Procedural training for internal medicine residents pursuing subspecialty training: a national survey of fellowship program directors.

In 2019, the American Board of Internal Medicine (ABIM) changed procedural requirements for internal medicine (IM) residents, emphasizing that IM residents should 'have the opportunity to develop competence in procedures which will further their development as fellows in their chosen subspecialty'. While residents need to perform procedures, 'not all residents need to perform all procedures'. We sought to identify which procedures IM fellowship directors (FD) prefer graduating residents entering their fellowships have experience with and competence to perform. A total of (N = 1,463) FDs in the fifteen subspecialties of medicine were identified through the ACGME website and reached via email with a REDCap link to access the survey. The survey was developed amongst the primary authors and included demographic questions and a list of procedures. For each procedure listed, FDs were asked to indicate whether incoming fellows should have knowledge and understanding of, some experience but not competence in, or competence to perform the procedure. The survey also included Likert scale questions aimed at understanding FD attitudes regarding the value of learning procedures during IM training and a free text response soliciting their opinion on the ABIM change in procedure requirements. A total of 424 surveys were completed by FDs from the 15 ABIM subspecialties. Most of the FDs in 8 of 15 subspecialties indicated they preferred incoming fellows have competence in 1-10 (mean 5) of 19 procedures listed and these varied by specialty. One hundred free text responses were received and assigned to one or more themes. This survey can provide guidance to IM program directors and residents applying to subspecialties to tailor their procedural training to the specialty of their choosing.