Outpatient Procedure CORE PCIM Rotation

Lesson Plan
Outpatient Procedures Core PCIM Rotation

Strengthening procedural skills in the outpatient setting

Summary

1. Subject(s): Musculoskeletal joint injections (knee, shoulder), Pelvic exam/Pap testing, Introduction to Point of Care Ultrasound (POCUS), Non-emergent EGD/Colonoscopy, urological procedures

2. Objectives: 

   1. By the end of this rotation, the resident should have basic competency in the skills of: knee & shoulder joint injections (with and without ultrasound guidance), pelvic exam/Pap testing, 

   2. Residents will also have basic understanding of POCUS as it pertains to the outpatient setting

   3. The resident will observe prostate biopsies, EGD/Colonoscopies to provide context and experience for when patients are referred. 

Adult Learning Tip: What do you know about these topics?  Have you cared for patients needing these procedures?  What questions have come to mind?  How could you integrate these procedures into your practice?  Use your questions as conversation starters to introduce to your subspecialty faculty as you get to know them over the next few weeks.

3. Time Allotment: A dedicated 2-week section of an X block for a focused learning experience.  

Materials & Resources

Adult Learning Tip: Use the resources below to familiarize yourself with the supplies, steps and techniques involved so you can have a more nuanced learning experience when you are on the rotation.  

1. Resources:

   1. Modules

      1. ACP POCUS Online Modules (free with ACP membership) - these take a significant amount of time to complete, but are an outstanding introduction

         1. https://www.acponline.org/meetings-courses/focused-topics/point-of-care-ultrasound-pocus-for-internal-medicine/pocus-online-learning-activities

   2. MKSAP

      1. Chief created quizzes

      2. System based chapters / reviews

   3. Videos & Websites

      1. Pelvic exam/Pap testing

         1. https://stanfordmedicine25.stanford.edu/the25/PelvicExam.html

         2. https://www.youtube.com/watch?v=AllLe3qI7uc

      2. Knee Injection

         1. Exam: https://stanfordmedicine25.stanford.edu/the25/knee.html

         2. Uptodate Discussion: https://www.uptodate.com/contents/joint-aspiration-or-injection-in-adults-technique-and-indications

         3. Video - Injection - Antero-lateral approach: https://medconnection.ucsfhealth.org/videos/how-to-do-a-knee-injection

      3. Shoulder Injection

         1. Exam: https://www.nejm.org/doi/full/10.1056/nejmvcm1212941f

         2. Video - Injection - Subacromial approach: https://medconnection.ucsfhealth.org/videos/how-to-do-a-subacromial-shoulder-injection

      4. Colonoscopy

         1. https://webfiles.gi.org/links/committees/Public%20Relations/2021CRC-infographic.pdf

         2. https://gastro.org/clinical-guidance/follow-up-after-colonoscopy-and-polypectomy-a-consensus-update-by-the-u-s-multi-society-task-force-on-colorectal-cancer/ 

   4. Journal Articles

      1. Analysis of the Cost and Efficacy of Intra-Articular Knee Injections: https://journals.lww.com/jaaosglobal/Fulltext/2022/02000/Analysis_of_the_Cost_and_Efficacy_of.11.aspx

Assessment

At the end of your rotation, your faculty subspecialty attendings will be asked to complete an evaluation on your performance.  This will reflect your progress on the objectives outlined above.  You will have an opportunity to evaluate our rotation as well - we look forward to specific feedback which will help us grow and improve these experiences going forward!