Competency: Understand the indications, contraindications, and potential complications of common clinical procedures and perform the basic clinical procedures expected of a new PGY-1
Something that is going to be important for me going forward in my career in medicine is procedures. I am applying for residency in categorical internal medicine, but what happens to me after that is still up in the air. I’m pretty sure I want to pursue fellowship after residency, but the subspecialty that I want to go after is still a little undecided. Right now, I am learning towards nephrology, in particular, interventional nephrology. Other subspecialties that I am thinking about right now include gastroenterology and pulmonology/critical care, both heavily procedure-focused fields. So, for me, procedures are going to be at the heart of my future practice in some way, shape or form. One of the ways I have wanted to shape my medical school education was to put a focus on preparing me to perform procedures at a high level at the beginning of intern year.
Since starting the third year of medical school, I have tried to put myself in position to at least help residents and fellows with procedures, if not be able to perform some under supervision. I have been very fortunate in this pursuit that the residents and fellows that I have worked with have had great patience and given me the chance to do a good number of supervised procedures on the wards. I remember my first time doing a procedure on a real person in the neurological ICU and then up to the last one I did during my most recent emergency medicine rotation. Each time I have had the chance to do a procedure it has helped to further reinforce that desire to have these physical interventions be a permanent part of my medical practice in the future. It also inspired me to seek out more knowledge about procedures and how they fit into the tapestry of patient care. That curiosity has brought me to my advanced competency in Critical Care and Procedures.
The critical care and procedures advanced competency is a four week deep dive into common procedures performed in the ICU, the indications, contraindications and the current research behind particular techniques. This course gives a lot of more time in the clinical skills and simulation labs along with shadowing different personnel in the ICU such as the pharmacist and respiratory therapist, so that we gain further appreciation for the multidisciplinary approach to critical care medicine. I’ve really enjoyed the course that Dr. Exline has put together and has given me that little bit of extra confidence that will hopefully carry over into intern year and having to do procedures all of the time.
Thanks to my experiences on the wards and in my advance competency, I feel that will have some extra confidence heading into my intern year to help with and perform procedures for the patients that I see to. As a resident, my goal for improvement in this area is to be involved in as many procedures as possible. I feel the best way to become successful at procedures is to get as many repetitions as you can on them. I know there are some residents that don’t like to be involved in procedures and can do the minimum amount to be signed off on them in their program. I do not intend to be this way. I want to be as involved as I can while also being accountable to those around me that my share of the daily work will also get done. This is my plan for improvement moving forward in this area.
Artifact 1: 
This is an excerpt from our course description for the advanced competency in critical care and procedures rotation. This shows the objectives of the course and what is expected of us to become more competent in.
Artifact 2: 
This is my appointment for my ACLS renewal coming up on March 5th. I am committed to keeping up certifications for interventions that has potential to save patients lives.