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Procedures Curriculum_Procedures CurriculumInternal Medicine
Updated:2011-11-23 Category:Medicine
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Procedures Curriculum

Internal Medicine Residency Program

University of Nevada School of Medicine (Las Vegas)

Educational Purpose:

Recognizing that the individual physician, upon completion of his or her training and eventual practice type and locale, may or may not continue to perform procedures, does not minimize the need to learn about various procedures, including their indication, complications, and interpretations of fluids recovered.

Teaching Methods

Procedures will be learned on the inpatient rotations, and during Emergency Medicine and ambulatory rotations. Knowledge competency will be attained via directed teaching from supervising attendings or residents, and from self study, including the use of the New England Journal of Medicine video series.

ACLS is taught during intern orientation and all residents are required to be certified prior to beginning. There are also quarterly review sessions during the resident noon conference series.

Procedures to be Learned

The resident will develop knowledge and performance competency of the procedures listed below. The resident will develop the knowledge to understand and explain the indications, contraindications, recognition and management of complications, pain management, sterile techniques, specimen handling, interpretation of results, and requirements and knowledge to obtain informed consent.

    ACLS Draw arterial blood (submit 5 procedure cards/notes) Draw venous blood (submit 5 procedure cards/notes) Place an intravenous line (submit 5 procedure cards/notes) Pap smear and endocervical culture (submit 5 procedure cards/notes) Central Line Insertion (submit 5 procedure cards/notes per type of access obtained; i.e., internal jugular, subclavian, femoral) -- Residents must obtain performance competency in at least one technique for central venous catheter placement. Paracentesis (submit 3 procedure cards/notes)

The procedures listed below require that a resident develop the knowledge to understand and explain the indications, contraindications, recognition and management of complications, pain management, sterile techniques, specimen handling, interpretation of results, and requirements and knowledge to obtain informed consent.

    Arterial line insertion Arthrocentesis Central Line Insertion Incision and drainage of an abscess Lumbar puncture Nasogastric intubation PA catheter insertion Paracentesis Thoracentesis

Residents will be provided the opportunity to achieve knowledge and procedural competency in the following procedures if the resident identifies that the procedure is relevant to future practice:

    Arterial line insertion Arthrocentesis Central Line Insertion Incision and drainage of an abscess Lumbar puncture Nasogastric intubation PA catheter insertion Paracentesis Thoracentesis Cryosurgical removal of skin lesions

Patient Characteristics

There is a diverse patient population, male and female, of all ages from adolescent to geriatric, representing most ethnic and racial backgrounds, from all social and economic strata. The resident will only perform procedures on patients on the teaching service unless they are rotating in the Emergency Department, in a private physican’s office and performing the procedure in that setting (e.g., arthrocentesis during the orthopedic surgery elective), or in the setting of an ACLS protocol.

Reading lists and other educational resources to be used:

    New England Journal of Medicine Series of Articles and Videos on Clinical Medicine Series
      Paracentesis: N Engl J Med 2006;355:e21;

      http://content.nejm.org/cgi/content/short/355/19/e21

        Central Venous Catheterization: N Engl J Med 356:e21, May 24, 2007; http://content.nejm.org/cgi/video/356/21/e21/ Thoracentesis: N Engl J Med 355:e16, October 12, 2006; http://content.nejm.org/cgi/content/short/355/15/e16 Lumbar Punctures: N Engl J Med 355:e12, September 28, 2006; http://content.nejm.org/cgi/content/short/355/13/e12 Incision and Drainage of an Abscess: Fitch MT, Manthey DE, McGinnis HD, Nicks BA, Pariyadath M. N Engl J Med 2007;357:e20, November 8, 2007; http://content.nejm.org/cgi/video/357/19/e20/ Pelvic Examination: Edelman A, Anderson J, Lai S, Braner DAV, Tegtmeyer K. N Engl J Med 2007;356:e26, June 28, 2007; http://content.nejm.org/cgi/video/356/26/e26/ Orotracheal Intubation: Kabrhel C, Thomsen TW, Setnik GS, Walls RM. N Engl J Med 2007;356:e15, April 26, 2007; http://content.nejm.org/cgi/video/356/17/e15/
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