Patient Care

Interns Learn Ultrasound-Guided Procedures


Internal medicine (IM) interns at the University of Texas Health Sciences Center in San Antonio are learning how to perform ultrasound-guided procedures (e.g. thoracentesis, paracentesis, lumbar puncture), gaining confidence in procedural skills that they can then take into residency and beyond,

according to an innovation poster presented at HM12.1 The procedure service, which is a monthlong, mandatory rotation for IM interns, had its origins in funds allocated for an additional chief resident position that focused on quality and patient safety and the championing of procedures by one of the program’s directors, says David Schmit, MD, a chief resident and the abstract’s lead author.

Three chief residents, who lead the service, developed and teach its structured curriculum, which includes an instructional video, didactic presentations on indications, contraindications, risks and benefits, practice on a simulator, and instruction in obtaining appropriate consents from patients. Trainees perform each procedure under the chief residents’ supervision and complete competency checklists. Many participants complete the required five supervised procedures while still interns. “We since opened the service to second-year residents” so they can go back and master its curriculum, Dr. Schmit says.

Results in the first seven months of the service included 342 procedures performed by medical trainees, with 100% success for paracentesis and thoracentesis; slightly lower rates were seen for lumbar puncture. The rate of pneumothorax resulting from procedures declined to 4% from 12.5%, and the overall complication rate was 2.6%. Equally important, Dr. Schmit says, were 85 requests for procedures that were not performed because trainees recognized contraindications or safety considerations.


  1. Schmit D, King P, Velasquez ST, Wathen P. The design, implementation and impact of an internal medicine resident ultrasound-based procedure service. Paper presented at: HM12, Society of Hospital Medicine; April 2012; San Diego.

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