Procedural experience and comfort level in internal medicine trainees

BACKGROUND: The American Board of Internal Medicine (ABIM) has recommended a specific number of procedures be done as a minimum standard for ensuring competence in various medical procedures. These minimum standards were dete rmined by consensus of an expert panel and may not reflect actual procedura l comfort or competence. OBJECTIVE: To estimate the minimum number of selected procedures at which a majority of Internal medicine trainees become comfortable performing that procedure, DESIGN: Cross-sectional, self-administered survey, SETTING:A military-based, a community-based. and 2 university-based program s. PARTICIPANTS:Two hundred thirty-two internal medicine residents. MEASUREMENTS: Survey questions included number of specific procedures perfo rmed, comfort level with performing specific procedures, and whether respon dents desired further training In specific procedures. The comfort threshol d for a given procedure was defined as the number of procedures at which tw o thirds or more of the respondents reported being comfortable or very comf ortable performing that procedure. RESULTS: For three of seven procedures selected, residents were comfortable performing the procedure at or below the number recommended by the ABIM as a minimum requirement. However, residents needed more procedures than reco mmended by the ABIM to feel comfortable with central venous line placement, knee joint aspiration, lumbar puncture, and thoracentesis, Using multivari ate logistic regression analysis, variables independently associated with g reater comfort performing selected procedures included increased number per formed, more years of training, male gender, career goals, and for skin bio psy, training in the community-based program, Except for skin biopsy, comfo rt level was independent of training sits. A significant number of advanced -year house officers in some programs had little experience in performing s elected common ambulatory procedures. CONCLUSION: Minimum standards for certifying internal medicine residents ma y need to be reexamined in light of house officer comfort level performing selected procedures.