Gorgone Matthew, McNichols Brian, Lang Valerie J, Novak William, O'Connor Alec B
J Grad Med Educ. 2018 Oct;10(5):583-586. doi: 10.4300/JGME-D-18-00399.1.
Training residents to become competent in common bedside procedures can be challenging. Some hospitals have attending physician-led procedure teams with oversight of all procedures to improve procedural training, but these teams require significant resources to establish and maintain.
We sought to improve resident procedural training by implementing a resident-run procedure team without routine attending involvement.
We created the role of a resident procedure coordinator (RPC). Interested residents on less time-intensive rotations voluntarily served as RPC. Medical providers in the hospital contacted the RPC through a designated pager when a bedside procedure was needed. A structured credentialing process, using direct observation and a procedure-specific checklist, was developed to determine residents' competence for completing procedures independently. Checklists were developed by the residency program and approved by institutional subspecialists. The service was implemented in June 2016 at an 850-bed academic medical center with 70 internal medicine and 32 medicine-pediatrics residents. The procedure service functioned without routine attending involvement. The impact was evaluated through resident procedure logs and surveys of residents and attending physicians.
Compared with preimplementation procedure logs, there were substantial increases postimplementation in resident-performed procedures and the number of residents credentialed in paracenteses, thoracenteses, and lumbar punctures. Fifty-nine of 102 (58%) residents responded to the survey, with 42 (71%) reporting the initiative increased their ability to obtain procedural experience. Thirty-one of 36 (86%) attending respondents reported preferentially using the service.
The RPC model increased resident procedural training opportunities using a structured sign-off process and an operationalized service.
培训住院医师熟练掌握常见的床边操作具有挑战性。一些医院设有由主治医师领导的操作团队，对所有操作进行监督以改善操作培训，但这些团队的建立和维持需要大量资源。
我们试图通过建立一个由住院医师管理且无常规主治医师参与的操作团队来改善住院医师的操作培训。
我们设立了住院医师操作协调员（RPC）这一角色。对操作时间要求较低的感兴趣的住院医师自愿担任RPC。当需要进行床边操作时，医院的医疗人员通过指定的传呼机联系RPC。制定了一个结构化的资格认证流程，通过直接观察和特定操作清单来确定住院医师独立完成操作的能力。清单由住院医师培训项目制定并经机构专科医生批准。该服务于2016年6月在一家拥有850张床位的学术医疗中心实施，该中心有70名内科住院医师和32名内科 - 儿科住院医师。该操作服务在无常规主治医师参与的情况下运行。通过住院医师操作记录以及对住院医师和主治医师的调查来评估其影响。
与实施前的操作记录相比，实施后住院医师执行的操作以及在腹腔穿刺术、胸腔穿刺术和腰椎穿刺术方面获得资格认证的住院医师数量大幅增加。102名住院医师中有59名（58%）回复了调查，其中42名（71%）报告该举措提高了他们获得操作经验的能力。36名主治医师受访者中有31名（86%）报告优先使用该服务。
RPC模式通过结构化的签字批准流程和可操作的服务增加了住院医师的操作培训机会。
