The Design, Implementation and Impact of an Internal Medicine Resident Ultrasoundbased Procedure Service

Meeting: Hospital Medicine 2012, April 1-4, San Diego, Calif.

Abstract number: 97729

Background:

The American Board of Internal Medicine (ABIM) states that Internists who perform procedures must obtain the appropriate training to safely and competently perform that procedure. ABIM also recommends initial training in these procedures be simulation–based, but there is wide variability in existing curriculum from didactics to the classic “see one, do one, teach one.” Bedside ultrasonography is a burgeoning field within internal medicine residency programs as studies show improved procedure success with decreased procedure–associated complications. Despite this, no literature exists describing the implementation or impact of an internal medicine resident run ultrasound–based procedure service.

Purpose:

To design, create and implement an internal medicine rotation to teach a standardized curriculum in ABIM essential procedures using ultrasound guidance.

Description:

At our institution, prior procedure curriculum consisted of simulation–based training with procedure expertise obtained using the “see one, do one, teach one” method. This introduced significant variability in the technique, success rate and complication rate, as residents were taught by different supervisors each month. This inconsistency, along with emerging evidence in support of bedside ultrasonography, provided the impetus for the creation of an ultrasound–based procedure service. The procedure service is a one–month–long rotation during the intern year, with a team consisting of 2 interns and a chief resident. The curriculum begins with pre–testing of intern knowledge, introduction to the ultrasound, didactics on the indications, contraindications, risks, benefits of all procedures, instruction on appropriate consenting, viewing of online procedure videos, and simulation training with LP, CVC, thoracentesis, paracentesis task trainers. After this introduction, we practice visualization of normal organs, cavities and vessels on patient volunteers followed by standardized hands–on teaching of procedures. Table 1 outlines the data collected as of Dec. 1, 2011. These data show 100% success rate for thoracentesis and paracentesis. More importantly, 85 consults did not have procedures performed either because there was not enough fluid or a contraindication existed (DIC, anticoagulation prior to LP, hypotensive, severe anemia), thus preventing unnecessary and potentially harmful procedures. In order to demonstrate competency, interns must take a post–test on procedure knowledge, pass several competency checklists illustrating proficiency and safety and be deemed competent by the chief resident.

Conclusions:

The introduction of an ultrasound–based procedure rotation provides a standardized curriculum for interns with improved procedure success and a decrease in unnecessary and potentially harmful procedures.

Table 1Overview of procedure data from July 2011–November 2011. In parenthesis is the success rate of that procedure during that month. The bottom row depicts aggregate data

  Consults Received Procedures Performed US w/o enough fluid Paracentesis Thoracentesis LP Procedures not done because of safety
July 67 43 14 25 (100%) 7 (100%) 11 (91%) 3
August 73 51 12 29 (100%) 10 (100%) 5 (83%) 5
September 83 58 12 32 (100%) 10 (100%) 11 (100%) 12
October 71 43 11 26 (100%) 11 (100%) 4 (50%) 6
November 57 43 5 23 (100%) 13 (100%) 6 (100%) 5
Total 351 238 54 135 (100%) 51 (100%) 37 (86%) 31
Procedure Data from July 2011 to November 2011.

To cite this abstract:

Schmit D, Wathen P, King P, Velasquez S. The Design, Implementation and Impact of an Internal Medicine Resident Ultrasoundbased Procedure Service. Abstract published at Hospital Medicine 2012, April 1-4, San Diego, Calif. Abstract 97729. Journal of Hospital Medicine. 2012; 7 (suppl 2). https://www.shmabstracts.com/abstract/the-design-implementation-and-impact-of-an-internal-medicine-resident-ultrasoundbased-procedure-service/. Accessed May 26, 2019.

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