Who Wants to Do Internal Medicine Procedures? A Cross-Sectional Survey

Introduction

Training in invasive bedside procedures has long been considered a cornerstone of Internal Medicine training. However, the number of procedures performed by internal medicine residents across the United States is declining and few Internists will regularly perform these procedures after training.¹ Upon graduation from residency, a significant proportion of residents feel anxious, lack proficiency, and seek additional training in their procedural skills.² The challenges and consequences of inadequate training during residency extend into early career faculty who are required to supervise residents performing the same procedures in which they lack procedural expertise.³

However, there is debate regarding the overall necessity of training all residents to achieve competence in all invasive bedside procedures. The American Board of Internal Medicine (ABIM) advocates that residents must have the opportunity, not a requirement, to develop competence in procedures that will further their development as fellows or independent practitioners.⁴ Identifying and describing the characteristics of internal medicine residents who are highly interested in performing procedures are important prerequisites in achieving ABIM guidelines to provide procedural opportunities for interested residents. In order to address this first step, we sought to describe the current self-reported interest level in procedural training and identify factors associated with high procedural interest among internal medicine residents at a single large tertiary academic medical center.

Methods

Internal medicine residents were invited to complete an anonymous online survey in July 2017 prior to the launch of a Medical Procedure Service (MPS) at Vanderbilt University Medical Center (VUMC), a large quaternary academic hospital in Nashville, Tennessee. In the survey, potential responses for initial interest level included: 1) Very interested 2) Interested 3) Somewhat interested 4) Not very interested or 5) Not interested at all. Residents categorized as having “high” procedural interest were defined as those who marked “very interested” on the survey questionnaire. All other responses were categorized as a “lower” group. Statistical analyses were performed using SAS 9.4. Statistical significance was assessed using an alpha level of 0.05. Descriptive statistics were reported to include frequencies and percentages for categorical variables. Continuous variables were reported as means with standard deviations (SD) or medians with interquartile ranges (IQR), depending upon variable central tendency. To examine differences between groups (high interest v. lower) for demographic or procedure-related variables, chi-square or t-tests were used. The non-parametric Fisher’s Exact or Wilcoxon Rank Sum tests were used if the assumptions to the chi-square or t-tests were violated—VUMC Institutional Review Board deemed the study exempt.

Results

Of 155 residents, 92 (59.4%) completed the survey—the average age was 28.6 years, with nearly 40% first-year residents and 60% male residents, and sixty-six (72.5%) residents had high interest in performing procedures (see table). Residents with high interest performed more procedures under supervision than lower residents (p=0.03). Those interested in cardiology and pulmonology as intended subspecialties tended to have high interest in procedures. Age, gender, postgraduate year, and total number of procedures performed without supervision or observed procedures were not predictive of procedural interest.