The Development of an Innovative Crowdsourced Resident Procedure Team Model to Improve Bedside Procedural Proficiency in the Inpatient Setting.

Ysabel C Ilagan-Ying, Robert Cotter, Chang Su, Benjamin A Rodwin, John C Huston
Author Information
  1. Ysabel C Ilagan-Ying: is a Resident Physician, Department of Medicine, Yale School of Medicine. ORCID
  2. Robert Cotter: is a Medical Student, Yale School of Medicine. ORCID
  3. Chang Su: is a Resident Physician, Department of Medicine, Yale School of Medicine. ORCID
  4. Benjamin A Rodwin: is Assistant Professor, Department of Medicine, Yale School of Medicine and VA Connecticut Healthcare System; and. ORCID
  5. John C Huston: is a Fellow, Department of Pulmonary, Critical Care, and Sleep Medicine, Yale School of Medicine. ORCID

Abstract

Bedside procedures are a necessary skill for many residents. Practice changes, including the discontinuation of a minimum number of procedures required by the American Board of Internal Medicine, may have resulted in decreased incentive for residents to seek procedural opportunities. To improve residents' procedural output and confidence in abdominal paracentesis, arterial and central venous line placement, nasogastric intubation, and ultrasound-guided peripheral intravenous catheter insertions (USPIV). A novel Resident Procedure Team (RPT) model was created using crowdsourced proficient (having completed ≥5 procedures) near-peers in combination with peer-led USPIV simulation workshops to increase the number of supervising residents available. Procedure logs and the number of residents who became qualified to perform and supervise procedures were tracked from July 2018 to June 2022 and compared before and after the implementation of the RPT in July 2020. Implementing the novel RPT model significantly increased the number of procedures performed (1875 procedures post-RPT vs 1292 pre-RPT; =.02). Abdominal paracentesis increased from 411 to 482 (17.3%), central venous line placement increased from 344 to 401 (16.6%), USPIV increased from 318 to 389 (22.3%), arterial line placement increased from 189 to 360 (90.5%), and nasogastric intubation increased from 30 to 243 (710.0%). Resident confidence levels increased significantly after RPT-led USPIV workshops (<.05 for all). Implementation of a novel, crowdsourced, resident-led procedure team and peer-led USPIV workshops helped increase the number of procedures performed by residents.

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Grants

  1. T32 HL007778/NHLBI NIH HHS

MeSH Term

Humans
Internship and Residency
Inpatients
Crowdsourcing
Clinical Competence
Education, Medical, Graduate

Word Cloud

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