Mourad Michelle, Ranji Sumant, Sliwka Diane
J Grad Med Educ. 2012 Jun;4(2):170-5. doi: 10.4300/JGME-D-11-00136.1.
Academic medical centers must provide safe inpatient procedures while balancing resident autonomy and education. We performed a randomized, controlled trial to evaluate the effect of a 2-week hospitalist procedure service (HPS) rotation on interns' self-perceived procedure ability, knowledge, and autonomy versus the standard curriculum.
We randomly selected 16 of 57 internal medicine interns (28%) to participate in the intervention group rotation, with 29 interns in the control group. All interns were surveyed before the start of residency and at the end of the postgraduate year-1 (PGY-1) and PGY-2 years to evaluate self-reported knowledge and ability to (1) safely perform procedures, (2) supervise procedures, and (3) use bedside ultrasound.
Ninety-four percent of HPS interns (15/16) and 71% of control interns (29/41) completed all surveys. Baseline knowledge and experience did not differ significantly between the groups. The intervention group performed significantly more paracentesis (9 versus 4; P < .001), thoracentesis (6 versus 2; P < .001), and lumbar puncture (4 versus 3; P < .001) procedures than did the control group. After their first year, residents who completed the HPS rotation rated their ability to safely perform and supervise all of the assessed procedures as higher (P < .05 for all procedures) and were more likely to rate self-perceived knowledge as very good or excellent in all surveyed aspects of procedure performance (P < .05).
A 2-week hospitalist-supervised procedure service rotation substantially improved residents' experience, confidence, and knowledge in performing bedside procedures early in their training, with this effect sustained through the PGY-2 year. Standardized procedure service rotations are a viable solution for programs seeking to improve their procedure-based education.
学术医疗中心必须在平衡住院医师自主权和教育的同时提供安全的住院手术。我们进行了一项随机对照试验，以评估为期两周的住院医师手术服务（HPS）轮转对实习生自我认知的手术能力、知识和自主权的影响，并与标准课程进行比较。
我们从57名内科实习生中随机挑选了16名（28%）参加干预组轮转，对照组有29名实习生。所有实习生在住院医师培训开始前以及研究生一年级（PGY-1）和PGY-2学年结束时接受调查，以评估自我报告的知识和能力，包括（1）安全进行手术，（2）监督手术，以及（3）使用床边超声。
94%的HPS实习生（15/16）和71%的对照组实习生（29/41）完成了所有调查。两组之间的基线知识和经验没有显著差异。干预组进行的腹腔穿刺术（9次对4次；P＜0.001）、胸腔穿刺术（6次对2次；P＜0.001）和腰椎穿刺术（4次对3次；P＜0.001）明显多于对照组。在第一年之后，完成HPS轮转的住院医师对自己安全进行和监督所有评估手术的能力评价更高（所有手术的P＜0.05），并且在手术操作的所有调查方面，他们更有可能将自我认知的知识评为非常好或优秀（P＜0.05）。
为期两周的由住院医师监督的手术服务轮转在培训早期显著提高了住院医师进行床边手术的经验、信心和知识，这种效果一直持续到PGY-2学年。标准化的手术服务轮转是寻求改进基于手术的教育项目的可行解决方案。
