Department of Medicine, Division of Hospital Medicine, University of California San Francisco, San Francisco, CA 94143, USA.
J Gen Intern Med. 2010 Apr;25(4):351-6. doi: 10.1007/s11606-009-1226-z.
At teaching hospitals, bedside procedures (paracentesis, thoracentesis, lumbar puncture, arthrocentesis and central venous catheter insertion) are performed by junior residents and supervised by senior peers. Residents' perceptions about supervision or how often peer supervision produces unsafe clinical situations are unknown.
To examine the experience and practice patterns of residents performing bedside procedures.
Cross-sectional e-mail survey of 653 internal medicine (IM) residents at seven California teaching hospitals.
Surveys asked questions in three areas: (1) resident experience performing procedures: numbers of procedures performed and whether they received other (e.g., simulator) training; (2) resident comfort performing and supervising procedures; (3) resident reports of their current level of supervision doing procedures, experience with complications as well as perceptions of factors that may have contributed to complications.
Three hundred sixty-seven (56%) of the residents responded. Most PGY1 residents had performed fewer than five of any of the procedures, but most PGY-3 residents had performed at least ten by the end of their training. Resident comfort for each procedure increased with the number of procedures performed (p < 0.001). Although residents reported that peer supervision happened often, they also reported high rates of supervising a procedure before feeling comfortable with proper technique. The majority of residents (64%) reported at least one complication and did not feel supervision would have prevented complications, even though many reported complications represented technique- or preparation-related problems.
Residents report low levels of comfort and experience with procedures, and frequently report supervising prior to feeling comfortable. Our findings suggest a need to examine best practices for procedural supervision of trainees.
在教学医院，床边程序（腹腔穿刺术、胸腔穿刺术、腰椎穿刺术、关节穿刺术和中心静脉导管插入术）由初级住院医师进行，并由高级同行监督。住院医师对监督的看法或同行监督多久会产生不安全的临床情况尚不清楚。
检查住院医师进行床边程序的经验和实践模式。
对加利福尼亚州 7 家教学医院的 653 名内科住院医师进行了横断面电子邮件调查。
调查询问了三个方面的问题：（1）住院医师执行程序的经验：执行的程序数量以及他们是否接受了其他（例如模拟器）培训；（2）住院医师执行和监督程序的舒适度；（3）住院医师报告他们目前执行程序的监督水平、并发症经验以及可能导致并发症的因素的看法。
367 名（56%）住院医师做出了回应。大多数 PGY1 住院医师进行的任何程序都少于五次，但大多数 PGY-3 住院医师在培训结束时至少进行了十次。每个程序的住院医师舒适度随着程序执行次数的增加而增加（p < 0.001）。尽管住院医师报告说经常进行同行监督，但他们也报告说在感到有把握掌握正确技术之前经常监督程序。大多数住院医师（64%）报告至少有一次并发症，并且不认为监督会防止并发症，尽管许多人报告并发症代表技术或准备相关问题。
住院医师报告对程序的舒适度和经验水平较低，并且经常在感到舒适之前进行监督。我们的研究结果表明，需要检查实习生程序监督的最佳实践。
