelley DK, Keyserling TC, et al. Confidence of academic general internists and family physicians to teach ambulatory procedures. J Gen Intern Med. 2000;15:353–360.PubMedCrossRefGoogle Scholar
  21. 21.
    Corrigan JM, Thompson LM. Involvement of health maintenance organizations in graduate medical education. Acad Med. 1991;66(11):656–61.PubMedCrossRefGoogle Scholar
  22. 22.
    American College of Physicians. Learning from Practitioners: Office-Based Teaching of Internal Medicine Residents. Philadelphia, PA: American College of Physicians; 1995.Google Scholar
  23. 23.
    American Board of Internal Medicine. Policies and Procedures for Certification. Philadelphia, PA: American Board of Internal Medicine; 1997.Google Scholar
  24. 24.
    Gabryel TF, Brierley MA, Izzo JF Jr. How completely internal medicine residents at a New York state teaching hospital met the expectations of credentialing protocol. Acad Med. 1991;66(10):613–5.PubMedCrossRefGoogle Scholar

Copyright information

© Society of General Internal Medicine 2000

Authors and Affiliations

  • Glenda C. Wickstrom
    • 1
  • Maria M. Kolar
    • 2
  • Thomas C. Keyserling
    • 3
  • David K. Kelley
    • 4
  • Sharon X. Xie
    • 5
  • Bryan A. Bognar
    • 6
  • Carmen L. Lewis
    • 7
  • Connie T. DuPre
    • 8
  1. 1.the Department of MedicineSumma Health System/Northeastern Ohio Universities College of MedicineAkron
  2. 2.Section of Internal MedicineWest Virginia University School of MedicineMorgantown
  3. 3.Department of MedicineUniversity of North Carolina at Chapel Hill School of MedicineChaapel Hill
  4. 4.Department of MedicinePennsylvania State University School of MedicineHershey
  5. 5.Department of Health Evaluation SciencesPennsylvania State UniversityHershey
  6. 6.Department of Internal MedicineUniversity of South Florida School of MedicineTampa
  7. 7.Department of MedicineUniversity of Virginia School of MedicineRichmond
  8. 8.Section of General MedicineMedical College of GeorgiaAugusta

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