Clinical research studyAJM OnlineBeyond the Comfort Zone: Residents Assess Their Comfort Performing Inpatient Medical Procedures
Section snippets
Study Site
We studied inpatient medical procedures performed by internal medicine residents at a 556-bed tertiary care Boston teaching hospital. The internal medicine training program in 2003 and 2004 included 63 postgraduate year 1 (PGY1) residents (16 in a 1-year preliminary program), and 46 postgraduate year 2 (PGY2) and 46 postgraduate year 3 (PGY3) categorical residents. Residents completed required and elective rotations in general medicine, cardiology, oncology, emergency medicine, intensive care,
Resident Characteristics
A total of 106 (68%) of 157 residents logged procedures during the academic year (Table 1). Fifty-five residents (52%) were PGY1, 53 (50%) were female, and 94 (89%) were enrolled in the 3-year categorical program. Fourteen residents (13%) performed the index procedure for the first time, and 56 (53%) had performed the procedure 1 to 5 times previously.
Patient Characteristics
Patients had a mean age of 62.7 years (range 21-95 years). More than 50% were male, and 69% were white. Medicare (48%) was the principal insurer,
Discussion
We studied 527 procedures performed by 106 internal medicine residents at a Boston teaching hospital and found that more than half of resident physicians were uncomfortable performing at least 1 aspect of 4 common bedside procedures. First-year residents and those with the least prior experience most often said that they lacked comfort. Lack of comfort was also strongly associated with lack of supervision. In contrast, supervision by medical procedure service physicians doubled the odds that
Acknowledgments
The authors acknowledge Dr. Brett Kalmowitz for his assistance creating the procedure log and Dr. Mitchell Rabkin for reviewing a draft of this article.
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This study was supported in whole by grants from the Risk Management Foundation of the Harvard Medical Institutions and the Stoneman Center for Quality Improvement in General Medicine and Primary Care. Funding supported collection, management, analysis, interpretation of data, and preparation of the article. Dr. Weingart was supported in part by a K08 clinical scientist career development award from the US Agency for Healthcare Research and Quality.