Procedural Experience and Confidence Among Graduating Medical Students

OBJECTIVE: Bedside procedures are a vital component of patient care particularly for surgeons. Anecdotal evidence and previous studies from individual institutions reveal a lack of exposure to these interventions in medical school. Our objective was to ascertain medical students' experience and confidence in performing bedside procedures. DESIGN: Our study included a multi-institutional, anonymous, Health Insurance Portability and Accountability Act-compliant electronic survey. Using a 4-point Likert scale, students were asked how many times they had performed each of 18 common bedside procedures and their anticipated confidence in completing it independently. Statistical analysis included student t test, Chi-square test, analysis of means, linear regression, and Bonferroni correction for multiple comparisons. PARTICIPANTS: In total, participants included 2260 4th year medical students at 17 allopathic medical schools. RESULTS: Overall, 644 students replied (28.5% response rate). Most respondents had never placed an arterial line (71%), central venous line (81%), chest tube (89%), intra-osseous line (95%), injected a joint (63%), or had performed cardiopulmonary resuscitation (50%), a lumbar puncture (57%), paracentesis (66%), or thoracentesis (92%). Venipuncture, suturing, and Foley catheter placement were the only procedures which greater than 50% of students had performed more than 5 times. Significant correlation was observed (r = 0.7) between experience and confidence, with men being reported significantly higher experience and confidence than women (p < 0.0001). Students entering anesthesia and emergency medicine residencies reported significantly higher experience than those matriculating into other specialties (alpha = 0.003); students entering emergency medicine and surgery reported significantly higher confidence levels (alpha = 0.003). CONCLUSION: The largest survey of its kind, the present study demonstrates that medical students are underexposed to essential bedside procedures and feel uncomfortable performing them a trend that has worsened over 25 years. Students entering surgical specialties have significantly higher levels of confidence, although a corresponding difference in experience was not observed. (C) 2016 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.