Who Oversees Internal Medicine House Staff Procedures? Hospitalist Inexperience and Discomfort with Procedure Supervision in an Academic Medical Center

1UCSF Medical Center, San Francisco, CA
2UCSF Medical Center, San Francisco, CA

Meeting: Hospital Medicine 2010, April 8-11, Washington, D.C.

Abstract number: 135

Background:

Despite the removal of most internal medicine (IM) residency procedure requirements, residents at all levels continue to perform bedside procedures. Hospitalists may find themselves responsible for oversight of inpatient procedures performed by their residents. Little is known about hospitalist experience and maintenance of procedure skills in this role. Our goal was to determine academic hospitalist self‐reported procedure experience and comfort in the supervision of invasive bedside procedures and to identify who residents report as their supervisors for procedures.

Methods:

A crass‐sectional, 10‐question e‐mail survey was distributed to 30 academic hospitalists at our institution who rotate on the general medicine wards asking questions about frequency of performing and supervising procedures and comfort with these procedures on a 4‐point Likert scale. A cross‐sectional email survey was also distributed to 167 IM residents at our institution asking who their supervisors are for procedures. Procedures evaluated included: central lines, thoracentesJs, paracentesis, lumbar puncture, arthrocentesis, and ultrasound for bedside procedures.

Results:

The response rate was 18 academic hospitalists (60%) and 99 medicine residenIs (63%). The majority of hospitalists reported no direct supervision of house staff performing procedures, and the majority also feel uncomfortable performing central lines, thoracentesis, and ultrasound guidance for procedures (see Table 1). More than half of hospitalists had not personally performed central lines, thoracentesis, paracentesis, lumbar puncture or ultrasound guidance for a procedure in the last 2 years. Most residents had performed fewer than 5 of each procedure at the end of the PGY‐1 year but had performed at least 10 of nearly every procedure by the end of their R3 year. Only 8 residents (8%) reported receiving attending supervision for any procedures compared to 98 (97%) who reported peer supervision. A significant number of residents (40%) reported supervising a procedure prior to feeling comfortable with the procedure themselves.

Conclusions:

Despite changes in residency procedure requirements, residents continue to face situations in which they perform bedside invasive procedures, most often with peer supervision. Although they are considered responsible for the supervision of their house staff in the care of medical patients, hospita list faculty at our academic institution do not often perform procedures themselves, and many feel uncomfortable supervising house staff for procedures. Given the apparent limitations of hospitalists to safely supervise procedures, solutions such as formal procedure curricula, simulation, and dedicated faculty for procedure supervision may help to ensure improved procedure education and supervision in the academic hospital.

Author Disclosure:

D. Sliwka, none; M. Mourad, none.

To cite this abstract:

Sliwka D, Mourad M. Who Oversees Internal Medicine House Staff Procedures? Hospitalist Inexperience and Discomfort with Procedure Supervision in an Academic Medical Center. Abstract published at Hospital Medicine 2010, April 8-11, Washington, D.C. Abstract 135. Journal of Hospital Medicine. 2010; 5 (suppl 1). https://www.shmabstracts.com/abstract/who-oversees-internal-medicine-house-staff-procedures-hospitalist-inexperience-and-discomfort-with-procedure-supervision-in-an-academic-medical-center/. Accessed May 23, 2019.

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