Must-know procedures

[Apoplexy__]

Based on my MS3 experience with rotations thus far, it seems as though I'll have to go out of my way to even suture or do injections on most rotations, let alone intubations or central lines.

What procedures must you know before graduating med school? In what rotations does this procedural experience mostly come from?

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[DrBowtie]

Based on my MS3 experience with rotations thus far, it seems as though I'll have to go out of my way to even suture or do injections on most rotations, let alone intubations or central lines.

What procedures must you know before graduating med school? In what rotations does this procedural experience mostly come from?

Must know? Probably none.

 

[Kaustikos]

Based on my MS3 experience with rotations thus far, it seems as though I'll have to go out of my way to even suture or do injections on most rotations, let alone intubations or central lines.

What procedures must you know before graduating med school? In what rotations does this procedural experience mostly come from?

Honestly? Fourth year is where you learn/find out how to do procedures. I never did a central line third year (thankfully...). Don't get discouraged by the fact that you're not doing much at this point. If you're interested in surgery; then endorse that and see if they'd let you learn how to do certain things. It all comes down to how patient you are/willing you are to learn things. Some want to have you watch them do things first before letting you try (makes sense). Others will let you try. It just depends. If you wanna practice knot tying; ask the scrub nurse to use a tie to practice knots with; most are okay with it if you're not interrupting them. And don't think it'll insult the attending/resident; you're practicing, which shows a lot. Just be sure to completely dismiss them the entire time. I've usually asked for one during procedures and just practice doing it while I watch if I'm not actively helping. I'd also try to get into laporascopic procedures; they generally have multiple incision sites and some people are okay with you getting a feel for suturing.
Unfortunately, some people just won't let you do anything. It's just the way it is.

 

[Apoplexy__]

Good to hear. I read another thread that some residency programs have an orientation week/month where they teach you all necessary procedures. People had mixed views about how much you should know coming into residency, since not all programs have this procedural orientation.

So if there are no absolute must-knows, is there a short list of things you'd look stupid for not knowing?

And don't think it'll insult the attending/resident; you're practicing, which shows a lot. Just be sure to completely dismiss them the entire time.

Ha...wait what?

 

[Wordead]

If you're going into a surgical specialty or ob, you should know how to hand tie and instrument tie. I think that's about it.

 

[Psai]

Sounds like you want an anesthesia rotation. I'm on ob I just scrubbed into a c section and the resident let me suture the camper's fascia which was nice. My school had a skills session where they taught how to tie knots and I practiced it the day before with a lot of help from an em resident. The practice time really paid off for the OR although my hands started shaking on the second one handed tie because I was like holy **** this is a person right here

 

[Apoplexy__]

Hah, honestly...I want to go into Rads or Rad/Onc. Just trying not to look incompetent in my PGY-1.

Pretty reassuring that the expectations seem to be so low.

 

[VisionaryTics]

At the start of the year, residents aren't going to let you do much. As the year goes on, you'll be able to do more and more.

You should leave med school knowing how to do hand and instrument ties, a few suturing techniques (simple interrupted and running, sub-cuticular, vertical mattress), and that's probably about it. Anything else is icing on the cake.

Oh, you want to go into rads. You don't need to know anything with regards to skills.

 

[DrBowtie]

For rads if you can do some thoras and paras prior to residency that would be useful.

 

[Kaustikos]

Hah, honestly...I want to go into Rads or Rad/Onc. Just trying not to look incompetent in my PGY-1.

Pretty reassuring that the expectations seem to be so low.

I don't think they let you guys near patients...

 

[MilkIsGood]

Sounds like you want an anesthesia rotation. I'm on ob I just scrubbed into a c section and the resident let me suture the camper's fascia which was nice. My school had a skills session where they taught how to tie knots and I practiced it the day before with a lot of help from an em resident. The practice time really paid off for the OR although my hands started shaking on the second one handed tie because I was like holy **** this is a person right here

lucky. im on ob as well and i get to retract and cut sutures. yipee

 

[meliora27]

By the end of MS3 I had enough experience to feel comfortable in most settings to:

Tie instrument knots
Tie two handed knots
Intubate
Central lines (IJ or Femoral)

I did an EM rotation at a community hospital without residents which is where I was able to get a lot of lines and tubes.

