How did you learn procedures in Family Med residency?

[Captain DO]

Wondering how it works.

Does every residency make an effort to teach procedures such as I&D, suturing, ingrown toenail, etc or is it hit or miss?

When you learn the procedures, is it during a surgical/emergency rotation, or is it a faculty workshop?

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[cabinbuilder]

The residency doesn't "make the effort", it comes down to you making the effort and making it known that you want to learn procedures. Learn them in clinic with clinic patients and the attending preceptor. Learn in the ER when the doc there is doing a line, or intubation. Have nursing teach you IV's. Do an interventional radiology rotation and learn central lines in the suite and ICU. Do a GI rotation and learn scopes and lap band adjustments. Do an ortho rotation and learn how to splint, cast, and do joint injections/drain effusions, inject knees and shoulders. Have the surgeons teach you suturing (multiple layers). Be proficient in taking off lesions and doing biopsies. Do a podiatry rotation to learn about nail excisions, fungus treatment, complete removals, taking care of wounds on the soles, etc.

 

[JustPlainBill]

The residency doesn't "make the effort", it comes down to you making the effort and making it known that you want to learn procedures. Learn them in clinic with clinic patients and the attending preceptor. Learn in the ER when the doc there is doing a line, or intubation. Have nursing teach you IV's. Do an interventional radiology rotation and learn central lines in the suite and ICU. Do a GI rotation and learn scopes and lap band adjustments. Do an ortho rotation and learn how to splint, cast, and do joint injections/drain effusions, inject knees and shoulders. Have the surgeons teach you suturing (multiple layers). Be proficient in taking off lesions and doing biopsies. Do a podiatry rotation to learn about nail excisions, fungus treatment, complete removals, taking care of wounds on the soles, etc.

Agree with everything cabinbuilder said --- and make sure you go to an unopposed or non-University based residency where you don't have to wait in line behind other residents/programs to get them -- make sure your clinic either has a separate procedures clinic or gets enough of them so that statistically you can get them -- with us, all of the procedures went out to the specialists and we ran mainly a DM/HTN/HLD clinic -- we didn't rotate through with the surgery service since they used FM residents to do their admission h&P's and scutwork rather than getting any real training -- so we went with a community surgeon who was all about providing us a "relaxing" rotation and would generally send us home at 11 -- nice guy but not great training -- with ortho we either watched them do pre-ops or rotated with an FM Sports medicine guy who also had us watch him do his new US guided injections ---

enough griping, it's in the past but please learn from my mistakes -- and get some good training.

 

[teacherman84]

This is a good thing to ask about on interviews of its importance to you.

We have a dedicated procedures days within our clinic that we (our residency clinic as well as the non resident fm clinic) refer to for procedures we don't have time for in clinic (excisional biopsies, toenails, nexplanon removal, vasectomy, colpo, circumcision, the occasional paracentesis). We do a lot in our own clinic (iud, nexplanon, shave/punch biopsies, toenails, injections) which we supervised until proficient and once 2 attendings say your good you can practice that skill independently. By second year I'm letting med studs do a lot of procedures because I'm signed off already.
We have separate schedules within our clinic where we'll do OMT/acupuncture if that is something you do.
Ortho/sports blocks we get a little bit of casting and a lot of injections...well do joints with both and our fm sports guy will walk you through us guided stuff, prp/prolo, triggers, steroid.
ER blocks you get in the most suturing/splinting. Were unopposed so on surgery you get to sew and if you get to the case early anesthesia will let you intubated or place the line.
Inpatient wards you get any A line, central lines, thoracentesis.
If you want colonoscopy, you will have time set aside to do scopes...our residents who want to learn csopes leave residency with well over 100 on their own.
Most of us finish intern year with at least a few c sections as primary skin to skin...those who like ob get more as a senior.

I saw a variety on the interview trail, if it's a priority to you and how you want to practice in the future, be sure you bring it up.

 

[JustPlainBill]

This is a good thing to ask about on interviews of its importance to you.

We have a dedicated procedures days within our clinic that we (our residency clinic as well as the non resident fm clinic) refer to for procedures we don't have time for in clinic (excisional biopsies, toenails, nexplanon removal, vasectomy, colpo, circumcision, the occasional paracentesis). We do a lot in our own clinic (iud, nexplanon, shave/punch biopsies, toenails, injections) which we supervised until proficient and once 2 attendings say your good you can practice that skill independently. By second year I'm letting med studs do a lot of procedures because I'm signed off already.
We have separate schedules within our clinic where we'll do OMT/acupuncture if that is something you do.
Ortho/sports blocks we get a little bit of casting and a lot of injections...well do joints with both and our fm sports guy will walk you through us guided stuff, prp/prolo, triggers, steroid.
ER blocks you get in the most suturing/splinting. Were unopposed so on surgery you get to sew and if you get to the case early anesthesia will let you intubated or place the line.
Inpatient wards you get any A line, central lines, thoracentesis.
If you want colonoscopy, you will have time set aside to do scopes...our residents who want to learn csopes leave residency with well over 100 on their own.
Most of us finish intern year with at least a few c sections as primary skin to skin...those who like ob get more as a senior.

