• Robert Nathanson, Hasan Baher, Jason Phillips, Megan Freeman, Raj Sehgal, Jane O'Rorke, and Nilam J Soni.
• Medicine Service, South Texas Veterans Health Care System, San Antonio, TX, USA. nathansonr3@uthscsa.edu.
• J Gen Intern Med. 2023 Oct 1; 38 (13): 307730813077-3081.

BackgroundLack of experienced faculty to supervise internal medicine (IM) residents is a significant barrier to establishing a medical procedure service (MPS).AimDescribe the development and 10-year outcomes of an MPS led by IM chief residents.SettingUniversity-based IM residency program affiliated with a county and Veterans Affairs hospital.ParticipantsCategorical IM interns (n=320) and 4th-year IM chief residents (n=48) from 2011 to 2022.Program DescriptionThe 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 EvaluationFrom 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.DiscussionA chief resident-led MPS is a practical and safe approach for IM residency programs to establish an MPS when experienced attending physicians are unavailable.© 2023. This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply.

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