 

[Peonyuprising]

By the end of MS3 I had enough experience to feel comfortable in most settings to:

Tie instrument knots
Tie two handed knots
Intubate
Central lines (IJ or Femoral)

I did an EM rotation at a community hospital without residents which is where I was able to get a lot of lines and tubes.

I exactly did the same.

 

[operaman]

I think the "must-know" thing is a soft call and generally related to whatever specialty you want to do. If you want to be a surgeon, being relatively proficient with suturing/tying is important; you don't want to be doing your sub-I in fourth year when the attending asks you to close and you have to admit you don't know how to suture. If you want to do anesthesia, being mildly comfortable intubating is good, though obviously some patients are harder than others and even the residents struggle with some of them. The more you learn how to do in your desired field, the better you will look next year and the more they will let you do.

 

[neusu]

Rectal exam

 

[joeDO2]

Probably nothing is need to know. The short list of procedures commonly asked of a 4th year:
1. Basic suturing
2. NG tubes
3. Rectals
4. I&D
5. Splinting

Things offered if you want:
1. Intubation
2. LPs
3. Ultrasound (may be helpful for your field)

Also its always good to have an idea how to do basic nursing tasks to help them out if you have nothing to do...ie blood draws, IVs, injections etc.

 

[Kaustikos]

Probably nothing is need to know. The short list of procedures commonly asked of a 4th year:
1. Basic suturing
2. NG tubes
3. Rectals
4. I&D
5. Splinting

Things offered if you want:
1. Intubation
2. LPs
3. Ultrasound (may be helpful for your field)

Also its always good to have an idea how to do basic nursing tasks to help them out if you have nothing to do...ie blood draws, IVs, injections etc.

Agreed to the last part. I always always always help nurses. If I'm in the OR, I arrive early to help prepare. And not just lines.. I help cath, move the patient, drape etc. And I also help post op until the patient is in the room. This is clutch when you have back to back cases because the nurses have to clean and setup.

I'd say it's important to move beyond instrument tie by fourth year. At least know one handed ties... They're easier, quicker and will save you a lot of headache.
Lastly: knowing how to gown and glove is important. Not just for the OR. I know you do it in the ICU and it's a lot easier if you know how to do it yourself.

 

[Psai]

Probably nothing is need to know. The short list of procedures commonly asked of a 4th year:
1. Basic suturing
2. NG tubes
3. Rectals
4. I&D
5. Splinting

Things offered if you want:
1. Intubation
2. LPs
3. Ultrasound (may be helpful for your field)

Also its always good to have an idea how to do basic nursing tasks to help them out if you have nothing to do...ie blood draws, IVs, injections etc.

I haven't seen anyone do a rectal yet. Seems like people prescribe a bunch of miralax and maybe some senna and wait it out.

 

[Pons Asinorum]

I haven't seen anyone do a rectal yet. Seems like people prescribe a bunch of miralax and maybe some senna and wait it out.

rectal exam ≠ disimpaction

 

[Psai]

Oh that was stupid haha
I haven't seen a rectal exam either though

 

[DermViser]

Oh that was stupid haha
I haven't seen a rectal exam either though

Yeah, it's bc usually the MS-3s/interns are made to do them.

 

[KnuxNole]

Must know? Probably none.

Agreed, I was expected to know nothing, which was what I knew. I never sutured in med school, touched a vagina in med school, or tubed anyone haha. I would say leaving residency knowing to do simple suturing would be nice. I guess if people do it in med school, that's cool, but then again, you don't learn in med school

 

[Psai]

Agreed, I was expected to know nothing, which was what I knew. I never sutured in med school, touched a vagina in med school, or tubed anyone haha.

yeah i was wondering about that. they taught us how to do a pelvic exam in second year but the only exam i've performed was under anesthesia

 

[Wordead]

Agreed, I was expected to know nothing, which was what I knew. I never sutured in med school, touched a vagina in med school, or tubed anyone haha. I would say leaving residency knowing to do simple suturing would be nice. I guess if people do it in med school, that's cool, but then again, you don't learn in med school

Aren't you family med? Why dont they teach you to suture?

