HealthNovember 18, 2022

Residency onboarding: Be sure your students are on the same page

One of the most important aspects of residency is learning, performing, and perfecting medical procedures. However, residents graduate from many different types of medical schools, bringing certain strengths and weaknesses that reflect the biases in their training to their residencies.

It’s a challenge to know their level of preparation, as well as their learning styles. But there are resources to help residency program directors (PDs), assistant program directors (APDs), and faculty determine the readiness of their residents to undertake patient procedures — and to assist the residents in acquiring the necessary skills to complete them successfully.

Resident assessment presents obstacles

Internal medicine (IM) residency PDs have limited and often subjective information about the residents seeking to join their programs. Yes, they can look at each candidate’s medical school curriculum and performance. They also have P.R.I.M.E. evaluations. But Dr. Amy Eddy, internal medicine residency program director at Spokane Teaching Health Center, says it’s tough to find objective data in sifting through all the applications.

“Medical students show a variety of preparation when they come to us. We’re trying to determine if each student is at a reporting versus an interpreter versus a manager stage. You always wonder if you’re receiving a true representation of the applicant. COVID made clinical experiences more variable for medical students, so it’s even harder to know what each medical school curriculum included, as well as the school’s expectations. Plus, virtual interviewing has made it more difficult to get a feel for each person and the person to get a feel for our program.”

The National Residency Matching Program® (NRMP®) reports that the 2022 Main Residency Match was the largest in its 70-year history, with 39,205 positions offered and 36,943 positions filled. There’s a lot of room for variability among a cohort of that size!

Numerous procedures required for internal medicine residents

According to the American College of Physicians, resident trainees must be able to competently and safely perform the following medical procedures:

  • Advanced cardiac life support
  • Arterial and venous blood sampling
  • Pap smear and endocervical culture
  • Placement of a peripheral venous line

Internal medicine (IM) residents must also understand and be able to explain additional procedures:

  • Abdominal paracentesis
  • Arterial and central venous line placement
  • Arthrocentesis
  • Electrocardiography
  • Incision and drainage of an abscess
  • Lumbar puncture
  • Nasogastric intubation
  • Pulmonary artery catheter placement
  • Thoracentesis

But the types and numbers of procedures that IM residents perform vary from hospital to hospital. Dr. Eddy emphasizes that her residents are very procedure-oriented:

Our residents love to do procedures, as they feel like they’re learning skills and becoming better doctors. We have no fellows in the hospital, so part of our culture is that our residents do the procedures. Many have done a hundred central lines when they graduate. We also have a faculty member who teaches an amazing point-of-care ultrasound (POCUS) program, and we also have an POCUS elective.
Dr. Amy Eddy, Internal Medicine Residency Program Director at Spokane Teaching Health Center

Dr. Eddy admits that it’s surprising that some institutions consider it sufficient to read about a procedure and pass a test. Residents need only exposure to the procedure but don’t have to demonstrate competence in it.

Hospitals and health systems must also consider the safety factor. Incorrectly executed procedures can lead to unintended hospitalizations, healthcare-acquired infections (HAIs), and even patient deaths. While institutions recognize this and file safety reports if there are errors, it’s always preferable to maintain high-quality patient safety standards by ensuring that procedures are learned and performed correctly.

Be creative with initiatives, resources to aid in learning procedures

Since virtual interviews are continuing for this year’s new residents, PDs must find new ways to determine levels of medical school preparation as well as instructional methods to help them attain a standard proficiency in completing procedures. Dr. Eddy likes a strategy her institution is trying with its new residents:

“In an effort to better understand levels of development, this year’s incoming interns completed individualized learning plans in collaboration with their medical school advisor, indicating where they felt more or less prepared. We passed that information along to their residency advisors.”

Using evidence-based simulations in medical residency

To equip residents for hands-on patient care, Dr. Eddy recommends using simulations for procedures — “The first time an intern does a procedure should not be on a real person” — and sharing procedures, with a resident starting the procedure, then supervising the intern who completes it.

It’s more important than ever to have standardized teaching materials available to residents and to the faculty. When it comes to didactic education on performing procedures, Dr. Eddy notes that non-in-person resources are still “very scattered.” Yes, it may be easy for an intern or resident to find a YouTube video on how to place a central line. But do they notice the source of the video or know the competency of the person performing it? Is that video demonstrating best practices?

Your internal medicine residency program needs consistent, evidence-based, step-by-step guidance in teaching medical procedures. Dr. Eddy is excited about the increasing availability of professionally developed videos, like Lippincott Medical Procedures, that give residents a standard foundation for learning and perfecting patient procedures. These videos can be built into a program’s instructional schedule, viewed independently by the residents, or a combination of the two.

Preparing resident students for practice

Take a look at your internal medicine residency program and how it prepares your interns and residents. Is there consistency in how they’re learning the fundamentals, like patient procedures? Do they feel confident and empowered as they develop their patient care practice? Do your residents and faculty have the right educational resources to mitigate risk, reduce variability of care, and maintain compliance?

It’s time to move beyond the “see one, do one, teach one” methodology of medical procedure instruction so all residents in your program learn, perform, and master procedures at the same level of competency.

Introducing Lippincott® Medical Procedures
Lippincott Medical procedures is a comprehensive resident and trainee solution with easy-to-access skill-building and multimedia modules on how to perform core procedures safely and with confidence.
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