The University of Miami (UM) Miller School of Medicine’s division of hospital medicine, Jackson Memorial Hospital’s (JMH) internal medicine residency training program, and the UM-JMH Center for Patient Safety (CPS) have joined forces to provide safer patient care through a novel approach: A standardized curriculum for teaching invasive bedside procedures.
Trainees (interns, residents, and fellows) have long performed procedures such as lumbar puncture (spinal tap), thoracentesis (removal of fluid from the chest cavity), and insertion of central venous catheters (long IV catheters used in acutely ill patients), among others. Historically, they learned how to do this through the “see one, do one, teach one” apprenticeship model. This has resulted in the delivery of care by trainees, at times unsupervised by a skilled physician, which may lead to preventable complications. We sought to improve patient care by devising and implementing a practical training program.
Joshua D. Lenchus, DO, RPh, FACP, FHM, associate program director of the JMH medicine residency and associate director of the UM-JMH CPS, developed and launched this simulation-based, blended approach to procedural performance. Implemented in July of 2007 as a component of the training program, his team has trained nearly 750 learners, across a variety of specialties. A multi-disciplinary group of faculty serves as volunteer instructors, and sessions last from two to four hours, depending on the procedure. Dr. Lenchus has recently opened the instruction for trainees and attendings of other institutions.
To date, he has demonstrated that such training increases participant knowledge base and technical skill, improves self-reported confidence and competence, and, most importantly, decreases iatrogenic procedural complications, thereby providing safer patient care, at a cost savings to the institution. The results of this training program have been reported in professional journals such as the Journal of the American Osteopathic Association and Medical Teacher.