 

[KnuxNole]

They do, which is the first time I learned how, I've done a few office procedures and lac repairs in the ED.

 

[Wordead]

They do, which is the first time I learned how, I've done a few office procedures and lac repairs in the ED.

Ah, okay. I misread your statement.

 

[joeDO2]

i wish they took a month in school and used it for procedures training. i'm pretty sure i could handle a little less histology and still function as a doc. they can teach that stuff when people decide on path.

 

[Pons Asinorum]

Agreed, I was expected to know nothing, which was what I knew. I never sutured in med school, touched a vagina in med school, or tubed anyone haha. I would say leaving residency knowing to do simple suturing would be nice. I guess if people do it in med school, that's cool, but then again, you don't learn in med school

How you made it through medical school without suturing or doing a pelvic exam is hard for me to fathom. And I thought you were doing EM? I guess I'm thinking back a few years.

 

[KnuxNole]

How you made it through medical school without suturing or doing a pelvic exam is hard for me to fathom. And I thought you were doing EM? I guess I'm thinking back a few years.

Oh that's an easy question, it's cause med students didn't do a lot of hands on stuff, or rather, they weren't allowed. On surgery, students weren't allowed to sow on live people. It was not a requirement to suture, so I never did it. On OB, males were forbidden to do a pelvic exams, check crevices, etc. basically I had to learn about gyn thru blueprints and instead of from real patients...most of the time I was kicked out of rooms for being a guy.

 

[mimelim]

Oh that's an easy question, it's cause med students didn't do a lot of hands on stuff, or rather, they weren't allowed. On surgery, students weren't allowed to sow on live people. It was not a requirement to suture, so I never did it. On OB, males were forbidden to do a pelvic exams, check crevices, etc. basically I had to learn about gyn thru blueprints and instead of from real patients...most of the time I was kicked out of rooms for being a guy.

No offense, but that sounds like a really ****ty medical school. Who stopped people from doing those things? The hospital, medical school or what? You are saying that not a single medical student did any of those things at your school?

 

[KnuxNole]

No offense, but that sounds like a really ****ty medical school. Who stopped people from doing those things? The hospital, medical school or what? You are saying that not a single medical student did any of those things at your school?

The residents/attendings, on OB. It was expected in their culture, that males don't touch vajajays, so the female residents enforced that with wildfire. A lot of the guys didn't want to do OB, so they enjoyed not being forced to do them. Thankfully in residency, where you actually learn to be a doctor for once, I got to *gasp* examine a vagina, do paps, check cervix, and deliver lots and lots of babies!! The females I'm sure delivered babies.

Same with sutures. I never did them until intern, and now they are fun to do

 

[Pons Asinorum]

The residents/attendings, on OB. It was expected in their culture, that males don't touch vajajays, so the female residents enforced that with wildfire. A lot of the guys didn't want to do OB, so they enjoyed not being forced to do them. Thankfully in residency, where you actually learn to be a doctor for once, I got to *gasp* examine a vagina, do paps, check cervix, and deliver lots and lots of babies!! The females I'm sure delivered babies.

Same with sutures. I never did them until intern, and now they are fun to do

I guess the weird thing is that I did a ton of all that on just my 6 wk Ob/Gyn rotation, allowing me to make an informed decision on whether or not I choose to pursue a vagina-heavy specialty.

 

[KnuxNole]

Yeah, I imagine the males who wanted to do ob either had to really push, or do 4th year electives where they got to do them. For 4 th year rotations, unless it was a sub I surgery, they didn't expect anything of me procedure wise. Then again, almost all of my 4 the year were non surgery rotations, which make sense haha

 

[Kaustikos]

i wish they took a month in school and used it for procedures training. i'm pretty sure i could handle a little less histology and still function as a doc. they can teach that stuff when people decide on path.

Our school has clinical training/skills... but I was at a satellite site/campus so I don't know if the center campus had it. Nonetheless, we had suturing/iv/etc workshops. Funny part was me suturing for the first time and this surgeon walks over, looks at me working, and says "So... you're not interested in surgery, are you?"
But it honestly didn't matter during MS1/MS2 because I forgot that **** by the time I was an MS3. Now that I'm doing my CT surg elective - suturing/tying knots/lines have become easy. It's all about doing it repeatedly, not once in a blue moon.

