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Development of a Chief Resident Medical Procedure Service: a 10-Year Experience.

Nathanson R, Baher H, Phillips J, Freeman M, Sehgal R, O'Rorke J, Soni NJ. Development of a Chief Resident Medical Procedure Service: a 10-Year Experience. Journal of general internal medicine. 2023 Oct 1; 38(13):3077-3081.

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Abstract:

BACKGROUND: Lack of experienced faculty to supervise internal medicine (IM) residents is a significant barrier to establishing a medical procedure service (MPS). AIM: Describe the development and 10-year outcomes of an MPS led by IM chief residents. SETTING: University-based IM residency program affiliated with a county and Veterans Affairs hospital. PARTICIPANTS: Categorical IM interns (n = 320) and 4-year IM chief residents (n = 48) from 2011 to 2022. PROGRAM DESCRIPTION: The MPS operated on weekdays, 8 am-5 pm. After training and sign-off by the MPS director, chief residents trained and supervised interns in ultrasound-guided procedures during a 4-week rotation. PROGRAM EVALUATION: From 2011 to 2022, our MPS received 5967 consults and 4465 (75%) procedures were attempted. Overall procedure success, complication, and major complication rates were 94%, 2.6%, and 0.6%, respectively. Success and complication rates for paracentesis (n = 2285) were 99% and 1.1%, respectively; 99% and 4.2% for thoracentesis (n = 1167); 76% and 4.5% for lumbar puncture (n = 883); 83% and 1.2% for knee arthrocentesis (n = 85); and 76% and 0% for central venous catheterization (n = 45). The rotation was rated 4.6 out of 5 for overall learning quality. DISCUSSION: A chief resident-led MPS is a practical and safe approach for IM residency programs to establish an MPS when experienced attending physicians are unavailable.




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