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Procedural Skills of the General Internist: A Survey of 2500 Physicians

Robert S. Wigton, MD; Jo A. Nicolas, BA; and Linda L. Blank, BA
[+] Article, Author, and Disclosure Information

Results presented in part in March 1988 at the Sixty-Ninth Annual Session of the American College of Physicians, New York, New York, and in April 1988 at the Eleventh Annual Meeting of the Society of General Internal Medicine, Arlington, Virginia.

This study was funded in part by and conducted under the auspices of the Clinical Privileges Project Steering Committee of the American College of Physicians.

Requests for Reprints: Robert S. Wigton, MD, University of Nebraska Medical Center, 42nd and Dewey Avenue, Omaha, NE 68105.

Current Author Addresses: Dr. Wigton and Ms. Nicolas: University of Nebraska Medical Center, 42nd and Dewey Avenue, Omaha, NE 68105. Ms. Blank: American Board of Internal Medicine, Inc., 200 S.W. Market Street, Portland, OR 97201-5719.

© 1989 American College of PhysiciansAmerican College of Physicians

Ann Intern Med. 1989;111(12):1023-1034. doi:10.7326/0003-4819-111-12-1023
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Study Objective: To determine which of 40 clinical procedures general internists do in their practice, how often these procedures are done, and what training is needed to develop and maintain competence in each.

Design: Mailed survey.

Participants: A random sample of 2500 American College of Physicians (ACP) members identified as general internists; 1806 (72%) responded. Of these, we excluded 398 who were board eligible or board certified in a subspecialty and 143 with unknown status. The resulting sample of 1179 was augmented in selected analyses by an additional sample of 199 rural internists.

Results: General internists did, on average, 16 of the 40 procedures. Practice characteristics markedly affected the number and variety of procedures done. A larger number of different procedures was independently associated with smaller cities, smaller hospitals, younger age, increased hours in patient care, and certain regions of the country. Practice characteristics varied considerably by practice type and location. Many procedures were done infrequently. There was reasonable agreement on the experience needed to attain and maintain competency in each procedure. The majority of respondents favored hospital credentialing for 22 of the 40 procedures.

Conclusions: General internists do a wide variety of procedures, the number and frequency of which are affected by the characteristics and location of their practice. Despite opinion to the contrary, more recently trained general internists do a wider variety of procedures than older colleagues. These results provide data to help define standards for training and credentialing and suggest that we should reexamine general internists' training in procedural skills.





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