ABIM Required Procedures

The ABIM does not specify a minimum number of procedures to demonstrate competency; however, to assure adequate knowledge and understanding of the common procedures in internal medicine, each resident should be an active participant for each procedure five or more times.

To graduate from the program, you are expected to complete five of each of the following procedures:

  • Advanced cardiac life support
  • Drawing venous bloood
  • Drawing arterial blood
  • Pap smear and endocervical culture
  • Placing a peripheral venous line

Please log these procedures *and* all other procedures that you perform in MedHub.

 Other Procedures (paracentesis, thoracentesis, lumbar puncture, central line placement, arterial line placement):

1. Daytime non-emergent floor patient procedures: To be done with procedure service (pager 1111) or ICU attending supervision.

2. Daytime ICU procedures: Also to be supervised by the ICU attending or procedure service.

3. Nighttime emergent procedures: To be supervised by the most experienced senior resident available (as documented in MedHub). There must documentation of emergency conditions — in other words, the rationale for emergent placement — in the patient’s chart as well as full procedure documentation.

A signed consent form must be present on the chart before performing any of the following procedures in non-emergency settings:

  • Central venous catheter placement
  • Arterial lines
  • Lumbar puncture
  • Thoracentesis
  • Paracentesis

Central Line Placement

In 2013, the hospital instituted a standardized training in central line placement for all housestaff. A registered nurse trained in central line procedures should be present for all non-emergent line placements; s/he will document compliance with best practices. Central lines must be placed with the patient on telemetry except in emergency situations.

The hospital’s policy on central line placements is found here.

IDPH Catheter Removal ProtocolSummary and Clarification

Due to an Illinois Department of Public Health Survey, the policy detailed below was implemented on March 22, 2011. This policy will remain in place until a competency validation process has been completed for this particular procedure.

General Care Units: All catheters 7.5 French (Fr) and larger must be removed by the Pulmonary and Critical Care Procedure Service (188-1111). The notable catheters that are subject to this policy include all the Kendall dialysis catheters, the Arrow Introducer catheter (AK-09903-CDC), aka “Cordis Catheter” and all catheters used for the Thoratec devices. A list of all 7.5 Fr and larger catheters is attached for your review.

Intensive Care Units: 7.5 Fr or larger catheters must be removed by an ICU Attending or with an ICU Attending at the patient’s bedside providing direct supervision.

All catheters 7 Fr and smaller will be exempt from the policy and may be removed by Residents, Physician Assistants, Advance Practice Nurses, Registered Nurses and Medical Students.

Emergency Exception Only: If a catheter must be removed emergently and the Pulmonary and Critical Care Procedure Service is not available, an Attending must use his/her clinical judgment to determine whether removal of the catheter can wait until 7am for the Procedure Service. If the catheter must be removed immediately, the Attending Hospitalist On Call must be paged to remove the catheter. The emergent nature of the patient’s condition must be documented in the medical record.

Medical Students: A third or fourth year Medical Student may NOT remove 7.5 Fr or larger catheters unless they are under the direct supervision of an ICU Attending. Only after the Residents have completed the competency validation program described above may a Resident provide supervision of a Medical Student in the removal of a 7.5 Fr or larger catheter.  We expect the Residents to be able to complete this competency training in the next 1-2 weeks.

Femoral catheters are exempt and the policy restrictions described above do not apply.