I saw a variety on the interview trail, if it's a priority to you and how you want to practice in the future, be sure you bring it up.

Can I go back to your residency as an intern? Sounds like a good one ---

 

[teacherman84]

It's good...but you have to sell yourself off into indentured servitude to come here.

 

[JustPlainBill]

It's good...but you have to sell yourself off into indentured servitude to come here.

you wouldn't have to twist my arm too hard to visit Langley,Wright-Patt, Dickey-Goober, Andersen,Hickam,Rhein-Main or other various and sundry places ---

 

[NurWollen]

It's good...but you have to sell yourself off into indentured servitude to come here.

How so?

Edit: never mind, I got it. Military.

 

[primadonna22274]

I'm at an unopposed FM program in a regional medical center.
We have dedicated procedures months PGY2 and PGY3, as well as an ultrasound month elective and an optional 2 wk procedures elective PGY1. We do all the lines and endoscopy we want and then some, and usual hospital bedside procedures (thoracentesis, paracentesis, LP etc).
We have dedicated procedurist faculty and other residents who are signed off on central lines proctor the new residents.
Procedures is important at my program because we tend to train folks for the rural trenches. I wold not have ranked highly a program that didn't have this benefit, but that's just my preference.

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[Doctor4Life1769]

I'm at an unopposed FM program in a regional medical center.
We have dedicated procedures months PGY2 and PGY3, as well as an ultrasound month elective and an optional 2 wk procedures elective PGY1. We do all the lines and endoscopy we want and then some, and usual hospital bedside procedures (thoracentesis, paracentesis, LP etc).
We have dedicated procedurist faculty and other residents who are signed off on central lines proctor the new residents.
Procedures is important at my program because we tend to train folks for the rural trenches. I wold not have ranked highly a program that didn't have this benefit, but that's just my preference.

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Y'all do endoscopies?

 

[cabinbuilder]

Y'all do endoscopies?

I trained to do them but never got a chance out in real life.

 

[Doctor4Life1769]

I trained to do them but never got a chance out in real life.

That's cool.
Who interprets the findings?
Were you also doing the biopsy?

 

[primadonna22274]

Absolutely. Upper and lower EGD/colonoscopy, the occasional EGD-guided PEG. We don't do bronchs. Can do direct laryngoscopy in clinic although I never have. Saw plenty in the ENT office...not that complicated but I haven't needed to. (Yet.)

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[Doctor4Life1769]

Absolutely. Upper and lower EGD/colonoscopy, the occasional EGD-guided PEG. We don't do bronchs. Can do direct laryngoscopy in clinic although I never have. Saw plenty in the ENT office...not that complicated but I haven't needed to. (Yet.)

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Who did interpretations? Did you do biopsies?
You'd be held to the same standard as a GI doc, what if you missed something?

 

[primadonna22274]

Yes, we do interpretations and biopsies with our attending FM proceduralist who has been doing these for 30 years and fought hard to maintain our hospital's privileges to continue to train the residents to do them. Now, in truth a small handful of us have the will to do enough of them throughout residency to get credentialed to do them after residency, but the opportunity is there and we do have graduates who are doing them in the community. I'm not much good with the scope myself but then I never had a knack for video games either.
We have GI and general surgery backup and a good relationship with both although rarely have needed to call for backup.
There are certainly scopes that we go in and look and see a hot mess that we recognize is better to back out and get a specialist's eyes on the case, but we see lots of normal and abnormal, too. In my part of SC there aren't enough fellowship-trained GIs to do all the scopes to serve our population, so they're happy to share the work.

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[Doctor4Life1769]

Yes, we do interpretations and biopsies with our attending FM proceduralist who has been doing these for 30 years and fought hard to maintain our hospital's privileges to continue to train the residents to do them. Now, in truth a small handful of us have the will to do enough of them throughout residency to get credentialed to do them after residency, but the opportunity is there and we do have graduates who are doing them in the community. I'm not much good with the scope myself but then I never had a knack for video games either.
We have GI and general surgery backup and a good relationship with both although rarely have needed to call for backup.
There are certainly scopes that we go in and look and see a hot mess that we recognize is better to back out and get a specialist's eyes on the case, but we see lots of normal and abnormal, too. In my part of SC there aren't enough fellowship-trained GIs to do all the scopes to serve our population, so they're happy to share the work.

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That's really cool.