Office procedures

[PMD1982]

Hi Guys,
I'm in my third year of IM residency. I'm currently interviewing for primary care jobs. I am finding that one question often asked during interviews is in regards to outpatient procedures. (which procedures am I proficient at, etc) Like most IM residents, I am very comfortable with insertion of central venous catheters, draining ascites, etc. If I were to practice hospital medicine, then I would be all set. However, I want to do primarily ambulatory care. I have little experience with typical office procedures such as freezing warts, skin biopsies...
My question(s) is, where did you most of you learn your outpatient procedures, residency or not until you had your first job? At this point, I don't think I will learn anything further in terms of office procedures during my residency so are there any useful books to read up on?
Suggestions?

Thanks!!

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[cheruka]

I am just a lowly fourth yr. But, this is the exact reason I am not comfortable with IM. After thinking for a long time I only applied to FM this yr. My day will go so much faster if I can do procedures...
Keeping my fingers crossed.

 

[VA Hopeful Dr]

Hi Guys,
I'm in my third year of IM residency. I'm currently interviewing for primary care jobs. I am finding that one question often asked during interviews is in regards to outpatient procedures. (which procedures am I proficient at, etc) Like most IM residents, I am very comfortable with insertion of central venous catheters, draining ascites, etc. If I were to practice hospital medicine, then I would be all set. However, I want to do primarily ambulatory care. I have little experience with typical office procedures such as freezing warts, skin biopsies...
My question(s) is, where did you most of you learn your outpatient procedures, residency or not until you had your first job? At this point, I don't think I will learn anything further in terms of office procedures during my residency so are there any useful books to read up on?
Suggestions?

Thanks!!

Most big conferences have procedure workshops. I believe ACP has their annual meeting coming up in April, might want to look into that.

The textbook we use, that I like is this..

http://www.amazon.com/Pfenninger-Fowlers-Procedures-Primary-Care/dp/0323052673

 

[lowbudget]

This is a very common thing that's not highlighted enough between the difference between FM and IM when medical students are considering specialties. This is also an important point for FM programs that are inpatient-heavy with poor outpatient experience. Those programs say that if you can do inpatient, outpatient is easy. Perhaps... but outpatient medicine is different from inpatient medicine. Procedures is one of those things.

Outpatient procedures not only make your day go by faster, but it also allows you to make more money.

You're still a 3 year IM resident. If you've still got 6 months left. You should rotate with a family physician who does a good number of outpatient procedures. Bookwise, Pfenninger and Fowler's Procedures in Primary Care. They also hosts some Procedures CME through National Procedures Institute which (IMO) are super expensive. CME conferences hosted by AAFP usually has a procedures workshop where you can do it on some dummies. The other thing would be to join a practice where a partner can walk you through a procedure.

Freezing warts and shave biopsies are super simple. You just need to know when it is ok to do it and when it's not ok to do it which is mostly cognitive. And at that point, it's a matter of practicing and figuring out how to get better and better at them.

 

[smq123]

Or do a rheum elective where you get to do joint injections.

You may also shadow a dermatologist who does a lot of procedures. I think that the punch biopsy is a huge tool to have in your arsenal.