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Outpatient Procedure Competency of Internal Medicine-Pediatrics Residents at Graduation

David C. Kaelber, Gretchen Caspary, Thomas Melgar, Brian D. Kan, John K. Chamberlain.. Internal Medicine & Pediatrics, Case Western Reserve Univ, Cleveland, OH; Dept of Research, Amer Academy of Pediatrics, Elk Grove, IL; Internal Medicine & Pediatrics, Michigan State Univ Kalamazoo Ctr for Medical Studies, Kalamazoo, MI; Internal Medicine & Pediatrics, Cedars Sinai Medical Center, Los Angeles, CA; Internal Medicine & Pediatrics, Univ of Rochester, Rochester, NY.

Background: Combined internal medicine and pediatric (Med-Peds) residents are expected to be competent in a number of outpatient procedures upon graduation.

Objective: To assess the training and comfort level for typical outpatient procedures among graduating Med-Peds residents, and determine where programs might improve their training.

Design/Methods: As part of the annual AAP Graduating Med-Peds Resident Survey, all residents graduating between 2003 and 2005 (615/1117 responded) were asked about their training in outpatient procedures. In 2005, graduating residents were also asked about their training and self-perceived competency for 34 specific outpatient procedures.

Results: Residents were much more likely to report "too little" training for outpatient procedures (73%) compared to (30%) inpatient procedures (p<.001). The responses regarding the training and experience questions: 1) received formal training, 2) successfully completed the procedure at least once, and 3) were comfortable performing the procedure unsupervised, respectively, for the six RRC-required procedures, were high: lumbar puncture (96%, 99%, 99%), paracentesis (93%, 98%, 88%), thoracentesis (91%, 95%, 71%), arthrocentesis & joint injection (85%, 92%, 66%), venipuncture (83%, 97%, 94%), and bladder catheterization (77%, 90%, 86%). However, the vast majority of residents wished for more training in several non-RRC required procedures, especially carpal tunnel injection (74%), shoulder reduction (73%), removal of conjunctival foreign body (72%), DeQuervain's injection (72%), trigger point injection (71%), skin biopsy (69%), and Morton's neuroma injection (67%).

Conclusions: Three-quarters of Med-Peds residents report dissatisfaction with the amount of training they receive in outpatient procedures. While residents are exposed well to RRC-required procedures, residents desire training in other procedures. Residency programs should consider offering training to residents in some non-RRC required outpatient procedures.
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