How much procedures do you get to do in 3rd yr

[Deepa100]

So far, I was allowed to dothe following:
suturing in surgeries and lacerations
stapling in surgeries and ER
Driving the lap camera, suctioning blood and fluids, retracting during surgeries
A few Pelvic exams
Several rectal exams
Flex sigmoidoscopy and colonoscopy ( just the last part when the scope comes out), plucking out polyps during EGD and colonoscopies
knee and shoulder joint injections
Abscess I &D
Drawing meds for anesthesiology and intubations (tried 10 or so, actually successfully did 3/4)
Cryotherapy using liquid nitrogen
Inserting and removing NG tubes, urinary catheters
Physical exams of all different types

What do you think of it? Also, what do you think of attendings who tell you flat out you will not be allowed to do procedures?

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[ZagDoc]

I think that's a pretty good checklist of things you should try to accomplish by the end of medical school. I'd also try to score a couple paracentesis and maybe an LP or two. My list looked similar, but it took part of fourth year to get there.

In hindsight, the one thing I wish I got way more comfortable with as a med student was IVs, blood draws, and ABGs. Can't count the number of times as a resident in the middle of the night someone's IV crapped out, they're NPO cause they got a rip-roaring ileus so you can't give them PO pain meds, and the IV team is slammed. Or someone is in respiratory distress post-op, not severe enough to warrant a rapid response, but you want an ABG to get a sense of their metabolic status. Or you need a stat lab drawn but the nurse won't be back for 2 hours because she's on her smoke break. I do a ton of that stuff now, but would have definitely made things easier in the beginning if I had that skill set coming in.

 

[Deepa100]

Thanks for your response, very helpful. I did do blood draws for 2-3 hrs one day when I was in Anesthesiology. I had to ask for it and the nurses were cool with it, though they seemed to be surprised by my request. I will ask for the other things you mentioned such as ABGs, paracentesis and LPs too. Is ICU/CCU a good place to try and learn them?

 

[SlickNickMD]

supervised but otherwise done on my own

Paracentesis
Incision and drainage of various abscesses
Arterial line (radial)
Proctosigmoidoscopy
Removing chest tubes
Putting in wound vacs



Operating room and trauma/ ER
Lap camera, stapling, incisions, retracting, foleys, suture cutting, suturing

 

[QuizzicalApe]

They let you retract?

 

[ArcGurren]

Family Med - venipuncture, one ABG, small abscess drainage, ear wax irrigation, B12 shots, intra-articular corticosteroid shots

Medicine - ABGs, foley, helped out on an LP; got to use a scope during an EGD briefly (really cool!) and work a trans-esophageal echo.

Surgery - Outside of the OR: foleys, ABGs, central line, arterial line, bedside abscess I&D, NG tube. lots and lots of dressing changes as well (though that doesn't really qualify as procedure per se). Inside of the OR: stapling and suturing some wounds

 

[KnuxNole]

They let you retract?

After you master the insane art of scrubbing into an OR, then one day you too might be blessed with the ability to retract

 

[SlickNickMD]

They let you retract?

Medical students who scrub in are typically nothing more than walking retractors, suction and suture scissors

Depending on the attending/resident and having proven yourself as an indispensable asset to the surgery team you may get to do more-Make incisions, staple bowel, or close/suture

 

[sineapse]

Also, what do you think of attendings who tell you flat out you will not be allowed to do procedures?

It's their right, at the end of the day...you are the unlicensed student so if something goes wrong, it's on them.

I would classify as having 'done' a procedure where I did it from start to finish, therefore I wouldn't include some of the things you said i.e. pulling out a colonoscope or suctioning blood

My goal for the end of med school was to be a good intern. Period. No need to do any of the fancy stuff, that can come during residency.

Admitting patients (H&P and plan and orders) thoroughly, quickly and efficiently.
Getting **** hot at my examinations: no ambiguity whether I heard a murmur or some crackles at the bases.
ABGs
NG tubes
Catheters
Suturing

My 'preventing me from looking like an idiot' set:

Absolute pro at starting IVs and blood draws. I believe this is a basic skill of a doctor and at the end of the day, if no-one else can do it, you will have to do it.

Writing safe prescriptions, being able to draw up drugs and administer them (IV/IM/SQ)

Same for setting up IV fluids and blood-if I am in the middle of nowhere, I don't want to look like a jackass with a bag of fluid and a giving set.

Giving oxygen and setting up nebulisers

 

[QuizzicalApe]

Medical students who scrub in are typically nothing more than walking retractors, suction and suture scissors

Depending on the attending/resident and having proven yourself as an indispensable asset to the surgery team you may get to do more-Make incisions, staple bowel, or close/suture

Whoooooosh.

