Anesthesiology Shadowing Intubation?

[MDschoolorbust]

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Obviously things like this shouldn't be included.

However what about experiences like looking at a patient's MRIs or scans with a doctor? Or triaging patients before they see the doctor (blood pressure, weight, etc.)? I don't even know what is allowed or not.

 

[WTEngel]

I saw an anesthesia attending let a critical care attending intubate a patient in the ICU. First, the critical care attending intubated the esophagus, the the anesthesia attending correctly removed it and placed it in the trachea. 2 hours later I'm called because the patient isn't moving and is hypotensive not responding very well to pressors or fluids. Well, 2 things happened. First the patient had a history of rheumatoid arthritis when I reviewed the chart. The ICU attending did not even know this. At some point their cervical spine was sublexed in the mayhem. Next, the patient was getting hypotensive from their spinal shock an hour later. Lastly, the CXR showed mediastinum air because when the ICU attending intubated the esophagus he perforated it. This patient died because an Anesthesia attending let someone who didn't know what they were doing do an intubation. This was a major lawsuit and thank god my name wasn't on that chart.

So story is, don't put that you intubated a patient as a pre-med student.

Where on Earth do critical care attending physicians "not know what they are doing" when it comes to intubation?

In the case you describe, it does indeed sound like this particular physician underperformed, but making the generalization that critical care attendings are novices at airway management is a stretch I think.

Where I work, anesthesia is only called for airway management when high risk airways have been identified or if the attending calls for it, which is rarely.

Granted, a critical care attending in a large facility like the ones I have worked in is likely going to be more experienced than a critical care attending at a small regional or rural facility.

 

[Ashley1989]

No, because it includes surgical tech students, PA students, OR nurse orientees, student nurse anesthetists, and even high school student observers, on a very regular basis.

Would I let a pre-med intubate? No. They're there to watch and see what you do, and if they decide to go into the field, they'll have their turn.

I appreciate the second part a lot. I realize we both agree but i do feel strongly about what was said for the first part. For the first part, Every person you listed there has a scope of practice and/or specific training which allows them to do certain things. (except for the high school
Students, but im saying the people who it is assumed have a scope of practice who would be participating on the surgery who the contract would apply to) Would an ER tech or CNA ever be allowed to intubate? No way, but they are under contract and legally covered to do what is in their scope of practice under the direction of the surgeon which makes that contract that the patient signed work. This doesnt give the surgeon free reign to pull in the CNA, maintenance worker, or a bystander walking to visit their relative on another floor, and ask them to intubate. A pre med has the same scope of practice as the maintenance worker or family member: none. The only difference is that the pre med intends to become a doctor which makes them even more dangerous then the ordinary person because many of us think highly of ourselves and find no issue in accepting the offer to do something like intubation because we like to think that we are so "bada**" and are going to make a great doctor, so dont see the danger in it, or worse yet consider it hands on experience or something. It doesn't matter that they want to be a doctor, they have not had any training whatsoever that would qualify them to do something like intubation regardless of if they're under the instruction of the doctor or not. That is why I feel at least in my opinion that that part of the contract would not hold up in court if a pre med intubated and caused injury to the patient.

I realize we are both arguing the same point, so this isn't specifically to you but just to everyone in general.

 

[mmmcdowe]

Obviously things like this shouldn't be included.

However what about experiences like looking at a patient's MRIs or scans with a doctor? Or triaging patients before they see the doctor (blood pressure, weight, etc.)? I don't even know what is allowed or not.

Those things are fine, we are mostly talking about things that could cause physical injury to a patient. At most, I would through in a caveat of provided you have the necessary training to do them (HIPPA for the former, basic health tech skills for the latter). However, these are also not things worth mentioning specifically on the application because they don't really add anything of value to it beyond the lessons learned (which don't require divulging specifics).

 

[catzzz88]

Intubation is nothing.

When I shadowed a cardiologist, he let me stitch a heart valve replacement into place. 👍

illegal? Maybe. Cool? Definitely! Immoral? Nah.


BTW I am just kidding.



Best,
C

 

[Laboratorian]

I know it's not common, but I have heard of pre-med students being allowed to perform intubation under the direction and close supervision of the anesthesiologist they're shadowing.

