Internally versus externally trained residents and fellows hired as attendings at a large integrated healthcare system: a 20-year retrospective study.

BACKGROUND: There remains a question of whether graduates trained internally are different than those trained elsewhere. We examine the difference between physicians trained within our Graduate Medical Education (GME) programs versus physicians trained elsewhere. Our large integrated healthcare system is unique in addressing this objective due to its large physician labor hiring needs across different specialties of GME graduates. METHODS: A retrospective review was performed from Jan 2000 to August 2020 of Kaiser Permanente Southern California (KPSC) physicians hired: KPSC GME trained versus non-KPSC GME trained. We examined five variables: retention, leadership (current or historical), physician relations cases, member appraisal of physician and provider services survey (MAPPS) scores, and rate of board certification. Chi-square test of proportions was used for comparison, p < 0.05 was significant. RESULTS: From Jan 2000 to August 2020, 2940 residents and fellows graduated from KPSC GME programs, of which 1127 (38%) were hired on at KPSC as full time attendings. Across all five metrics (Retention 82% vs 76% (p = < 0.01), Leadership [current 13% vs 10% (p = < 0.01)or historical 17% vs 14% (p = 0.01)], Physician Relations 23% vs 26% (p = 0.04), MAPPS 75% vs 69% (p = < 0.01), and Board Certification 81% vs 74% (p = < 0.01)), KPSC outperformed non-KPSC GME-trained physicians to a statistically significant degree. CONCLUSIONS: We have shown that an internally sponsored GME program can represent an opportunity for recruitment of physicians that may have higher retention rates, higher probability of being physician leaders, decreased likelihood of physician relations issues, improved patient satisfaction, and increased rates of board certification.

Patient Tolerability With Office Transperineal Biopsy Using a Reusable Needle Guide.

OBJECTIVE: Transrectal ultrasound-guided (TRUS) prostate biopsy is associated with a 1%-5% risk of severe sepsis, despite the use of prophylactic antibiotics. Recent studies have demonstrated the feasibility of transperineal (TP) prostate biopsy in the outpatient setting under local anesthetic (LA). We demonstrate the safety, efficacy, and tolerability of our technique for performing TP biopsy under LA in the clinic setting using a reusable needle guide. METHODS: A biplanar ultrasound probe with an attached adjustable, reusable needle guide was evaluated for transperineal biopsy. A 17 gauge x 10 cm coaxial needle is attached to the needle guide. The skin is infiltrated, bilaterally, approximately 2 cm anterolateral to the anal verge with 1% lidocaine using a 25 gauge needle. A deeper prostatic block is then performed using a 20 gauge spinal needle. Administration of the anesthetic is delivered to the musculature of the pelvic floor, superficial-to-deep. Prostate samples are obtained using an 18 gauge x 25cm biopsy gun. All biopsies on a side can be obtained utilizing a single perineal skin puncture site. Patients who underwent office TP biopsy after May 2019 also completed a 10-item patient experience questionnaire regarding pain or discomfort experienced during the procedure. RESULTS: In 2019, a total of 74 patients underwent office TP prostate biopsy under local anesthesia using a reusable needle guide, while 564 underwent office TRUS biopsy. Prostate biopsy was positive for malignancy in 58.1% of TP patients vs 57.6% in TRUS patients (P = .93). TP biopsy had a lower utilization of prophylactic antibiotics compared to TRUS biopsy: 33.8% vs 99.5% (P < .001), yet there were no admissions, UTI, or sepsis for TP patients, compared to 6 admissions (1.1%) for TRUS biopsy (P = .01)). The mean VAS score ± SD for pain or discomfort caused by the overall office TP biopsy was 3.68 ± 1.96. CONCLUSION: We demonstrate that office TP biopsy under LA with a reusable needle guide can be safely introduced with equivalent cancer detection rates whilst nearly eliminating the risk of urinary sepsis. This was achieved while also significantly reducing the use of prophylactic antibiotics. The procedure was well tolerated, with the most common complaint being local infiltration of anesthetic. We believe that office TP biopsy under LA can be performed with good patient tolerability, as almost 94% of patients were willing to undergo the procedure again. There is also the potential for reduction in overall cost with the use of a reusable needle guide.