Factors influencing resident performance of invasive bedside procedures

Abstract

Cynthia Kay, Aniko Szabo, Jeffrey L Jackson

Objective: We explore United States internal medicine residents’ decision making regarding the performance and referral of invasive bedside procedures. Methods: We conducted a qualitative study comprised of a 5-question resident survey and resident focus groups at our tertiary academic medical center. Results: Residents rated time, available supervision, and their training as being most important when deciding whether to perform or refer procedures. Those who performed their own procedures rated more factors as being important in their decision compared to those who referred (p < 0.001). Six themes including time, supervision, opportunity, patient characteristics, logistics, and resident expectations emerged from the focus groups as influencing referrals. Conclusions: Residents refer the majority of procedures they encounter. A number of barriers to resident performance of procedures emerged. Further research is necessary to address these identified barriers and determine if and how referral status affect resident education, hospitalization costs, and overall patient care.