Development of a Chief Resident Medical Procedure Service: a 10-Year Experience

Background: Lack of experienced faculty to supervise internal medicine (IM) residents is a significant barrier to establishing a medical procedure service (MPS). Aim: Describe the development and 10-year outcomes of an MPS led by IM chief residents. Setting: University-based IM residency program affiliated with a county and Veterans Affairs hospital. Participants: Categorical IM interns (n=320) and 4^th-year IM chief residents (n=48) from 2011 to 2022. Program Description: The MPS operated on weekdays, 8 am–5 pm. After training and sign-off by the MPS director, chief residents trained and supervised interns in ultrasound-guided procedures during a 4-week rotation. Program Evaluation: From 2011 to 2022, our MPS received 5967 consults and 4465 (75%) procedures were attempted. Overall procedure success, complication, and major complication rates were 94%, 2.6%, and 0.6%, respectively. Success and complication rates for paracentesis (n=2285) were 99% and 1.1%, respectively; 99% and 4.2% for thoracentesis (n=1167); 76% and 4.5% for lumbar puncture (n=883); 83% and 1.2% for knee arthrocentesis (n=85); and 76% and 0% for central venous catheterization (n=45). The rotation was rated 4.6 out of 5 for overall learning quality. Discussion: A chief resident–led MPS is a practical and safe approach for IM residency programs to establish an MPS when experienced attending physicians are unavailable.