Advanced Procedures

Rationale

A number of advanced procedures may be performed by general internists but usually not third-year clerks. However, a knowledge of the key indications, contraindications, risks, and benefits of these procedures is essential for high quality patient care. Physicians, regardless of specialty, must be able to explain to their patients, in understandable terms, what will be experienced during a procedure.

Prerequisites

Knowledge of relevant anatomy and an ability to communicate with patients.

Specific Learning Objectives

1. Knowledge: Each student should be able to describe:
   1. key indications, contraindications, risks, and benefits of each of the following advanced procedures:
      1. arthrocentesis.
      2. central venous catheterization.
      3. flexible sigmoidoscopy.
      4. lumbar puncture.
      5. thoracentesis.
      6. paracentesis.
      7. Swan Ganz catheterization.
      8. bone marrow aspiration.
      9. skin biopsy.
   2. alternatives to a given procedure.
   3. what the patient’s experience of the procedure will be.
2. Skills: Each student should be able to:
   1. participate in obtaining informed consent for advanced procedures, including the explanation of the purpose, possible complications, alternative approaches, and conditions necessary to make the procedure as comfortable, safe, and interpretable as possible.
3. Attitudes: Each student should:
   1. demonstrate responsibility for helping to provide informed consent.
   2. demonstrate a commitment to explaining the patient’s experience in understandable terms.
   3. communicate risks and benefits of procedures to patients regularly.
   4. maximize patient comfort during a procedure.