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 simulationbased, 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 procedureassociated complications. Despite this, no literature exists describing the implementation or impact of an internal medicine resident run ultrasoundbased procedure service.
To design, create and implement an internal medicine rotation to teach a standardized curriculum in ABIM essential procedures using ultrasound guidance.
At our institution, prior procedure curriculum consisted of simulationbased 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 ultrasoundbased procedure service. The procedure service is a onemonthlong rotation during the intern year, with a team consisting of 2 interns and a chief resident. The curriculum begins with pretesting 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 handson 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 posttest on procedure knowledge, pass several competency checklists illustrating proficiency and safety and be deemed competent by the chief resident.
The introduction of an ultrasoundbased 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 2011November 2011. In parenthesis is the success rate of that procedure during that month. The bottom row depicts aggregate data
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 April 4, 2020.