The Procedure & Consultation Rotation is a 4 week rotation done in the first year of your internal medicine residency at Abbott Northwestern Hospital. 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.

Bedside ultrasound is becoming an integral part of many procedures, including central lines, paracentesis and thoracentesis. Residents are trained in the use of bedside ultrasound using a portable ultrasound machine owned by the residency program. Our procedure simulators in the simulation center are "ultrasound-real" to give our trainees the most realistic simulation environment.

Additionally, the skill of being an effective internal medicine consultant is an increasingly important part of the hospitalist's role and constitutes an important learning aspect of this rotation during the first year of internal medicine residency.

The Abbott Northwestern Clinical Simulation Center was started by the residency program in response to the national trend for an increasing role of using high-fidelity "ultrasound-real" patient simulation to foster experiential procedure and examining in a safe environment.

Although simulation technology is relatively new to the field of medicine, the technology has previously been well established in other professions. Flight simulators for pilots and astronauts, military training exercises, management training for business executives, and technical operations for nuclear power plants are all examples of simulation technology currently in use by other professionals. Research has shown improved procedure outcomes in physicians trained with simulators prior to performing procedures on patients.

The clinical simulation center allows Abbott Northwestern Hospital's faculty and trainees to apply state-of-the-art simulators to learning the practice of invasive procedures in a risk-free environment with the ultimate goal being benefit to our patients.

A typical month on the Procedure Rotation:

The resident on the rotation goes through a methodical training regimen consisting of procedural knowledge acquisition, technical skills acquisition, full simulation training on state-of-the-art ultrasound real simulators in the clinical simulation center, and finally performance of procedures on patients, in that order. 

During an average 4 week rotation the procedure team performs the breakdown of procedures shown in the table below:

Throughout all of these steps, the resident receives feedback and assessment by the clinical procedure team staff assuring competency before moving on to the next level of procedures.  Formal assessment with multimedia interactive testing tools occurs at various points during the 4 week rotation.  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. 

This new rotation is expanding steadily as it becomes a routine part of the hospital services.  The goal is for continued growth, balanced with ample educational and simulation training time while the resident is on the rotation.