HOLY SH😱T!

 

[Pose]

Obviously things like this shouldn't be included.

However what about experiences like looking at a patient's MRIs or scans with a doctor? Or triaging patients before they see the doctor (blood pressure, weight, etc.)? I don't even know what is allowed or not.

Just be careful with the word "triage." You are not trained to triage. Triage entails taking a history, assigning an acuity, and so on. Just use a different word, like taking vital signs or something.

 

[45408]

Dude, come on. You and I both know that unless it's spelled out, the patients are assuming its medical students/residents and not randoms up from the local vo-tech. That said, ST/PA/SRNAs have a legit reason to be around. High school kids do not and they're not covered, they're not there as a part of a legit educational experience related to their plan of study.

1. The HS students are only observers.
2. They have a legitimate reason to be around. They're considering medicine as a potential career, and when you're a senior in HS, you have to pick your college and major within a matter of months. How else would someone know to be pre-med or go to nursing school? It's a great opportunity.
3. It's a formal class at their high school, so it's actually part of a legit educational experience related to their plan of study.

 

[mmmcdowe]

1. The HS students are only observers.
2. They have a legitimate reason to be around. They're considering medicine as a potential career, and when you're a senior in HS, you have to pick your college and major within a matter of months. How else would someone know to be pre-med or go to nursing school? It's a great opportunity.
3. It's a formal class at their high school, so it's actually part of a legit educational experience related to their plan of study.

I would still voice concerns since presumably the hospital isn't covering these kids on their insurance.

 

[TheMightySmiter]

I shadowed a surgery in high school, no big deal. I doubt most patients would have a problem with this if they have been trained on HIPAA. For the sake of the hospital's liability, I'm sure they have been. You can do very little harm by just watching and it's a super common thing at teaching hospitals. However, the only people who should be performing real tasks should be those who are trained or in training. It's true that intubations on the operating table are not that big a deal. It's where most people practice when they need to be able to do it in an emergency situation (ie paramedic students, med students, etc.). These people have all had training on simulators, for the most part, and they need to know how to do it for the job they are actually training for. Not so with pre-meds.

 

[Revolver1045]

I do agree that it has little or no benefit for the for the pre med that is doing the intubation, and I concur that if done it should not be stated on an amcas application. The legality of the situation given the various contracts of the physicians and staff as well as the one that I signed I am also not so sure on, but to the people that raise a point of concern I respectfully disagree. Given the situation of having multiple professionals to help guide you and to watch for any potential concerns, coupled with visualizing the actual intuabtion tube in the trachea on a screen and the monitoring of the patients O2 and CO2 I don't believe it is as big of a concern as you make it out to be. When I had done the intubations I had never thought it was cool or something to brag about or whether or not I should or shouldn't do it. For me, it was just part of the overall shadowing experience, same as taking blood pressure with an internist or gloving up looking through dead bodies with a forensic pathologist. Given the records of the anesthesiologists and care team I was with as well as their careful demeanor I never for one second felt the situation was out of their control and thus when asked (and told one instance) to intubate I said yes. The procedure is quiet simple: you watch a video screen and stick a tube down someones throat. Done. Was the patient at a higher risk? In my opinion I don't think so given that the anesthesiologist and nurse anesthetist are right there to make sure everything went smoothly and that the tube was placed correctly. I realize I am not going to change any opinions, but that's how I feel on the matter. If offered the opportunity you can say yes or no. I don't think it will make any difference to you or the patient given that you are with a good care team.

 

[45408]

I would still voice concerns since presumably the hospital isn't covering these kids on their insurance.

Concerns for an observer?

And you're right, I'm sure it's the school paying for any insurance.

 

[PlatypusMD]

Depending on the consent form and on the shadowing agreement, it might be included in the consent. Our surgical consent says that "Dr. So-and-so will do the operation, OR anyone else of his choosing. I understand that residents and students will participate in the operation." Some students are in some kind of formal rotation though, versus following someone to work that day.

This is a matter of *informed* consent. Does the patient's understanding of the word "student" align with the intended scope of the consent form? If not, that's a huge problem, and the consent form should be revised. As others have said, I doubt that most patients being put under would knowingly approve of having a pre-med student--let alone a high school student--actively participate in the intubation.

