Internal Medicine Residents’ Exposure to and Confidence in Managing Hospital Acute Clinical Events
BACKGROUND: Internal Medicine (IM) residency graduates should be able to manage hospital emergencies, but the rare and critical nature of such events poses an educational challenge. IM residents’ exposure to inpatient acute clinical events is currently unknown.
OBJECTIVE: We developed an instrument to assess IM residents’ exposure to and confidence in managing hospital acute clinical events.
METHODS: We administered a survey to all IM residents at our institution assessing their exposure to and confidence in managing 50 inpatient acute clinical events. Exposures assessed included mannequin-based simulation or management of hospital-based events as a part of a team or independently in a leadership role. Confidence was rated on a five-point scale and dichotomized to “confident” versus “not confident.” Results were analyzed by multivariable logistic regression to assess the relationship between exposure and confidence accounting for year in training.
RESULTS: A total of 140 of 170 IM residents (82%) responded. Postgraduate year 1 (PGY-1) residents had managed 31.3% of acute events independently vs 71.7% of events for PGY-3/4 residents (P < .0001). In multivariable analysis, residents’ confidence increased with level of training (PGY-1 residents were confident to manage 24.9% of events vs 72.5% of events for PGY-3/4 residents, P < .0001) and level of exposure, independent of training year (P = .001). Events with the lowest levels of exposure and confidence for graduating residents were identified.
CONCLUSIONS: IM residents’ confidence in managing inpatient acute events correlated with level of training and clinical exposure. We identified events with low levels of resident exposure and confidence that can serve as targets for future curriculum development.
© 2019 Society of Hospital Medicine
Internal Medicine (IM) residency graduates are expected to manage a wide range of acute clinical events.1 Urgent and emergent inpatient situations require a broad knowledge base for rapid bedside diagnosis, yet the essential clinical skills required to manage acute clinical events pose a unique training challenge given the rarity and high-stakes nature of several such emergencies. For example, in three years of residency, a trainee may never have the opportunity to manage anaphylaxis, yet IM graduates must be able to recognize and quickly initiate proper lifesaving treatment for this relatively rare event2 when it does occur.
In an era of work-hour limitations and heightened trainee supervision, residents perceive diminished familiarity with several clinical situations3-5 and may feel unprepared to handle crisis events such as cardiac arrest.6 Given the sporadic nature of clinical medicine, many residents may not be exposed to certain acute inpatient clinical scenarios by the end of their training, a potentially critical education gap. To our knowledge, IM residents’ level of exposure to acute clinical events has not previously been studied. The aims of this study were to develop an instrument aimed at assessing IM residents’ exposure to hospital acute clinical events at a large academic medical center and to investigate the relationship between exposure and confidence in managing these events.
