ABSTRACT #12

Development Of A Dedicated Procedural Curriculum For Internal Medicine Residents

Sidra Salman, James Salonia

PURPOSE AND GOALS: Procedural proficiency is integral to internal medicine residency training, and greatly impacts patient care, correlating with the rate of hospital-acquired infections and patient outcomes. We postulate that the lack of dedicated procedural training causes a deficiency in comfortability and procedure certification rates amongst graduating cohorts. We developed a longitudinal procedure curriculum for internal medicine residents at the Mount Sinai Morning-West residency program, with the following objectives: familiarization with equipment, acquisition of required knowledge and procedural skills, and integration of skills through simulation and direct patient procedures.

METHODS: The initial step in the curriculum was the development of a website to serve as a foundation of procedural knowledge; a resource residents can utilize for continued education. It includes modules for each core procedure: nasogastric/orogastric tube placement, arterial puncture, sterile approach, ultrasoundguided peripheral IV, central and arterial line placement, paracentesis, thoracentesis, and lumbar puncture. Each module contains a checklist of equipment available at our hospital, and pertinent information including: indications, contraindications, complications, instructional steps, and videos. For integration and application of knowledge, residents are offered a 2 week elective for hands-on practice through simulation or direct patient procedures.

EVALUATION PLAN: A pre and post-survey assessment was utilized to assess for deficiencies in procedural training, and measure the change in comfortability, certification rates, and procedural knowledge before and after implementation of the curriculum.

SUMMARY OF RESULTS: Although the project is currently ongoing, 18 residents have completed the survey thus far: 72% PGY2s, 16% PGY1s, and 11% PGY3s. 89% of residents felt there was a deficiency in procedural training, primarily due to a lack of opportunities to perform them (72%), and lack of training and knowledge about the procedure (17%). The majority of residents felt comfortable with and were certified in naso/orogastric tube placement, arterial puncture, and ultrasound guided IV placement. Residents felt most uncomfortable performing, and were less frequently certified in: central line, arterial line, paracentesis, thoracentesis, and lumbar punctures. The surveys showed a significant deficiency in pertinent procedural knowledge, including: sterile approach, assessing safe procedure sites, and identifying important anatomy.

REFLECTIVE CRITIQUE: Among internal medicine residents, there is a significant deficiency in comfortability, certification rates, and knowledge base of core procedures, highlighting a need for dedicated procedural training. We have developed a longitudinal procedural curriculum which includes a website and procedural elective. As more residents complete the training program, we hope to measure the change in certification rates and assess which learning strategies provided were most effective in improving proficiency.