 

[Doodledog]

I do agree that it has little or no benefit for the for the pre med that is doing the intubation, and I concur that if done it should not be stated on an amcas application. The legality of the situation given the various contracts of the physicians and staff as well as the one that I signed I am also not so sure on, but to the people that raise a point of concern I respectfully disagree. Given the situation of having multiple professionals to help guide you and to watch for any potential concerns, coupled with visualizing the actual intuabtion tube in the trachea on a screen and the monitoring of the patients O2 and CO2 I don't believe it is as big of a concern as you make it out to be. When I had done the intubations I had never thought it was cool or something to brag about or whether or not I should or shouldn't do it. For me, it was just part of the overall shadowing experience, same as taking blood pressure with an internist or gloving up looking through dead bodies with a forensic pathologist. Given the records of the anesthesiologists and care team I was with as well as their careful demeanor I never for one second felt the situation was out of their control and thus when asked (and told one instance) to intubate I said yes. The procedure is quiet simple: you watch a video screen and stick a tube down someones throat. Done. Was the patient at a higher risk? In my opinion I don't think so given that the anesthesiologist and nurse anesthetist are right there to make sure everything went smoothly and that the tube was placed correctly. I realize I am not going to change any opinions, but that's how I feel on the matter. If offered the opportunity you can say yes or no. I don't think it will make any difference to you or the patient given that you are with a good care team.

Since LizzyM hasn't weighed in on this, I will. As always, note that I am one individual physician who has spent more than a decade on an adcom. Adcoms are made up of individuals who often view things very differently. Therefore, I speak only for myself in saying that any premed who in any way, in their application or during the interview, stated that they had done a procedure such as intubation, in the US or during a global experience, unless they were formally trained in it (e.g. a former RT), would get my strongest possible recommendation for rejection.

You are entitled to believe there is nothing wrong with a pre-med doing an intubation without formal training. I am entitled to disagree and believe that your participation in that procedure makes you an applicant that I do not wish to see admitted to my medical school.

 

[MiracleforMD]

Since LizzyM hasn't weighed in on this, I will. As always, note that I am one individual physician who has spent more than a decade on an adcom. Adcoms are made up of individuals who often view things very differently. Therefore, I speak only for myself in saying that any premed who in any way, in their application or during the interview, stated that they had done a procedure such as intubation, in the US or during a global experience, unless they were formally trained in it (e.g. a former RT), would get my strongest possible recommendation for rejection.

You are entitled to believe there is nothing wrong with a pre-med doing an intubation without formal training. I am entitled to disagree and believe that your participation in that procedure makes you an applicant that I do not wish to see admitted to my medical school.

Boom.

 

[TheMightySmiter]

Boom.

Adcommed.

 

[mmmcdowe]

Concerns for an observer?

And you're right, I'm sure it's the school paying for any insurance.

Sorry, was referring more to participants.

 

[Gigantron]

Since LizzyM hasn't weighed in on this, I will. As always, note that I am one individual physician who has spent more than a decade on an adcom. Adcoms are made up of individuals who often view things very differently. Therefore, I speak only for myself in saying that any premed who in any way, in their application or during the interview, stated that they had done a procedure such as intubation, in the US or during a global experience, unless they were formally trained in it (e.g. a former RT), would get my strongest possible recommendation for rejection.

You are entitled to believe there is nothing wrong with a pre-med doing an intubation without formal training. I am entitled to disagree and believe that your participation in that procedure makes you an applicant that I do not wish to see admitted to my medical school.

I'm so glad you're on an adcom. 👍

 

[Ironmandoc]

You have all been trolled. Admins delete this guy. Look at the join date...

