Procedure: Arthrocentesis
INTERNAL MEDICINE RESIDENCY PROGRAM
Faculty:
Sites: Sites: Carle Clinic
Association (CCA),
___________________________________________________________________________________
DESCRIPTION:
Education experience under the supervision of Dr.
I. GOALS
Develop
the knowledge, and skills for competent performance of arthrocentesis.
II.
OBJECTIVES
A. PATIENT CARE:
Objective
1: Demonstrate clinical skills of competent performance of arthrocentesis with
supervision and advance to independent performance.
Objective
2: Observe Universal Precautions at all times.
B. MEDICAL KNOWLEDGE:
Objective
1: Describe indications, contraindications, specific technical aspects of the
procedure, interpretation of results and complications.
Objective
2: Interpret results of procedure.
C. PRACTICE-BASED LEARNING AND
IMPROVEMENT
Objective
1: Demonstrate ability in medical decision making based on interpretation of
arthrocentesis results.
D. INTERPERSONAL AND COMMUNICATION
SKILLS
Objective
1: Communicate clearly, audibly and in lay language to explain the procedure to
the patient and family. Avoid medical jargon.
Objective
2: Work effectively with others on interdisciplinary and/or multidisciplinary
teams.
E. PROFESSIONALISM
Objective
1: Demonstrate respect and compassion to assure patient’s understanding of the
procedure.
Objective
2: Recognize the legal requirements of informed consent.
F. SYSTEM-BASED PRACTICE
Objective
1: Recognize financial issues of heath care, with emphasis on understanding
acute and chronic care, and the role of the Centers for Medicare and Medicaid
Services (CMS), and other third party payers.
III. METHODS
Residents
gain knowledge about arthrocentesis by first reading from standard medical
textbooks, e.g. Kelley's Textbook of Rheumatology, Cecil Textbook of Medicine, Ferri: Practical Guide to the Care of the Medical Patient,
and The Merck Manual. S/he must be thoroughly
acquainted with the indications, contraindications, specific technical aspects
of the procedure, interpretation of results and complications. Universal Precautions must be observed at all
times. The resident first observes and
then must perform at least three arthrocenteses satisfactorily under direct
supervision. S/he must satisfy the
cognitive and technical skills before allowed to perform independently.
The
resident demonstrates professional and communication skills by explaining the
procedure in lay terms to the patient. The resident may gain experience in different ways by performing this
procedure on patients at the various sites.
Carle
Clinic Association (CCA)
Drs. Naveed Salahuddin and Alberto Munoz provide
training as part of the Carle Rheumatology Rotation. The Carle Emergency Department physicians
pages residents in house (general medical ward and ICU) to perform
arthrocentesis. Dr. James Thomas is the physician contact for the Emergency
Department. Laura B. Brinkley,
Residents
have the opportunity to train in the DVAIHS Pain Clinic. The DVAIHS chief resident assigns the
Nephrology or VA-Ambulatory residents to train once per week.
Provena
Training
is available in PCMC Adult Medicine under the supervision of Dr. Scott Paluska. Residents contact Kathy Atwood, office manager on Friday afternoons to schedule for the upcoming week as his/her
rotation allows.
Additional
Training
The
resident also performs didactic and technical practice on a knee model
mannequin, available after 1st week of November in the Carle Medical Education
Department. Regular formal teaching
sessions on mannequins are set up and coordinated by the Chief residents at
CCA, PCMC, and DVAIHS sites. A workshop
for Joint injections at Carle Foundation Day (
Core
Conference Curriculum :
The core
conference curriculum is an 18 month curriculum, however, arthrocentesis is a
scheduled 12 month topic coordinated and taught by the Chief residents.
IV. EVALUATION
ACGME Competencies
According
to Accreditation Council of Graduate Medical Education (ACGME), training and
evaluation must include the following competencies: Patient Care, Medical
Knowledge, Practice – Based Learning and Improvement, Interpersonal and
Communication Skills, Professionalism, and System-Based Practice.
Patient Care will be evaluated by assessment of
the attending physician or clinician. Procedures performed will be documented.
Medical Knowledge will be evaluated by assessment of
the attending physician or clinician.
Practice-Based Learning and
Improvement will be
evaluated by assessment of the attending physician or clinician.
Interpersonal and Communication
Skills will be evaluated
by assessment of the attending physician or clinician.
Professionalism will be evaluated by assessment of
the attending physician or clinician.
System-Based Practice will be evaluated by assessment of
the attending physician or clinician.
V. REFERENCES
Cecil
Textbook of Medicine (current edition)
Ferri:
Practical Guide to the Care of the Medical Patient (current edition)
Kelley's
Textbook of Rheumatology (current edition)
The Merck
Manual (current edition)