Resident Physiciansʼ Comfort with Managing Feeding Tubes at the Completion of Internal Medicine Residency

Abstract

Purpose: Issues in geriatric gastroenterology are increasingly important with the aging U.S. population. Feeding tubes are often used in the elderly. Physicians' familiarity with managing feeding tubes is important. This study evaluated internal medicine resident physicians' comfort with feeding tube management and the effectiveness of various teaching modalities. Methods: An anonymous survey addressing core gastroenterology topics was distributed to all PGY-3 internal medicine resident physicians at an urban university medical center. Information was collected about the benefit of various teaching modalities utilized during residency training and physicians' comfort level with feeding tube management. The teaching modalities evaluated included attending rounds, autopsy conference, didactic rounds, direct patient care (inpatient and outpatient), grand rounds, individual reading, journal club, morning report and noon conference. Information was obtained on whether resident physicians participated in a gastroenterology elective. A database was developed. Statistical analysis was performed using Chi-square tables with statistical significance set at P < 0.05. Results: Twenty of 29 (69%) completed surveys were returned. Care of hospitalized patients and individual reading were reported to be the most beneficial teaching modalities for learning feeding tube management. There was a statistically significant difference (P= 0.00023) in the rate at which resident physicians report the teaching benefit of inpatient care compared to outpatient care. 50% of resident physicians who completed a gastroenterology elective during residency felt that more emphasis on feeding tubes was needed in residency. Only 20% of resident physicians reported comfort with feeding tube management at the end of residency training. Conclusion: Issues in geriatric gastroenterology are increasingly important with an aging U.S. population. Feeding tube management should be a component of internal medicine residency training. Physicians encounter feeding tubes in the hospital, primary care clinic, geriatric clinic and in long-term care settings. Resident physicians reported that care of hospitalized patients and individual readings were most beneficial in learning feeding tube management. Outpatient instruction was reported to be of limited benefit. Educational initiatives should be developed to enhance instruction about feeding tubes in internal medicine residency training.