 

[mmmcdowe]

I do agree that it has little or no benefit for the for the pre med that is doing the intubation, and I concur that if done it should not be stated on an amcas application. The legality of the situation given the various contracts of the physicians and staff as well as the one that I signed I am also not so sure on, but to the people that raise a point of concern I respectfully disagree. Given the situation of having multiple professionals to help guide you and to watch for any potential concerns, coupled with visualizing the actual intuabtion tube in the trachea on a screen and the monitoring of the patients O2 and CO2 I don't believe it is as big of a concern as you make it out to be. When I had done the intubations I had never thought it was cool or something to brag about or whether or not I should or shouldn't do it. For me, it was just part of the overall shadowing experience, same as taking blood pressure with an internist or gloving up looking through dead bodies with a forensic pathologist. Given the records of the anesthesiologists and care team I was with as well as their careful demeanor I never for one second felt the situation was out of their control and thus when asked (and told one instance) to intubate I said yes. The procedure is quiet simple: you watch a video screen and stick a tube down someones throat. Done. Was the patient at a higher risk? In my opinion I don't think so given that the anesthesiologist and nurse anesthetist are right there to make sure everything went smoothly and that the tube was placed correctly. I realize I am not going to change any opinions, but that's how I feel on the matter. If offered the opportunity you can say yes or no. I don't think it will make any difference to you or the patient given that you are with a good care team.

So you are saying that your first attempt at an intubation was in no way less skilled or more dangerous to the patient's airway than a physician that had done hit hundreds or thousands of time? I don't care if the anesthesiologist had your hands in puppet strings that he was controlling from behind a curtain, this is just not true. You lack the "feel" for it, the camera isn't the solution to removing all risk of intubation. The fact that you can't recognize this is probably more of the reason why you are getting so much backlash than your support for pre-meds doing intubations. Before I do any procedure for the first time, including intubations, I do anything that I can to gain some level of experience and thus decrease the risk to my patient. I practice on cadavers, dummies, friends, and I watch and study as much as I can. I don't always have the luxury of lots of prep, but I owe it to them to try to.

 

[calvnandhobbs68]

For me, it was just part of the overall shadowing experience, same as taking blood pressure with an internist or gloving up looking through dead bodies with a forensic pathologist. Given the records of the anesthesiologists and care team I was with as well as their careful demeanor I never for one second felt the situation was out of their control and thus when asked (and told one instance) to intubate I said yes. The procedure is quiet simple: you watch a video screen and stick a tube down someones throat. Done. Was the patient at a higher risk? In my opinion I don't think so given that the anesthesiologist and nurse anesthetist are right there to make sure everything went smoothly and that the tube was placed correctly.

Yeah man intubation is just like taking a BP or looking at dead bodies. Good point.

Hey but thanks for throwing your expert opinion out there. Next time we need an intubation assessment I'll make sure they call you up.

 

[Revolver1045]

Alright guys, i never said i was more skilled or that I'm an expert. I simply stated that with the blessing and guidance of an experienced and well trained anesthesiologist and their staff by your side I don't believe that it is an issue. Yes you dont have feel or experience or skill, but they do. And if they believe in their expert opinions that you can handle it i say give it a go. Like i stated earlier, some will disagree and that's fine. From here on out I concede to your comments.

 

[Ashley1989]

i'm so glad you're on an adcom. 👍

+1,000,000

 

[Old Grunt]

All this proves is that you took a risk for your own benefit, allowed the life of the patient to be put in the hands of the least qualified/absolutely not even qualified person, got lucky and seem to now feel that it is no big deal. It is a big deal, and it is reckless of you to do that in the first place but then posting on an online form saying that its not a big deal is irresponsible as well. How do you know someone isn't going to read this, have that same opportunity, not have that same luck with going in completely blind, do it wrong and hurt or even kill the patient as a result? Just because you got lucky doesn't mean you should say its okay, because someone may read this and not be as lucky.

No. The attending took a risk. As will every attending that allows you to do a procedure when you are a med student. Is it really necessary to come down on the integrity of a peer? The nature of learning is to not refuse a learning opportunity unless it's just something completely unconscionable.

Guess what? Nobody has done anything until they have done it. The World's greatest intubation jockey at one time did their first intubation on a living human.

I wouldn't Include it. As someone said, it's not going to impress anyone.

 

[xoxx]

Im pretty sure that in 50/50 states this would be considered an assault felony. Even if the anesthesiologist gave you the go, its highly illegal, and you can face potential charges + jail time if anyone reports i.

 

[MiracleforMD]

You have all been trolled. Admins delete this guy. Look at the join date...

