Procedural experience and comfort level in internal medicine trainees

Christopher M. Hicks, Ralph Gonzales, Michael T. Morton, Robert V. Gibbons, Robert Swift Wigton, Robert J. Anderson

Research output: Contribution to journalArticle

60 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)716-722
Number of pages7
JournalJournal of general internal medicine
Volume15
Issue number10
DOIs
StatePublished - Jan 1 2000

Fingerprint

Internal Medicine
Mental Competency
Biopsy
Skin
Spinal Puncture
Knee Joint
Consensus

Keywords

  • ABIM
  • Procedure comfort level
  • Residents

ASJC Scopus subject areas

  • Internal Medicine

Cite this

Procedural experience and comfort level in internal medicine trainees. / Hicks, Christopher M.; Gonzales, Ralph; Morton, Michael T.; Gibbons, Robert V.; Wigton, Robert Swift; Anderson, Robert J.

In: Journal of general internal medicine, Vol. 15, No. 10, 01.01.2000, p. 716-722.

Research output: Contribution to journalArticle

Hicks, Christopher M. ; Gonzales, Ralph ; Morton, Michael T. ; Gibbons, Robert V. ; Wigton, Robert Swift ; Anderson, Robert J. / Procedural experience and comfort level in internal medicine trainees. In: Journal of general internal medicine. 2000 ; Vol. 15, No. 10. pp. 716-722.
@article{a3be18edce6a4d0e96d6e09819c8a49b,
title = "Procedural experience and comfort level in internal medicine trainees",
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.",
keywords = "ABIM, Procedure comfort level, Residents",
author = "Hicks, {Christopher M.} and Ralph Gonzales and Morton, {Michael T.} and Gibbons, {Robert V.} and Wigton, {Robert Swift} and Anderson, {Robert J.}",
year = "2000",
month = "1",
day = "1",
doi = "10.1046/j.1525-1497.2000.91104.x",
language = "English (US)",
volume = "15",
pages = "716--722",
journal = "Journal of General Internal Medicine",
issn = "0884-8734",
publisher = "Springer Nature",
number = "10",

}

TY - JOUR

T1 - Procedural experience and comfort level in internal medicine trainees

AU - Hicks, Christopher M.

AU - Gonzales, Ralph

AU - Morton, Michael T.

AU - Gibbons, Robert V.

AU - Wigton, Robert Swift

AU - Anderson, Robert J.

PY - 2000/1/1

Y1 - 2000/1/1

N2 - 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.

AB - 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.

KW - ABIM

KW - Procedure comfort level

KW - Residents

UR - http://www.scopus.com/inward/record.url?scp=0033758372&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0033758372&partnerID=8YFLogxK

U2 - 10.1046/j.1525-1497.2000.91104.x

DO - 10.1046/j.1525-1497.2000.91104.x

M3 - Article

C2 - 11089715

AN - SCOPUS:0033758372

VL - 15

SP - 716

EP - 722

JO - Journal of General Internal Medicine

JF - Journal of General Internal Medicine

SN - 0884-8734

IS - 10

ER -