>Procedures

>Looking back, one of the areas that I think the med school experience fell short in was giving students procedural experience. There was plenty of practice on mannequins and dummies, but very little real experience. Looking back, here are a few examples

Placing an IV
Practiced on mannequins: About 10 times
Did it for real: 0
Opportunities to do it for real: There may have been some. In the ED, I could have bugged nurses to let me do it, but there were no formal opportunites that were not self motivated.
Is this a problem?: I don’t know. While I probably won’t be starting many IVs in the future, the skills involved would certainly carry over to other procedures.

Placing an NG Tube
Practiced on mannequins: About 5 times
Did it for real: 0
Opportunities to do it for real: Where I worked, the nurses took all the first cracks at the NG tubes. Docs wrote the orders and it just kinda happened. I actually only saw one NG tube placed and that was when the nurses couldn’t get it.
Is this a problem: I don’t think so. This is not rocket science and I feel that I could place one without too much difficulty. Although, I hope it wouldn’t end up like this…


Intubation:
Practiced on mannequins: 30+
Did it for real: 0
Opportunities to do it for real: If I had done the anesthesia rotation, I would have gotten to do it. I applied to this, but so did pretty much everyone else. Instead I got urology. awesome.
Is this a problem: No. There will be abundant opportunities to practice and master this skill in residency.

Suturing
Practice on mannequins: 20+
Did for real: Around 10
Opportunties to do it for real: In the ED, the residents were more than happy to allow the students to do the suturing. So I sewed up all the lacs I could as I found it enjoyable and it earned props from the residents. I actually ended up doing some ones that were pretty tricky including a few face lacs (which I thought plastics was supposed to do?). The hardest one to do was the inside of an 80yo womans mouth who had been in an MVA and bit her lip in the process.

Foley Catheter
Practiced on mannequins: About 5 times
Did it for real: around 6
Opportunities to do it for real: In the OR, the students were expected to place all the foleys. About 5 more than I cared to do.
Is this a problem: Seems about the right number. The hardest thing about the whole process in my opinion is maintaining your sterile field.

There were a few other procedures that I actually got some decent practice at were not part of the standard curriculum

Incision and drainage of abbesses – I loved draining these pus pockets. Probably the favorite thing I did on my ED rotations.
Needle drainage of peritonsular abcesses – Again in the ED

About ER Jedi

I’m a resident doctor in Emergency Medicine and I’ve learned during the past few years that 1) I’ve had some pretty amazing experiences 2) I have a very bad short-term memory. So this blog is just a place for me to write about some of these experiences, from the ER, medical school, the wards and life in general. At least that way I’ll have some idea as to where I’ve been all this time. A scrap-book of sorts, a place to vent, organize some clinical tools and post a few good songs I’ve heard along the way.

Posted on April 16, 2011, in Medical School. Bookmark the permalink. 7 Comments.

  1. >Interesting. I would say that down in India an average, not too enthusiastic intern would have done at least twice the work on real patients than you have, but the procedural strictness is often not maintained. I have written about my first IV line placement, which I did in a patient who was pretty severely dehydrated and it was a nightmare to raise a vein.Maybe I will write a post on what it was like in the first month of internship, when we had to find out what to do, how to do and shit like that mostly on our own.But anyways, now that you are going into an EM residency, all these things will be bread and butter for you now. Let us see what you write about procedures in a year's time. Maybe you will be sick and tired of it by then! 😛

  2. >I just had a DIEP flap at a teaching hospital. My plastic surgeon, a teacher, left his interns in charge of me for the weekend, as I was going home on Monday. One of them came by early in the am, not my best time of day and clumsily checked out the little heart beats in my new breast with doppler. I asked him if this was the kind of surgery he wanted to do and he said snappily'" This is the kind of surgery I do." Which I told the nurse later was not possible, as there are very few surgeons that do Diep flaps and I know for sure his name was not on the list. Just a thought, bedside manner is important. Every patient is a real person.

  3. >@mommemauA few thoughts on what your said…You are absolutely right that bedside manner is important. I assure you, this was emphasized way more than procedures in med school, haha. If one had to stereotype, surgeons are often known for their lack of bedside manner. Don't get me wrong, there are many kinda and wonderful surgeons out there, but there are also those that are rough around the edges. I'm not defending him/her in any way, but I think you were both right in terms of who is doing that surgery. The resident is learning how to do it, and depending on their year of residency, they are more or less involved. A senior resident will have done most of if not all of they surgery themselves, while a 1st year intern, will largely only assist. Regardless, two people always "do" a surgery (mostly). One is always the attending, whose name goes next to the procedure like you said, and the other the resident/intern who "leads" the surgery based on their skill and stage of training. So you were both right in a way. And again, not defending the person, just trying to promote understanding for why things happen and people say and do the things they do. If it was the weekend, I am guessing your resident/intern had been there since 5am or earlier the morning before and probably got little to no sleep before seeing you so early. Even the doctors with the worlds greatest bedside manner have been known to seem a little teste after 30 hours of call.

  4. >Thank you for talking about these procedures, i found it so interesting. Please don't think i'm too gross, bit i think draining an abcess must be sooo satisfying…yay! Have a good break and i look forward to your stories from Residency, if you ever find the time!

  5. >OK. Gotta check out this tracy thingy. If they think draining abscesses are oh so satisfying, then well, they must be something else. or they haven't seen some of the abscesses i have had to drain in my internship year. ugh.

  6. >I have to admit, I'm with Tracy on this. Nothing like putting some pressure on an abcess and watching the pus pour out. Sounds gross, but its incredibly satisfying for some sick reason.

  7. >Pranab must think i am truly a nut case! Ha! Well, whateva!

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