Normally, I'd agree. But I think there were like 2-3 posters who also said this was their experience. I want to call BS on all of them, but now it seems unlikely they are all lying.

 

[Gut Shot]

I do agree that it has little or no benefit for the for the pre med that is doing the intubation, and I concur that if done it should not be stated on an amcas application. The legality of the situation given the various contracts of the physicians and staff as well as the one that I signed I am also not so sure on, but to the people that raise a point of concern I respectfully disagree. Given the situation of having multiple professionals to help guide you and to watch for any potential concerns, coupled with visualizing the actual intuabtion tube in the trachea on a screen and the monitoring of the patients O2 and CO2 I don't believe it is as big of a concern as you make it out to be. When I had done the intubations I had never thought it was cool or something to brag about or whether or not I should or shouldn't do it. For me, it was just part of the overall shadowing experience, same as taking blood pressure with an internist or gloving up looking through dead bodies with a forensic pathologist. Given the records of the anesthesiologists and care team I was with as well as their careful demeanor I never for one second felt the situation was out of their control and thus when asked (and told one instance) to intubate I said yes. The procedure is quiet simple: you watch a video screen and stick a tube down someones throat. Done. Was the patient at a higher risk? In my opinion I don't think so given that the anesthesiologist and nurse anesthetist are right there to make sure everything went smoothly and that the tube was placed correctly. I realize I am not going to change any opinions, but that's how I feel on the matter. If offered the opportunity you can say yes or no. I don't think it will make any difference to you or the patient given that you are with a good care team.

I reckon what you have yet to experience is that you can potentially kill a patient every time you touch them. Doesn't matter if you're the world expert and follow the protocol exactly, the outcome can still be, as they say, adverse.

Case in point: I once had the pleasure of watching an anesthesiologist starting a spinal on an older lady. He put in the needle, and then pushed a tiny amount while watching her vitals. He did this because there is a small risk that the needle could be inside a vessel, in which case pushing a tiny bit would cause her heart rate to drop slightly but noticeably. Her heart rate was unchanged, so in his assessment the needle was in a satisfactory position.

At this point, had he been a cowboy with a premed looking over his shoulder, he might have given said premed the green light to push the rest of the drug. Had said premed done this, given the presence of a professional to help guide him/her and watch out for any potential concerns, he/she would have watched in abject horror as the patient slid off the gurney, crashed, and coded.

In summary, the people who let you intubate were idiots, and it's only a matter of time before you realize how completely stupid and reckless such an act truly is.

 

[MiracleforMD]

Now that 2 attendings covering the medical side and 1 revered adcom covering the application side have spoken, can we call it a horrible decision to participate OR list it and consider this thread done?

 

[45408]

Im pretty sure that in 50/50 states this would be considered an assault felony. Even if the anesthesiologist gave you the go, its highly illegal, and you can face potential charges + jail time if anyone reports i.

Negative, Ghostrider. It might be battery, but in the scenario given, I don't think it qualifies for assault in any state. Was the patient harmed?

 

[DavetheMD]

If I ever saw a pre med intubate someone I swear I would raise hell. It is wrong, reckless, and unethical.

I'm a Premed and an AEMT. Can you stomach the thought of me intubating patients?

 

[TheMightySmiter]

I'm a Premed and an AEMT. Can you stomach the thought of me intubating patients?

Totally different. Did you have training to intubate? Was it a part of your job? If you've intubated patients, it was because you were learning to do so for a legitimate medical profession in a controlled and legal environment. Not so with random pre-med shadower guy. Do you really think you can compare your situation to that?

 

[MiracleforMD]

I'm a Premed and an AEMT. Can you stomach the thought of me intubating patients?

EMT? Hell no. Come back after you have had your 2000 hours of classroom training to be a paramedic and then maybe.

 

[TheMightySmiter]

EMT? Hell no. Come back after you have had your 2000 hours of classroom training to be a paramedic and then maybe.

AEMT stands for Advanced-EMT, which I believe in some states is equivalent to a paramedic.

