Procedure Training

While we understand that not every resident wants to become proficient at every procedure in internal medicine, we believe anyone who wants to should have the best chance of doing so.

The old procedural training mantra in medicine used to be "see one, do one, teach one," but this is a relic of a bygone era.

It takes a lot to really be competent and safe at procedures. And once you've achieved competency, how does it last?

The current thinking is an approach called learn, see, practice, prove, do, maintain.

We aim to impart this approach through a curriculum that emphasizes both patient and resident safety without sacrificing procedural opportunities.

Our curriculum offers dedicated simulation-based exposure to peripheral IV placement, arterial and central line placement, paracentesis and thoracentesis- as well as the ultrasound skills necessary to perform them- with the goal of preparing you to take advantage of every procedural opportunity you have during residency. This is an optional curriculum, but is open to any intern who wishes to opt in.

After familiarizing yourself with the procedure through didactic materials, you will have the chance to practice in our fully equipped simulation center with a trained expert.

You will become proficient in the sim lab and then be able to perform the procedure in the clinical setting under direct supervision.

After each procedure, you will receive immediate feedback from your supervisor with tips on how to improve.

Once you have demonstrated competency, you will be certified to perform the procedure under indirect supervision- as long as you maintain your skills with regular practice!

For residents who have completed the curriculum and wish to practice in order to maintain their skills, we also offer “open sim” opportunities where any procedure can be practiced on camera, with feedback provided by an expert after viewing the session.

See our approach to procedure training

Dedicated Procedure Elective

The “Advanced Critical Care/Procedure Electives” are offered as separate elective rotations at both UC and the VA. The rotations are reserved for PGY-2 residents and above.

The VAMC elective is a multidisciplinary rotation where you will receive simulation-based and practical exposure to multiple procedures.

The majority of your procedural exposure will be in the MICU, where you will get one-on-one instruction from fellows and attendings and have the opportunity to teach interns.

There are additional opportunities with interventional radiology, neurology, anesthesia, and the PICC teams to practice thoracentesis, paracentesis, central lines, lumbar punctures, intubations, and ultrasound guided peripheral IVs.

The UCMC elective is based in the MICU- the acuity and number of procedures available usually facilitate multiple opportunities per day. You will otherwise round with the teams (you are not expected to take patients) in the morning and attend educational conferences.

Point of Care Ultrasound (POCUS)

Point-of-care ultrasound (POCUS) has become an invaluable tool for any clinical setting. This bedside application can be useful for both urgent situations as well as evaluating clinical scenarios that may lead to formal ultrasound examinations.

While you will receive informal exposure to bedside ultrasound in the medical stepdown (MSD), ICUs and certain electives, there has been growing resident interest in formalized ultrasound education. This has led to the creation of the two week POCUS elective.

In the Ultrasound elective (open to PGY-2s) you will have a focused, two-week experience learning the basics of bedside critical care ultrasound. In addition to the physics and “knobology” of ultrasound, you will learn scanning strategies for cardiac, thoracic, abdominal, and vascular exams. You will practice your skills during precepted scanning time with cardiology and critical care fellows and attendings.