Teaching and Assessing Bedside Procedures: A Standardized Cross-Disciplinary Framework for Graduate Medical Education.

ABSTRACT: Performing bedside procedures requires knowledge, reasoning, physical adeptness, and self-confidence; however, no consensus on a specific, comprehensive strategy for bedside procedure training and implementation is available. Bedside procedure training and credentialing processes across large institutions may vary among departments and specialties, leading to variable standards, creating an environment that lacks consistent accountability, and making quality improvement difficult. In this Scholarly Perspective, the authors describe a standardized bedside procedure training and certification process for graduate medical education with a common, institution-wide educational framework for teaching and assessing the following 7 important bedside procedures: paracentesis; thoracentesis; central venous catheterization; arterial catheterization; bladder catheterization or Foley catheterization; lumbar puncture; and nasogastric, orogastric, and nasoenteric tube placement. The proposed framework is a 4-stage process that includes 1 preparatory learning stage with simulation practice for knowledge acquisition and 3 clinical stages to guide learners from low-risk to high-risk practice and from high to low supervision. The pilot rollout took place at Henry Ford Hospital from December 2020 to July 2021 for 165 residents in the emergency medicine and/or internal medicine residency programs. The program was fully implemented institution-wide in July 2021. Assessment strategies encompass critical action checklists to confirm procedural understanding and a global rating scale to measure performance quality. A major aim of the bedside procedure training and certification was to standardize assessments so that physician trainers from multiple specialties could train, assess, and supervise any participating trainee, regardless of discipline. The authors list considerations revealed from the pilot rollout regarding electronic tracking systems and several benefits and implementation challenges to establishing institution-wide standards. The proposed framework was assembled by a multidisciplinary physician task force and will assist other institutions in adopting best approaches for training physicians in performing these critically important and difficult-to-perform procedures.

Does monitoring change in function in community-dwelling older adults alter outcome? A randomized controlled trial.

OBJECTIVE: To determine whether information about an older person's physical functioning provided to the patient and his or her physician delays functional decline and improves health outcomes. DESIGN: A randomized controlled trial was undertaken; the assessors were not blinded to the group allocation. SETTING: The study took place in a clinic within a hospital setting. PARTICIPANTS: Two hundred and sixty-five community-dwelling people over 65 years were recruited from family practice units. INTERVENTIONS: The intervention group received assessments of physical function with feedback to the participant and the participant's family physician or functional assessments alone over 18 months. Self-report measures for health status using the Short Form-36 (SF-36) and preclinical disability were used together with performance measures which included the lower extremity performance test and muscle strength. RESULTS: There were small, statistically significant group/time interactions which included disability scores, F=4.78, P < or =0.05), and the vitality subscale of the SF-36, F=7.47, P < or =0.01). CONCLUSION: Providing information about the results of detailed assessment of physical functioning to older adults and their physicians did not show significant differences in function scores between the intervention and control groups.