That being said, I wouldn't say the attending will let you do things if you prove yourself "indispensable", since you are generally the most dispensable thing in the OR, including most inanimate objects. Less so if the attending isn't using a self-retaining retractor, but still.

Generally if you don't prove yourself to be a useless pile and the attending isn't a douche, you'll progress to doing more interesting things. Interesting being a relative term, I guess. One more lap chole and I might have jumped down a linen chute.

 

[SlickNickMD]

Whoooooosh.

That being said, I wouldn't say the attending will let you do things if you prove yourself "indispensable", since you are generally the most dispensable thing in the OR, including most inanimate objects. Less so if the attending isn't using a self-retaining retractor, but still.

Generally if you don't prove yourself to be a useless pile and the attending isn't a douche, you'll progress to doing more interesting things. Interesting being a relative term, I guess. One more lap chole and I might have jumped down a linen chute.

Cold-blooded

The attendings feel bad when one of the residents try to cut the suture or suction cause I give them that "You took my job" facial expression. And yes after the lap surgeries lose their novelty, handling the camera just becomes a chore. Everyday in the OR is a struggle to not look like you're taking up space

 

[MossPoh]

Central line
Bunch of I&Ds including getting stuff together and drawing up the local
Parts of the coloposcopy
Couple venous draws
Lots of scope driving, suturing, stapling, suctioning mixed in with starting cuts, closing and anything that wasn't extremely delicate part of surgery.
Tons of intubations
Sawing and hammering some total knees along with closing
Drilling and screw placement for a few peds spinal fusions
Reduced a bunch of fractures
Flu shots/ B12 shots galore
Plenty of paps and pelvics
Lots of skin tag, SK and wart removal
Full procedure for kid with polydactyl
Joint injections
The cuts for an osteotomy
Start to finish for one TAL

I'm sure there is other junk I'm leaving off. Last rotation is obgyn for 3rd year. I have an estimated 25 deliveries on the books that he said I will probably do....which terrifies me.

 

[upright]

Central line
Bunch of I&Ds including getting stuff together and drawing up the local
Parts of the coloposcopy
Couple venous draws
Lots of scope driving, suturing, stapling, suctioning mixed in with starting cuts, closing and anything that wasn't extremely delicate part of surgery.
Tons of intubations
Sawing and hammering some total knees along with closing
Drilling and screw placement for a few peds spinal fusions
Reduced a bunch of fractures
Flu shots/ B12 shots galore
Plenty of paps and pelvics
Lots of skin tag, SK and wart removal
Full procedure for kid with polydactyl
Joint injections
The cuts for an osteotomy
Start to finish for one TAL

I'm sure there is other junk I'm leaving off. Last rotation is obgyn for 3rd year. I have an estimated 25 deliveries on the books that he said I will probably do....which terrifies me.

 

[MossPoh]

The funny thing is that the more useful stuff is what I've gotten fewer chances to do. Just the advantage of our preceptor format. Once they develop trust in you, they let you do quite a bit. A few of my classmates have been asked, "You know how to close, right?" and before they can reply the doc broke scrub and was walking out with the person still open on the table. Luckily, there are good scrub techs or PAs to help out most of the time.

 

[winkleweizen]

Ive done aboatload of rectals...I love it. Third year is so great.

 

[MossPoh]

I pride myself for not having to do a single rectal.

 

[Deepa100]

Yep, me too. It seems like Med students often come in handy for such things as rectals and placing urinary catheters

 

[Oxer45]

Once during a trauma, 3 med students did a foley that made the female resident cringe and the male patient scream (patient was passed out after a drug OD and some injury. He woke up in order to SCREAM!!. Pt's glasgow coma scale changed after the foley!) After the traumatic foley, med students were never asked to do a foley again.

 

[QuizzicalApe]

irl I have actually done relatively little to a conscious patient

beginning of 4th year I am going to need to walk into my subI and tell them 3rd year was sort of bull**** so please teach me how to do everything

 

[ensuii]

Once during a trauma, 3 med students did a foley that made the female resident cringe and the male patient scream (patient was passed out after a drug OD and some injury. He woke up in order to SCREAM!!. Pt's glasgow coma scale changed after the foley!) After the traumatic foley, med students were never asked to do a foley again.

Why wouldn't an OD dude scream having a plastic tube put down his penis? I'd be worried if he didn't scream...were they doing something wrong like trying to advance the foley with inflated tip?

 

[cofcemt]

A few of my classmates have been asked, "You know how to close, right?" and before they can reply the doc broke scrub and was walking out with the person still open on the table. Luckily, there are good scrub techs or PAs to help out most of the time.

This happened to me. Scared the crap out of me, but the scrub just started handing things to me and everything was fine. But I would pay money to see my face when it happened!

 

[ManBroDude]

Can't wait to be a "Right Upper Quadrant Man"! (an exerpt from Hot Lights, Blue Steel)