Family medicine procedures

[Reboa]

Hey all. I was just wondering what specific procedures attendings are actually doing in practice? Almost all of the attendings in our resident clinic don’t do or teach any, even something as simple as an I and D. It has been a very demoralizing experience to say the least. How many are doing procedures that they didn’t get formal training during residency and got trained as an attending? My current plan is to do procedure courses through NPI and other organizations.

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[cabinbuilder]

Joint injection/aspirations
I & d
Cyst removal
Mole/skin lesion excision
Laceration repair suture/staple/glue
splint placement
OMM
Nail removal - partial or full
Subungual hematoma
Foreign body removal: eye, skin, nose, ears
Nasal tampon placement
Ear lavage

I was trained at one point to do:
Central lines
Paracentesis
EGD
Colonoscopy
Stress tests

But never was practical and I lost those skills.

 

[AMEHigh]

This is what I do regularly...

IUD
Nexplanon
MVA
Endometrial biopsy
I&D
Skin biopsies
Bartholin cyst catheter placement (not too often)
Ear lobe repair

I did a few ingrown nail removals in residency, but haven't since then.
I can do joint injections, but do them much anymore especially since it's not a good long term solution
I have basic colposcopy training, but still not comfortable doing on my own yet, my employer has agreed to help me get more hands on training
I wish I got vasectomy training, that's on my to do list....I have some colleagues I might be working with in the future.

 

[MedicineZ0Z]

Hey all. I was just wondering what specific procedures attendings are actually doing in practice? Almost all of the attendings in our resident clinic don’t do or teach any, even something as simple as an I and D. It has been a very demoralizing experience to say the least. How many are doing procedures that they didn’t get formal training during residency and got trained as an attending? My current plan is to do procedure courses through NPI and other organizations.

So you're referring even simple biopsies to derm? And sending I&Ds to an urgent care or ED for the midlevels to do?

 

[deleted87716]

We do I&D, lesion biopsy/excision, laceration repair, and joint/bursa/trigger point injection. My partners (both female) also do IUD insertion/removal.

I learned to do more stuff in residency (flexible sigmoidoscopy, nasopharyngoscopy, colposcopy, vasectomy, etc.), but don't do them in practice because of lack of volume and equipment/malpractice cost.

 

[Reboa]

Thanks everyone for the excellent responses. And yes we’re referring to urgent care or even treating with abx and referring to surgery with some of the more conservative attendings. I die a little inside every time I have to refer an I and D, I honestly did more of them as a med student.

 

[hallowmann]

Thanks everyone for the excellent responses. And yes we’re referring to urgent care or even treating with abx and referring to surgery with some of the more conservative attendings. I die a little inside every time I have to refer an I and D, I honestly did more of them as a med student.

Wow, that's really unfortunate. I consider myself not getting a ton in the procedure department partly out of luck, but I'm comfortable with the following:

Colpos
I&Ds
Lac repairs
Nexplanon place/removals
IUD place/removals
Punch biopsies
Joint injections
Circumcisions (unlikely to do in future, not planning to do any OB)
Nasal tamponade
Ear lavage
Subungual hematoma
Some splints

Others in our categorical program have had more luck in the following as well:
Endometrial biopsies
Shave biopsies
Cyst excision and other derm excisions

Have also learned and done paracentesis, but honestly, I don't see myself being comfortable enough to do this on a regular basis except maybe for purely palliative reasons, and even then I'm not sure.

I'm a little jealous of those of you that have done scopes.

 

[MedicineZ0Z]

Wow, that's really unfortunate. I consider myself not getting a ton in the procedure department partly out of luck, but I'm comfortable with the following:

Colpos
I&Ds
Lac repairs
Nexplanon place/removals
IUD place/removals
Punch biopsies
Joint injections
Circumcisions (unlikely to do in future, not planning to do any OB)
Nasal tamponade
Ear lavage
Subungual hematoma
Some splints

Others in our categorical program have had more luck in the following as well:
Endometrial biopsies
Shave biopsies
Cyst excision and other derm excisions

Have also learned and done paracentesis, but honestly, I don't see myself being comfortable enough to do this on a regular basis except maybe for purely palliative reasons, and even then I'm not sure.

I'm a little jealous of those of you that have done scopes.

^ This seems like a reasonable expectation for any FM residency.

I think paracentesis is very easy and just comes down to very basic ultrasound confidence.

Thanks everyone for the excellent responses. And yes we’re referring to urgent care or even treating with abx and referring to surgery with some of the more conservative attendings. I die a little inside every time I have to refer an I and D, I honestly did more of them as a med student.

And you don't raise this as a concern? In the program I mean.

This is also why I don't think we can open more residencies and have too many as it is. So many specialties also have a problem with residencies not preparing residents well in many core aspects.

 

[manotter]

I am in a full scope position that is fairly balanced in its responsibilities.

In outpatient this last month: joint injections (US guided and not), IUD placement/removal, nexplanon removal, endometrial biopsy, colposcopy, LEEP, vasectomy, botox for migraines, shave and punch biopsy, cryotherapy, colonoscopy. Sometimes will also do I&D's, cyst/lipoma removals, OMT, accupuncture.

OB: first trimester US, all of L&D except c sections and forceps

Inpatient: para and thoracentesis, central line. Rarely arterial line or LP

Overall, most of my days I will end up doing at least one procedure.

 

[hallowmann]

^ This seems like a reasonable expectation for any FM residency.

I think paracentesis is very easy and just comes down to very basic ultrasound confidence.

Yeah, honestly for paras, I'm more concerned with complication risk even if everything is done right. I don't see myself doing inpatient in the future because of schedule, so again, when would I do it? Maybe in hospice.

 

[B1GM0N3Y86]

I'm outpatient
- joint and bursa injections
- I&Ds
- skin tag removal
- shave biopsy
- cryotherapy warts
- trigger point injections
- ganglion cyst aspiration
- ear irrigation
- laceration suturing however haven't had 1 stop in since being an attending 1.5 year ago