Asking for help: internal medicine residents' use of a medical procedure service.

摘要

BACKGROUND: Little is known about the professional help-seeking behavior of residents as they perform procedures in the hospital. OBJECTIVE: To determine when residents seek formal supervision to perform inpatient medical procedures. DESIGN: We conducted a prospective cohort study of resident physicians' use of formal supervision through a medical procedure service (MPS) for placing central venous catheters (CVCs) and performing thoracenteses. We compared resident, procedure, and patient characteristics among MPS and non-MPS procedures. We performed bivariable and multivariable analyses to examine factors associated with use of the MPS. We also performed a subgroup analysis of non-MPS procedures to assess the influence of resident, procedure, and patient characteristics on the choice of informal supervision. SETTING: Boston teaching hospital. SUBJECTS: Sixty-nine internal medicine residents. MAIN OUTCOME MEASURE: Use of an elective MPS for formal faculty supervision. RESULTS: Among 191 procedures performed, 79 (41%) used the MPS. Residents were more likely to seek faculty supervision via the MPS among patients with 3 or more comorbidities (odds ratio [OR], 2.1; 95% confidence interval [CI], 1.2-3.5). They were less likely to seek MPS supervision when procedures were performed urgently or emergently (OR, 0.4; 95% CI, 0.2-0.8). There were few differences in the characteristics of unsupervised and informally supervised procedures. CONCLUSIONS: Resident physicians appear to seek formal assistance appropriately for procedures they perform on sicker patients. Additional research is needed to understand whether overconfidence or poor access to attending physicians is responsible for their failure to seek consultation with urgent and emergent cases.