Surgical/Medical Procedures Class?

redd · Apr 8, 2009

Hi All,

I have officially finished up my 4th year of medical school and have 2 months to kill before I start my Internal Medicine residency. One thing I am worried about during residency is my ability to do medical and surgical procedures, things that I have noticed most of my classmates excel in I seem to struggle with. Things like suturing, putting in central lines, even maintaining a sterile field when I scrub in. I'm a really good student otherwise, very booksmart, but when it comes to procedures I am a mess.

Anyways, since I have 2 months to kill before residency starts I was thinking of taking some sort of a class where they would maybe teach suturing and maybe some other medical procedures. Does anyone have any suggestions as to where I can find a class like this if it exists and if not, any other suggestions???

Help is greatly appreciated.

Winged Scapula · Apr 8, 2009

Yes, it is called residency.

There is a WIDE variation in clinical knowledge and skills, especially at the start of intern year. I had never placed a central line or chest tube at the start of my surgical residency. But the steep learning curve forces you to get better at these things and almost every one evens out. There will be some who are always better and some who are worse, but most people average out. Since you aren't going into surgery, sounds like you won't have to be worried about doing much suturing or scrubbing in. There should be ample opportunities for you to do chest tubes, thoracentesis, etc.

You can always practice suturing at home, but I am not aware of any procedural classes you can take. I suppose if you have elective time this intern year you could always spend a month on a surgical service/SICU to get some more skills.

gutonc · Apr 9, 2009

I started residency in the MICU. I had placed a grand total of 1 central line (a subclavian during my surgery rotation), had failed at 4 LPs, done 1 successful thoracentesis (out of 1 attempted) and probably thrown in a total of 50-100 sutures between my ob/gyn, surgery and ER rotations. I'd also done a dozen or more bone marrow biopsies (I differentiated to Hem/Onc early in my career). I was probably about in the middle of my colleagues that month in terms of experience.

At the end of my residency, I didn't flinch at putting in an IJ or femoral line (still not 100% comfortable w/ SCs). Thora and paracenteses were routine. LPs got done when needed and I could throw in a stitch or 3 if needed to keep somebody from bleeding out before the surgeons got there. And at the end of my 1st year of Onc fellowship, if I never do another marrow again I'll be OK with that.

I agree w/ WS that if you really want experience with procedures you should do a SICU (or potentially a MICU or EM) month. But if you show up, day 1 of IM residency, not having any procedures under your belt, you will not be alone. You will also not be expected to be an expert at any of them.

Also, FWIW, the ABIM has recently determined that essentially none of the procedures you outline above are essential to IM education and, as such, are no longer required to graduate. You need to do PIVs, PAPs and a few other things but no chest tubes or other "surgical" procedures.

See one, do one, teach one. That's the way residency will be and by the end of your second ICU month as an intern, you'll probably feel comfortable supervising your med student in most routine ICU procedures.

redd · Apr 9, 2009

Thanks for the replies guys. I understand that at the start of residency I won't be expected to be an expert and I WILL learn during residency, but I KNOW that my learning curve when it comes to medical procedures will be below average. I was hoping there would be a way to sort of "get ahead" now in my free time to sort of mitigate the fact that I suck ha ha.

But maybe you are right and the only way is just to suck it up and start residency and not worry about it.

SouthernSurgeon · Apr 9, 2009

This may seem silly, and obviously watching is nowhere near the same as doing, but have you checked out the procedure videos on the New England Journal's website?

You say you are interested in a "class" on procedures - these videos are it; they lay out the steps very clearly and at a pace you can follow, as well as discuss basic "troubleshooting" and complications.

I watched many of them third year before a rotation where I thought I might get to do some procedures (i.e. before starting hepatology, watch paracentesis vid; before trauma, watch chest tube and central line), and I felt they were a good introduction.

gutonc · Apr 9, 2009

southernIM said:
This may seem silly, and obviously watching is nowhere near the same as doing, but have you checked out the procedure videos on the New England Journal's website?

You say you are interested in a "class" on procedures - these videos are it; they lay out the steps very clearly and at a pace you can follow, as well as discuss basic "troubleshooting" and complications.

I watched many of them third year before a rotation where I thought I might get to do some procedures (i.e. before starting hepatology, watch paracentesis vid; before trauma, watch chest tube and central line), and I felt they were a good introduction.

Good one. I actually watched them as a resident before doing a procedure I hadn't done in awhile just to review the step and common problems/complications.

chartero · Sep 15, 2009

fwiw, the National Procedures Institute offers CME courses on procedural skills. Other sources outside of residency: Annual scientific assemblies or conventions of bodies like the AAFP, ACEP, or ACP. Local medical bodies; CME arms of medical schools, hospitals, etc. National credentialing programs like ACLS and PALS, of course.

michaelrack · Sep 15, 2009

chartero said:
fwiw, the National Procedures Institute offers CME courses on procedural skills. Other sources outside of residency: Annual scientific assemblies or conventions of bodies like the AAFP, ACEP, or ACP. Local medical bodies; CME arms of medical schools, hospitals, etc. National credentialing programs like ACLS and PALS, of course.

The ACP has a lot of procedure courses available at its annual meeting- suturing, arthrocentesis, central lines, skin biopsy, etc. I have taken the suturing course every year for the last several years.

Top Gun · Sep 18, 2009

redd said:
Hi All,

I have officially finished up my 4th year of medical school and have 2 months to kill before I start my Internal Medicine residency. One thing I am worried about during residency is my ability to do medical and surgical procedures, things that I have noticed most of my classmates excel in I seem to struggle with. Things like suturing, putting in central lines, even maintaining a sterile field when I scrub in. I'm a really good student otherwise, very booksmart, but when it comes to procedures I am a mess.

Anyways, since I have 2 months to kill before residency starts I was thinking of taking some sort of a class where they would maybe teach suturing and maybe some other medical procedures. Does anyone have any suggestions as to where I can find a class like this if it exists and if not, any other suggestions???

Help is greatly appreciated.

Don't worry too much about your skill at procedures. When I was a med student, I sucked at doing ABG's and I had never placed an NG tube. By the end of my ICU rotation as an intern, I could get a blood gas from a stone. And during intern year NG tube's became routine for me. You'll get plenty of opportunity to practice procedures as you go through residency and you will get better.

Surgical/Medical Procedures Class?

redd

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Winged Scapula

Cougariffic!

gutonc

No Meat, No Treat

redd

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SouthernSurgeon

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gutonc

No Meat, No Treat

chartero

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michaelrack

All In at the wrong time

Top Gun

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