The Reasons Hospitalists Should Learn Hospital Procedures

by Joseph Esherick, M.D., FAAFP, FHM

 Hospitalists are in the ideal position to perform bedside procedures on their patients. They know every aspect about their patients and have had the opportunity to develop a good rapport and the trust of their patients. So, why are they not performing these procedures on their patients?

The reasons that hospitalists state for not performing hospital procedures are myriad. One important reason is the availability of other specialists who are capable of doing these procedures: for example, interventional radiologists can do these procedures in hospitals that have IR available. However, another important factor is that many hospitalists feel uncomfortable with their procedural skills. In many cases, hospitalists have allowed the procedural skills they developed in residency become rusty. This sentiment is reflected in an online survey conducted by The Hospitalist in May 2011, which found that 62% of hospitalists felt that their procedural skills had deteriorated during the preceding five years.

In other cases, physicians failed to learn procedural skills during residency to begin with. This is in part because of multiple changes in residency education enforced by the ACGME. First, the ACGME has progressively restricted resident inpatient hours, patient loads for residents, and overall resident training. This has affected procedural training for both residents in internal medicine but also in family medicine (the two primary specialties comprising the hospitalist movement). Secondly, the ACGME has eradicated the requirement that residents must develop some degree of proficiency in most bedside procedures as a requirement for graduation.

To compound the problem of bedside procedural training during residency, many attending physicians at teaching hospitals have allowed their procedural skills deteriorate. Therefore, junior residents are often learning procedures from senior residents who are often poor procedural educators.

 This is definitely a problem since hospitalists and midlevel providers working in the hospital setting are frequently the first responders to code blues and rapid response calls. As such, these providers must be proficient performing emergency procedures to help stabilizing these patients. Most leaders in hospital medicine believe that bedside procedures should be a core competency of all hospitalists

 So, how do hospitalists and midlevel providers working on the hospital wards and the ICU gain proficiency in hospital procedures and emergency procedures? Simulation-based training is the best way to obtain competence and confidence performing bedside procedures.

 Hospital Procedures Consultants (HPC) is the premier provider of Hospitalist and Emergency Procedures training in the U.S. HPC is a group of passionate and dedicated procedural expert instructors who have over 25 years of combined national experience in hospital procedure education. All of our instructors are full-time academic physicians working in the ER, ICU, and hospital wards who teach all of the procedures to residents and medical students every week. HPC has also trained over 2,000 clinicians (physicians, nurse practitioners, and physician assistants) around the country.

 HPC provides ten ACCME-accredited Hospitalist and Emergency Procedures CME courses around the United States every year. These course provide 21 hours AMA PRA Category 1 credit and qualify for 16 hours of Trauma CME. The courses provide simulation-based training in the following bedside procedures: ultrasound-guided peripheral IV placement, landmark-guided and ultrasound-guided central line placement, arterial line placement, and point-of-care ultrasound including the E-FAST exam, RUSH exam, limited echocardiography, vascular ultrasound, and chest ultrasound, tube thoracostomy, pigtail catheter placement for pneumothorax evacuation, needle decompression, ultrasound-guided thoracentesis, lumbar puncture, ultrasound-guided paracentesis, basic airway management, endotracheal intubation, intermediate airway placement (LMA and King tube placement), stylet-guided intubations, video laryngoscopy (Glidescope intubations), and basic suturing. 

 HPC provides the best comprehensive hospitalist procedures CME course at the most affordable price. Course tuition also includes complimentary breakfast, lunch, and breaks to all students, a complimentary Tarascon Medical Procedures Pocketbook, a complimentary procedural reference card and access to all online lectures and all 21 full-length procedural videos FOR 12 MONTHS. In addition, every student will receive a 2 GB USB flash drive that will be preloaded with our entire syllabus and our collection of evidence-based procedural articles.