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Raising the Bar for Procedural Competency Among Hospitalists

IN RESPONSE: We thank Dr. Weigel for his informative perspective on the state of procedural training in internal medicine at a rural community program. We agree that the scope of practice among internists and internists in training will vary according to structure and available resources. The lack of subspecialists (such as interventional radiologists) and open intensive care unit models in particular environments may, indeed, generate the procedural volume necessary for residents and hospitalists to develop and maintain skills, with the caveat that procedural experience does not necessarily equal competence (1). Wherever possible, we still recommend the use of lower-cost simulation for practice and assessment to increase patient safety. Dr. Weigel is concerned that advanced practice providers may represent competitors for the opportunity to perform procedures. Our previous work based on a national survey of program directors in internal medicine (2) showed that internal medicine residency programs are already engaging these providers to perform procedures, supervise, and assess residents in training. In our experience, they can play a complementary role in improving safety and the educational experience for both trainees and faculty.