 

[IlDestriero]

I'll happily teach a medical student how to effectively mask ventilate a patient, start an iv, and intubate when appropriate. In fact I did it today, twice. They need to learn these skills. They could soon find themselves in a position where they need to use these skills in an emergency to save someone's life. That is certainly not the case for a premed shadowing someone. Our Hospital explicitly prohibits all visitors from touching any patient or actively participating in their care. It doesn't matter if the visitor is a premed or a visiting tenured professor from another facility.
Even if this was not the case, I would never, under any circumstances, anywhere in the world, allow an untrained premed student to directly participate in the care of one of my patients.
If this is really occurring in the US it's a bit shocking and a gross violation of their patients trust.👎

Cheers!

 

[DavetheMD]

Totally different. Did you have training to intubate? Was it a part of your job? If you've intubated patients, it was because you were learning to do so for a legitimate medical profession in a controlled and legal environment. Not so with random pre-med shadower guy. Do you really think you can compare your situation to that?

Just asking her to put the definition of premed in context. Sometimes, lower ranking roles of the medical ladder are actually more skilled in specific areas. I would trust an AEMT or paramedic to perform an IV over a med student.

By the way, AEMTs should be taught how to intubate, but it's to the discretion of your medical direction whether or not you can perform the skill in EMS.

 

[MiracleforMD]

Just asking her to put the definition of premed in context. Sometimes, lower ranking roles of the medical ladder are actually more skilled in specific areas. I would trust an AEMT or paramedic to perform an IV over a med student.

By the way, AEMTs should be taught how to intubate, but it's to the discretion of your medical direction whether or not you can perform the skill in EMS.

AEMT stands for Advanced-EMT, which I believe in some states is equivalent to a paramedic.

Ok, well I was basically reiterating TMS's earlier point. If you have the formal, accredited training, then it's fine.

 

[mvenus929]

Dude, come on. You and I both know that unless it's spelled out, the patients are assuming its medical students/residents and not randoms up from the local vo-tech. That said, ST/PA/SRNAs have a legit reason to be around. High school kids do not and they're not covered, they're not there as a part of a legit educational experience related to their plan of study.

You put a lot of faith in patients. A good portion of the patients I introduce myself to then ask what I'm going to do when I become a nurse. I'm actually becoming a fan of the phrase 'student doctor', however much I thought it was silly 3 months ago, because then at least patients know that I'm going to be a doctor someday.

As a side note, while on my anesthesia rotation, I did introduce myself to patients and was there when they were being induced and all that (mask ventilating, calming them down as they are induced, etc), but I'm pretty sure no one ever mentioned to the patient that I was going to be the one doing the intubation.

I thought I had quoted another post where you talk about never doing something to put the patient at risk... and I just wanted to emphasize that you will do that throughout your career. There are risks to every single invasive thing you do. But you need to learn them, so you will be placing your patients at risk. Hopefully you'll have learned enough that you can do it without placing your patient at unnecessary risk, but you'll still be placing them at risk.

Given the situation of having multiple professionals to help guide you and to watch for any potential concerns, coupled with visualizing the actual intuabtion tube in the trachea on a screen and the monitoring of the patients O2 and CO2 I don't believe it is as big of a concern as you make it out to be.

[...]

The procedure is quiet simple: you watch a video screen and stick a tube down someones throat. Done. Was the patient at a higher risk? In my opinion I don't think so given that the anesthesiologist and nurse anesthetist are right there to make sure everything went smoothly and that the tube was placed correctly.

While allowing a trial of intubation with a student is generally safe (because the patient has enough oxygen that they aren't going to reduce the oxygen going to their brain for quite a while), I don't think it's quite as easy as you make it out to be. I attempted probably 4 intubations on my week of anesthesia (I wasn't allowed to do several due to anticipation of difficult airway, or rapid anesthesia in the cardiac cases), and I got one, and that one was only because I used a glidescope. I sent the tube down the esophagus in one case, and couldn't actually visualize the cords in the other cases. And in most cases, we don't use the glidescope.

 

[DavetheMD]

While allowing a trial of intubation with a student is generally safe (because the patient has enough oxygen that they aren't going to reduce the oxygen going to their brain for quite a while), I don't think it's quite as easy as you make it out to be. I attempted probably 4 intubations on my week of anesthesia (I wasn't allowed to do several due to anticipation of difficult airway, or rapid anesthesia in the cardiac cases), and I got one, and that one was only because I used a glidescope. I sent the tube down the esophagus in one case, and couldn't actually visualize the cords in the other cases. And in most cases, we don't use the glidescope.

