SHM Converge Scientific Abstract ePoster Gallery-A Pocket of Untapped Potential: Shifting Paradigms in Procedural Competency

Pdf Summary

This document describes a decentralized, low-resource model to improve paracentesis training and access in Internal Medicine residency programs. With procedural certification no longer required for residency, many hospitalists lack bedside procedure skills, and dedicated procedure services are not always available despite frequent clinical need. This can delay timely paracentesis, which is important for patients with cirrhosis and ascites.<br /><br />To address this gap, the authors implemented a workflow using Epic secure chat to rapidly connect learners with paracentesis-certified faculty and residents. The system was paired with structured online education, supervised bedside training, logging in New Innovations, and clear documentation/billing guidance. The goal was to improve safety, efficiency, and trainee competency without requiring a traditional, heavily staffed procedure service.<br /><br />Before the intervention, only 16 of 256 Internal Medicine residents (6.3%) were certified to independently perform abdominal paracentesis. During the intervention period from November 19, 2024, to March 10, 2025, there were 68 secure chats over 111 days, with an average pairing time of 1.4 minutes. Procedure volume increased from 39 in the prior year to 71 during the intervention, a 55% increase. Certification also improved, with 18 new certifications achieved during the intervention compared with 16 certified residents before implementation.<br /><br />The authors conclude that secure-chat-based real-time pairing created a scalable, sustainable alternative to traditional procedure services. Their model increased procedure volume, expanded resident certification, and reduced administrative burden while supporting timely, supervised care.

Asset Subtitle

Vasundhara Singh

Meta Tag

Author List Brian Markoff, Joseph Abraham, Lance Maresky, Vasundhara Singh

Category Innovations

Concept Paracentesis

Concept Procedural Certification

Concept Cirrhosis

Concept Cirrhotic Ascites

Concept Competency Gap

Distinguished Non-Finalist

Presenter Organization Icahn School of Medicine at Mount Sinai

Presenting Author Vasundhara Singh

Track Quality Improvement

Keywords

paracentesis

internal medicine residency

procedure training

Epic secure chat

decentralized workflow

resident certification

bedside supervision

cirrhosis and ascites

procedure services

clinical education

Paracentesis

Procedural Certification

Cirrhosis

Cirrhotic Ascites

Competency Gap