No offense, but that sounds like a really ****ty medical school. Who stopped people from doing those things? The hospital, medical school or what? You are saying that not a single medical student did any of those things at your school?

Not to steal his thunder - but my school has a similar "rule" wherein med students just stood by the door of deliveries/examinations at hospitals.

 

[notbobtrustme]

Not to steal his thunder - but my school has a similar "rule" wherein med students just stood by the door of deliveries/examinations at hospitals.

sucks I did my rotation in the heart of the ghetto and it was pretty much the wild west there. I practically delivered 20 babies by myself. Even got to through a sutures on a perineal tear but didn't complete it because the interns needed more practice.

 

[Kaustikos]

sucks I did my rotation in the heart of the ghetto and it was pretty much the wild west there. I practically delivered 20 babies by myself. Even got to through a sutures on a perineal tear but didn't complete it because the interns needed more practice.

I didn't care. Part of the reason is because I'd already delivered babies during my FM rotation. Actually, I delivered more babies during FM than OB/GYN. So... whatever. They still signed me off on delivering babies, so I didn't care. On reflection - it was never the attendings that were the problem; it was ALWAYS the residents/fellows.

 

[notbobtrustme]

I didn't care. Part of the reason is because I'd already delivered babies during my FM rotation. Actually, I delivered more babies during FM than OB/GYN. So... whatever. They still signed me off on delivering babies, so I didn't care. On reflection - it was never the attendings that were the problem; it was ALWAYS the residents/fellows.

ya, I agree, it depends heavily on your residents as well. It was my first rotation, so I was a bit more engaged than I might have been had ob/gyn been a later rotation. I also worked with some fairly awesome residents who were all about letting us med students do ****. Plus, it was July/August, which apparently are the most busy months for giving birth.

 

[mimelim]

Not to steal his thunder - but my school has a similar "rule" wherein med students just stood by the door of deliveries/examinations at hospitals.

I didn't care. Part of the reason is because I'd already delivered babies during my FM rotation. Actually, I delivered more babies during FM than OB/GYN. So... whatever. They still signed me off on delivering babies, so I didn't care. On reflection - it was never the attendings that were the problem; it was ALWAYS the residents/fellows.

So there wasn't actually a rule, you just had a bunch of bad residents?

 

[KnuxNole]

So there wasn't actually a rule, you just had a bunch of bad residents?

When you get a bunch of male students in a short rotation in a group of stressed out OB residents, it isn't too hard to imagine

 

[cbrons]

On OB, males were forbidden to do a pelvic exams, check crevices, etc. basically I had to learn about gyn thru blueprints and instead of from real patients...most of the time I was kicked out of rooms for being a guy.

The residents/attendings, on OB. It was expected in their culture, that males don't touch vajajays, so the female residents enforced that with wildfire.

This sounds like illegal discrimination. I have no interest in OB but this would piss me off, especially if your female classmates are getting the hands-on experience and you are consistently told to leave because of your gender. If the patient wants a female, that's one thing, but faculty excluding you based on gender is simply illegal. If women can cry foul all the time about the "good old boys culture" then male students shouldn't put up with this BS from uppity OB preceptors who they are paying to teach them. What's good for the goose is good for the gander.

 

[Mad Jack]

It's funny, OB/GYN wasn't really even considered a female specialty until fairly recently. These residents' batshiat insanity is unacceptable.

 

[KnuxNole]

This sounds like illegal discrimination. I have no interest in OB but this would piss me off, especially if your female classmates are getting the hands-on experience and you are consistently told to leave because of your gender. If the patient wants a female, that's one thing, but faculty excluding you based on gender is simply illegal. If women can cry foul all the time about the "good old boys culture" then male students shouldn't put up with this BS from uppity OB preceptors who they are paying to teach them. What's good for the goose is good for the gander.

