The Procedure & Ultrasound Rotation

We believe that a robust training and experience with core internal medicine procedures is essential for our residents. Accordingly, we have a required first year rotation and a dedicated resident procedure team for training in core internal medicine procedures. The resident bedside procedure team performs over 500 procedures annually and continues to grow.

The Procedure & Ultrasound rotation is a 4-week rotation done in the first year of your residency. It was started in July 2007 in response to the desire from our residents to have increased exposure to those procedures mandated by the ACGME, and more importantly, those thought to be important in the armamentarium of a practicing internist. The single resident on the rotation goes through a rigorous training regimen consisting of procedural knowledge acquisition, technical skills acquisition, full simulation training on state-of-the-art ultrasound real simulators in the residency's clinical simulation center, and finally performance of a large volume of procedures on patients. The average resident 4-week rotation includes 42 procedures.

Throughout all of these steps, the resident is working with one of two dedicated procedure team staff and receives feedback and assessment, assuring competency before moving on to the next level of procedures. There is significant 1-on-1 time between the resident and the procedure rotation staff necessary to adequately teach the intricacies and troubleshooting of the individual procedures.

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As you read in the previous section on bedside ultrasound, ultrasound is becoming a standard of care for the performance of many procedures, including central lines, paracentesis, thoracentesis, IV placement, joint injection/aspiration, and anatomically difficult lumbar punctures and arterial lines. During the procedure and ultrasound rotation, residents are trained in the procedural guidance use of bedside ultrasound using the residency's portable ultrasound machines. Our procedure simulators in the simulation center are "ultrasound-real" to give our trainees the most realistic simulation environment.

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This rotation also plays a key role in the overall IMBUS bedside ultrasound curriculum and experience as a first year resident. In addition to procedures, it provides 4 weeks of 1-on-1 bedside diagnostic ultrasound teaching with an experienced faculty member on the internal medicine ultrasound team.

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