Advancing Internal Medicine Training: Experience of a Bedside Procedure Service as a Resident Elective

Abstract

Background

In 2007, the American Board of Internal Medicine eliminated numeric procedure requirements for licensing. The level of exposure to procedures during residency, and subsequent competence of graduating residents, is variable. In 2015, our institution developed a bedside procedure service (BPS) with the intent to teach ultrasound guidance and procedural training to internal medicine residents with direct supervision of technique by Hospital Medicine faculty to optimize learning, increase confidence, and improve patient safety.

Objective

In this study, we review the number and complication rates of resident procedures on a dedicated internal medicine bedside procedure service (BPS) as a resident elective.

Methods

In this retrospective, observational, single-center study, we reviewed internally collected data from BPS procedures performed from 2015–2019. The BPS offers a variety of procedures done with ultrasound guidance at an adult tertiary care referral center. BPS services are available to all inpatient hospital services. A rotation with the BPS was offered as a stand-alone resident elective for the first time in 2015.

Results

69 residents performed a total of 2700 ultrasound-guided/assisted procedures and 146 diagnostic ultrasound scans from 2015–2019. Residents performed an average of 40 procedures during their elective month. There were 5 resident performed procedural complications with an overall complication rate of 0.19%.

Conclusions

Our BPS increased procedural opportunities for residents and allowed for real-time feedback by an experienced faculty member in a one-on-one setting. A dedicated rotation allows the time to focus on becoming proficient in invasive procedures with expert supervision.

Keywords:

• Procedures
• ultrasound
• residency

Ethic Approval and Consent to Participate

Institutional review board (IRB) approval of this study was granted by the Medical College of Wisconsin/Froedtert Hospital Institutional Review Board #5 on 11/3/2020 (#PRO00039269). All methods were carried out in accordance with relevant institutional guidelines and regulations. Informed consent was waived by the IRB for this study due to its retrospective nature.

Disclosure Statement

The authors have no conflicts of interest relevant to this article to disclose.

Funding

The author(s) reported there is no funding associated with the work featured in this article.

Data Availability Statement

The datasets generated and/or analyzed during this study are not publicly available due to the inability to fully de-identify the data such that protection of patient information can be assured. It is a requirement of the institution that this data be kept only on a secure server within the internal system of the institution. Aspects of the dataset could be made available from the corresponding author on reasonable request if adequate de-identification is possible.