What Procedures Should Internists Do?

Editorials6 March 2007What Procedures Should Internists Do?F. Daniel Duffy, MD and Eric S. Holmboe, MDF. Daniel Duffy, MDFrom American Board of Internal Medicine, Philadelphia, Pennsylvania. and Eric S. Holmboe, MDFrom American Board of Internal Medicine, Philadelphia, Pennsylvania.Author, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-146-5-200703060-00012 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail For decades, internal medicine residency training has prepared physicians to be generalists and learning bedside procedures has been an important element of training. In this issue, Wigton and Alguire (1) ask whether practicing internists perform the bedside procedures they were trained to do. The answer is, they are not: On average, internists perform 50% fewer procedures than they did 18 years ago. When only the procedures required for certification by the American Board of Internal Medicine (ABIM) are considered, 26% of internists performed lumbar puncture in 2004 compared with 73% in 1986. The trend also held for thoracentesis (23% vs. ...References1. Wigton RS, Alguire P. The declining number and variety of procedures done by general internists: a resurvey of members of the American College of Physicians. Ann Intern Med. 2007;145:355-60. LinkGoogle Scholar2. Brennan TA, Leape LL, Laird NM, Hebert L, Localio AR, Lawthers AG, et al. Incidence of adverse events and negligence in hospitalized patients. Results of the Harvard Medical Practice Study I. N Engl J Med. 1991;324:370-6. [PMID: 1987460] CrossrefMedlineGoogle Scholar3. Pronovost P, Needham D, Berenholtz S, Sinopoli D, Chu H, Cosgrove S, et al. An intervention to decrease catheter-related bloodstream infections in the ICU. N Engl J Med. 2006;355:2725-32. [PMID: 17192537] CrossrefMedlineGoogle Scholar4. American Board of Internal Medicine. Policies and Procedures for Certification in Internal Medicine for 2006. Accessed at www.abim.org on 27 December 2006. Google Scholar5. Fitts PM, Posner MI. Human Performance. Belmont, CA: Brooks/Cole; 1967. Google Scholar6. Resnick RK, MacRae H. Teaching surgical skills—changes in the wind. N Engl J Med. 2006;355:2664-9. [PMID: 17182991] CrossrefMedlineGoogle Scholar7. Wayne DB, Butter J, Siddall VJ, Fudala MJ, Wade LD, Feinglass J, et al. Graduating internal medicine residents' self-assessment and performance of advanced cardiac life support skills. Med Teach. 2006;28:365-9. [PMID: 16807178] CrossrefMedlineGoogle Scholar8. Smith CC, Gordon CE, Feller-Kopman D, Huang GC, Weingart SN, Davis RB, et al. Creation of an innovative inpatient medical procedure service and a method to evaluate house staff competency. J Gen Intern Med. 2004;19:510-3. [PMID: 15109314] CrossrefMedlineGoogle Scholar9. Wickstrom GC, Kelley DK, Keyserling TC, Kolar MM, Dixon JG, Xie SX, et al. Confidence of academic general internists and family physicians to teach ambulatory procedures. J Gen Intern Med. 2000;15:353-60. [PMID: 10886468] CrossrefMedlineGoogle Scholar10. Hicks CM, Gonzalez R, Morton MT, Gibbons RV, Wigton RS, Anderson RJ. Procedural experience and comfort level in internal medicine trainees. J Gen Intern Med. 2000;15:716-22. [PMID: 11089715] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAuthors: F. Daniel Duffy, MD; Eric S. Holmboe, MDAffiliations: From American Board of Internal Medicine, Philadelphia, Pennsylvania.Grant Support: None.Disclosures: Both authors are employed by the American Board of Internal Medicine.Corresponding Author: F. Daniel Duffy, MD, American Board of Internal Medicine, 510 Walnut Street, Suite 1700, Philadelphia, PA 19106; e-mail, dduffy@abim.org.Current Author Addresses: Drs. Duffy and Holmboe: American Board of Internal Medicine, 510 Walnut Street, Suite 1700, Philadelphia, PA 19106. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoThe Declining Number and Variety of Procedures Done by General Internists: A Resurvey of Members of the American College of Physicians Robert S. Wigton and Patrick Alguire Tailoring to the Needs of One's Practice: It's about Time Edward J. Volpintesta The Declining Number and Variety of Procedures Done by General Internists Jeanne M. Farnan and Vineet M. Arora The Declining Number and Variety of Procedures Done by General Internists Michael A. LaCombe Metrics Cited byHow Are We Handling Fluoroscopy-Guided Lumbar Puncture Requests? 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Farnan, MD and Vineet M. Arora, MD, MAThe Declining Number and Variety of Procedures Done by General InternistsMichael A. LaCombe, MDTailoring to the Needs of One's Practice: It's about TimeEdward J. Volpintesta, MDProcedural training at a crossroads: Striking a balance between education, patient safety, and quality 6 March 2007Volume 146, Issue 5 Page: 392-393 Keywords Blood Health care quality Intubation Lumbar puncture Patient advocacy Pulmonary artery catheters Radiologists Residency Safety Sub-specialty care ePublished: 6 March 2007 Issue Published: 6 March 2007 Copyright & PermissionsCopyright © 2007 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...