Ambulatory Training Program to Expand Procedural Skills in Primary Care. (June 2019)

• Record Type: Journal Article
• Authors: Fortuna, Robert J.; Marston, Bethany; Messing, Susan; Wagoner, Gunnar; Pulcino, Tiffany L.; Bingemann, Todd; Caiola, Enrico; Scofield, Steven; Nead, Karen; Robbins, Brett W
• Is Part Of: Journal of medical education and curricular development. Volume 6(2019)
• Publication Date: 2019-06
• Subjects: Education -- primary care -- procedures -- ambulatory -- joint injection -- ultrasound; Medical education -- Periodicals; Medicine -- Study and teaching -- Periodicals; Education, Medical; Medical education; Periodicals; Fulltext; Internet Resources; Periodicals; Periodicals; 610.71
• DOI: 10.1177/2382120519859298
• Languages: English
• ISSNs: 2382-1205

Abstract

Introduction: Outpatient procedures are an important component of primary care, yet few programs incorporate procedural training into their curriculum. We examined a 4-year procedural curriculum to improve understanding of ambulatory procedures and increase the number of procedures performed. Methods: A total of 56 resident and 8 faculty physicians participated in a procedural curriculum directed at joint injections (knee, shoulder, elbow, trochanteric bursa, carpal tunnel, wrist, and ankle), subdermal contraceptive insertion/removal, skin biopsies, and ultrasound use in primary care. We administered annual surveys and used generalized estimating equations to model changes. Results: Across the 4 years, there was an average 96% response rate. Mean comfort level with the indications for procedures increased for both resident (62.5 to 78.8; P < .0001) and faculty physicians (61.5 to 94.8; P < .0001). Similarly, mean comfort with performing procedures increased for both resident (32.1 to 62.3; P < .0001) and faculty physicians (42.2 to 85.4; P < .0001). Residents' comfort level performing procedures increased for all individual procedures measured. The mean number of procedures performed per year increased for resident (1.9 to 8.2; P < .0001) and faculty physicians (14.7 to 25.2; P = .087). Conclusions: A longitudinal ambulatory-based procedural curriculum can increase resident and faculty physician understanding and comfort performing primary-care-based procedures. This, in turn, increased the total number of procedures performed.