A Dynamic Risk Management Approach for Reducing Harm From Invasive Bedside Procedures Performed During Residency

Area of Science:

• Medical Education
• Patient Safety
• Quality Improvement

Background:

• Internal medicine residents perform many invasive bedside procedures.
• Current training often uses procedure volume as a proxy for competence, potentially compromising patient safety.
• There is a need to reframe training effectiveness using patient outcome metrics.

Purpose of the Study:

• To introduce the as low as reasonably achievable (ALARA) approach for assessing and reducing risks in bedside procedural training.
• To encourage training program directors to use ALARA calculations for risk trade-offs and improving patient outcomes.
• To explore quality improvement methods for assessing training resources and aims.

Main Methods:

• Introduction of the ALARA approach, adapted from the nuclear industry.
• Description of five training options for bedside procedures.
• Exploration of quality improvement tools: process maps, fishbone diagrams, failure mode and effects analysis, and risk matrices.

Main Results:

• The study proposes reframing procedural training effectiveness using outcome metrics instead of process measures alone.
• The ALARA approach offers a framework for managing risks in resident training.
• Various quality improvement methodologies can be applied to assess and enhance training programs.

Conclusions:

• Adopting the ALARA approach can enhance patient safety in internal medicine residency procedural training.
• Future research should focus on optimizing training programs for independent practice and patient outcomes.
• Faculty supervision decisions should align with ALARA risk management standards.