# Boosting Confidence and Skills: A Multidisciplinary Evaluation of an Emergency Department-Based Procedure Team Rotation

## TL;DR

This study shows that an emergency department-based Procedure Team rotation improves residents' confidence and skills in performing invasive procedures and enhances interdepartmental collaboration.

## Contribution

The study introduces and evaluates a novel interdepartmental Procedure Team rotation for EM residents to improve procedural training and communication.

## Key findings

- EM residents performed an average of 29.9 procedures per four-week rotation, with significant improvement in comfort for midlines, lumbar punctures, and paracenteses.
- ED attendings reported increased resident autonomy, and 70% of IM residents found consult placement very simple.
- Suggestions for improvement included extending availability and improving communication systems.

## Abstract

Introduction: Emergency Medicine (EM) residency programs aim to ensure residents' proficiency in performing invasive procedures. Staten Island University Hospital (SIUH) introduced an interdepartmental "Procedure Team'' to increase senior EM residents' exposure to such procedures. This study aims to evaluate the Procedure Team rotation's perceived effectiveness by assessing EM residents' improvement in comfort levels in performing procedures, EM attendings' perceptions of the curriculum's effectiveness in improving procedural and communication skills, and internal medicine (IM) resident feedback.

Methods: This is a mixed-methods study. Surveys and interviews assessed the curriculum's effectiveness, revealing feedback and areas for improvement. This study investigated the five most common procedures consulted for on the procedure team: ultrasound-guided intravenous access (US-IV), midline, central line, lumbar puncture, and paracentesis.

Results: Two hundred forty-two procedures were performed by the EM residents. On average, each resident performed 29.9 +/- 5.3 procedures per four-week rotation, with the most common procedure being the midline, which on average was performed 11.6 +/- 5.2 times, followed by paracentesis (8.9 +/- 2.1) and lumbar puncture (2.8 +/- 1.9). Response rates for the EM resident, ED attending, and IM resident surveys were 10 (100%), 23 (77%) and 27 (51%) respectively. The 10 EM postgraduate year (PGY)-3 respondents reported significant improvement in procedural comfort for midlines, lumbar punctures, and paracenteses post-rotation. Qualitative feedback from EM residents identified "education and procedural exposure" as the most valuable aspect, with 19 (70%) of 27 IM residents finding consult placement "very simple." ED-attending physicians reported increased resident autonomy over time. Suggestions for enhancing the Procedure Team included extending availability and improving communication, with 11 (41%) of IM respondents advocating for weekend coverage and a unified contact system.

Conclusions: Introducing a Procedure Team rotation in an EM residency program significantly boosts residents' confidence in performing procedures and supports interdepartmental communication and collaboration. It has the potential to enrich resident education with hands-on experience in high-risk procedures and enhance overall EM training.