True, but what can males do? I do think there are residents and attendings who are open to it, but probably get discouraged when a TON of patients don't want any part of a male touching their private parts at all. Hell, a good chunk go to a GYN for a routine PAP for the sole fact of seeing a female for their primary women's health needs, and then when a male student walks in, they are like "Oh hell naw, I ran away from that in the first place, get out!". Same thing in L+D with laboring mothers not wanting a man of all people checking her private areas, or even being in the delivery room to see a baby pop out and touch it.

 

[styphon]

The residents/attendings, on OB. It was expected in their culture, that males don't touch vajajays, so the female residents enforced that with wildfire. A lot of the guys didn't want to do OB, so they enjoyed not being forced to do them. Thankfully in residency, where you actually learn to be a doctor for once, I got to *gasp* examine a vagina, do paps, check cervix, and deliver lots and lots of babies!! The females I'm sure delivered babies.

Same with sutures. I never did them until intern, and now they are fun to do

Wow, I had some mean OB residents when I was a medical student - who were determined to make medical students cry - but they still let me do paps/cervical exams (maybe so they can yell/insult more?). I also became friends with a midwife group - who started letting me come in on deliveries.

 

[Psai]

The residents/attendings, on OB. It was expected in their culture, that males don't touch vajajays, so the female residents enforced that with wildfire. A lot of the guys didn't want to do OB, so they enjoyed not being forced to do them. Thankfully in residency, where you actually learn to be a doctor for once, I got to *gasp* examine a vagina, do paps, check cervix, and deliver lots and lots of babies!! The females I'm sure delivered babies.

Same with sutures. I never did them until intern, and now they are fun to do

That's not right

 

[WinslowPringle]

To the OP's question - important skills (not necessarily procedures, though) to have:
1. How to locate free food. (Really, basic MS1 skill here)
2. How to find the secretest of secret awesome bathrooms
3. How to assuage the scrub tech coming towards you with a glint in her eye...
4. How to judge the best time to leave in the afternoon and not catch everyone's attention for being a slacker and still not stay too late and look like a life-less brown-noser...

/jk. Seriously, useful procedures I found were - suturing/tying/stapling/closing and dressing wounds (self-taught but lots of practice on OB/Surgery); art line and intubation (anesthesia); paracentesis (IM); chest tube placement (EM). Yeah,you'll probably have to go out of your way to get some hands-on experience. It helps to be prepared beforehand, though; if there are procedures you'd like to know how to do, try looking up instructional videos online (NEJM has some) and when the opportunity arises, ask and put yourself in a good position to be available during the procedure.

 

[Psai]

To the OP's question - important skills (not necessarily procedures, though) to have:
1. How to locate free food. (Really, basic MS1 skill here)
2. How to find the secretest of secret awesome bathrooms
3. How to assuage the scrub tech coming towards you with a glint in her eye...
4. How to judge the best time to leave in the afternoon and not catch everyone's attention for being a slacker and still not stay too late and look like a life-less brown-noser...

/jk. Seriously, useful procedures I found were - suturing/tying/stapling/closing and dressing wounds (self-taught but lots of practice on OB/Surgery); art line and intubation (anesthesia); paracentesis (IM); chest tube placement (EM). Yeah,you'll probably have to go out of your way to get some hands-on experience. It helps to be prepared beforehand, though; if there are procedures you'd like to know how to do, try looking up instructional videos online (NEJM has some) and when the opportunity arises, ask and put yourself in a good position to be available during the procedure.

those top 4 are actually really useful

 

[jdh71]

The ONLY "must know" "procedure" is an H&P.

Demonstrate you can do that and maybe someone will actually let you near a patient with something sharp.

 

[Kaustikos]

Surprised no one even mentioned taking out drains, catheters or lines. I'd think it'd be embarrassing if you didn't know how to do those.

 

[jdh71]

Disagree. Other crucial must know procedures include:

1. Proper list printing (I.e. In Gravity rounding order, perfectly aligned so as to minimize steps from room to room on rounds)

2. Coffee fetching

Good points. All.

 

[KnuxNole]

Surprised no one even mentioned taking out drains, catheters or lines. I'd think it'd be embarrassing if you didn't know how to do those.

There seems to be a LOT of people who don't know how to do that. Usually they all defer that to surgical specialities only.