In the Nick of Time: Same-Day Simulation-Paired Procedure Clinic for Internal Medicine Residents

Internal medicine (IM) residents face declining opportunities to perform ambulatory procedures due to increased reliance on specialty services and competing demands. While simulation-based training improves short-term skill acquisition, it does not reliably translate into clinical proficiency without timely application and feedback.

To evaluate the feasibility and educational impact of a same-day simulation-paired procedure clinic (SPPC) on procedural volume, cognitive load (CL), and resident experience.

Beginning July 2020, postgraduate year (PGY) 1 IM residents at the University of Colorado who rotated through the Veterans Affairs Rapid Access Clinic (RAC) completed weekly simulations on 4 core procedures, each followed by a same-day procedure clinic. We analyzed changes in annual procedural volume from 2017 to 2025, administered post-procedural CL surveys via REDCap, and conducted qualitative interviews with residents, from September 2021 to April 2022, to explore their experiences with skill development and the learning environment. The curriculum utilized existing space, faculty, and materials at no added cost.

All 250 PGY-1 IM residents who rotated through RAC over 5 years participated in the SPPC curriculum. Residents' average annual procedural volume for the 4 procedures increased 96% (from 560.5 to 1099) after SPPC implementation. Thirty-three of 34 (97%) PGY-1 residents completed a total of 113 CL surveys, in which germane load (mental effort directed toward learning) was consistently rated higher than extraneous load (effort irrelevant to the task). Thematic analysis of interviews (n=18) revealed 2 main effects of the SPPC: (1) systematic skill development through deliberate practice and (2) reduced distractions and improved focus for learning.

A same-day SPPC was feasible within existing clinical infrastructure, and was associated with increased procedural opportunities and high resident-reported learning-focused cognitive engagement.