Confidence of graduating internal medicine residents to perform ambulatoryprocedures

OBJECTIVE: To evaluate the training of graduating internal medicine residen ts to perform 13 common ambulatory procedures, 3 inpatient procedures, and 3 screening examinations. DESIGN: Self-administered descriptive survey. SETTING: Internal medicine training programs associated with 9 medical scho ols in the eastern United States. PARTICIPANTS: Graduating residents (N = 128); response rate, 60%. MEASUREMENTS AND MAIN RESULTS: The total number of procedures performed dur ing residency, importance for primary care physicians to perform these proc edures, confidence to perform these procedures, and helpfulness of rotation s for learning procedures were assessed. The majority of residents performe d only 2 of 13 outpatient procedures 10 or more times during residency: sim ple spirometry and minor wound suturing. For all other procedures, the medi an number performed was 5 or fewer. The percentage of residents attributing high importance to a procedure was significantly greater than the percenta ge reporting high confidence for 8 of 13 ambulatory procedures; for all inp atient procedures, residents reported significantly higher confidence than importance. Continuity clinic and block ambulatory rotations were not consi dered helpful for learning ambulatory procedures. CONCLUSIONS: Though residents in this sample considered most ambulatory pro cedures important for primary care physicians, they performed them infreque ntly, if at all, during residency and did not consider their continuity cli nic experience helpful for learning these skills. Training programs need to address this deficiency by modifying the curriculum to ensure that these s kills are taught to residents who anticipate a career in primary care medic ine.