We have 29 SICU beds with incredible turn over. Other than our liver transplant patients that hang around a while, we move people very quickly and end up with a lot of CVICU, NICU and MICU overflow. We average maybe 6-7 CVC, Quintons and A-lines a day just ballparking it. With our liver population we probably do 1 paracentesis or thoracentesis a day. Our SICU team is made up of 2 NPs, and 3 residents between R1 and R3 (last month was three R2s, this month is an R1, R2 and R3). We have intermittent M3s and M4s that rotate with us. If I have procedures someone is doing them with me. If there is a student or an intern in the unit I grab them. If not, I send a text to the GS/VS interns. If nobody responds by the time I get my supplies I text the MS3s on the acute care surgery service. If we are busy and I need to keep things moving, I'm going to mostly do the procedures myself and talk them through what I'm doing with the expectation that if we have time to do things slowly that they will do as much as they can.
If we have free time, I have no problem taking someone step by step through procedures.
Now, also keep in mind that we have a 40 bed CVICU with a major heat and lung transplant programs as well as an incredibly busy Vascular service next door to our SICU. They don't have a single medical student there. Lord knows how many lines and other things would be available to students...
A radiologist left a guidewire in a patient and nearly killed them at a neighboring institution last year. On Vascular call an R4 called me after they put a triple lumen into the carotid. These are not MS3 mistakes. These are mistakes. When I do my lines I say out loud every single time, "Guidewire out" and make the person doing the line with me, or nurse acknowledge/verify that indeed the wire is out. When people who learn lines with me do their lines, they do the exact same thing. You learn by understanding theory and then having people with experience walk/talk you through things. If you aren't comfortable, someone should be helping you. I don't mean hand holding. I mean teaching. If you don't feel like you are getting that in medical school and residency, you are wasting your time.