Just out of curiosity have you been folding the epiglottis back when you insert the laryngoscope? I've watched people insert into the esophagus before, but it seems to be the key behind getting into the trachea.

 

[kestralray]

I reckon what you have yet to experience is that you can potentially kill a patient every time you touch them. Doesn't matter if you're the world expert and follow the protocol exactly, the outcome can still be, as they say, adverse.

Case in point: I once had the pleasure of watching an anesthesiologist starting a spinal on an older lady. He put in the needle, and then pushed a tiny amount while watching her vitals. He did this because there is a small risk that the needle could be inside a vessel, in which case pushing a tiny bit would cause her heart rate to drop slightly but noticeably. Her heart rate was unchanged, so in his assessment the needle was in a satisfactory position.

At this point, had he been a cowboy with a premed looking over his shoulder, he might have given said premed the green light to push the rest of the drug. Had said premed done this, given the presence of a professional to help guide him/her and watch out for any potential concerns, he/she would have watched in abject horror as the patient slid off the gurney, crashed, and coded.

In summary, the people who let you intubate were idiots, and it's only a matter of time before you realize how completely stupid and reckless such an act truly is.

I think I missed a part of your story. Why would the pre-med pushing the drug have led to crashing and coding?

 

[IlDestriero]

I think I missed a part of your story. Why would the pre-med pushing the drug have led to crashing and coding?

Much of the story is murky. I'm assuming it was actually an epidural. Slamming the local anesthetic into an epidural, even one which seems to have "passed" its test dose is not wise. I always administer a bolus in aliquots over several minutes. It doesn't take much IV bupivicaine to cause a seizure, arrhythmia, or arrest.
You don't test a spinal.

Cheers!

 

[45408]

You put a lot of faith in patients....As a side note, while on my anesthesia rotation, I did introduce myself to patients and was there when they were being induced and all that (mask ventilating, calming them down as they are induced, etc), but I'm pretty sure no one ever mentioned to the patient that I was going to be the one doing the intubation.

Atul Gawande addresses this at length in one of his books, about how as a surgery resident, most patients don't seem to realize that the resident will be doing the operation. When I meet a patient pre-op, I pretty much always say "Hi, I'm Dr. Prowler, one of the surgery residents, and I'll be working with Dr. Attending." I certainly don't cover up the fact that I'll be there, but based on what patients say - like "Oh, I see, you guys will be watching?" - you can tell that a lot of them don't understand "graduated autonomy." If a patient said something like that, I'd clarify that I'll be helping, but I've basically never told a patient "So, I'll be the one holding the scalpel, doing the suturing, etc." We certainly never told anyone specifically "We'll let the med student close your incision," even though I did close incisions as a med student. Of course, it's under appropriate supervision, but it's still not Dr. Attending holding the instruments.

This is a matter of *informed* consent. Does the patient's understanding of the word "student" align with the intended scope of the consent form? If not, that's a huge problem, and the consent form should be revised.

Not really relating to the original comment about HS students, but I do want to add something here. Your patients have something more like "partially informed consent."

I always mention the risk of bile duct injury when I'm talking to a patient about a cholecystectomy or other procedure near it, but I don't tell them that they could potentially require a massive reconstructive operation if it were clipped. I tell patients that they could have a trocar injury, but I don't tell them that people have died after a trocar went through the aorta or iliacs.

I've sat through discussions with patients about potential risks of a gastric bypass, and it's a pretty exhaustive list, but you can tell by the glazed over look in their eyes that they think it's basically impossible that they would end up with a life-threatening complication.

 

[Ashley1989]

No. The attending took a risk. As will every attending that allows you to do a procedure when you are a med student. Is it really necessary to come down on the integrity of a peer? The nature of learning is to not refuse a learning opportunity unless it's just something completely unconscionable.

Guess what? Nobody has done anything until they have done it. The World's greatest intubation jockey at one time did their first intubation on a living human.

I wouldn't Include it. As someone said, it's not going to impress anyone.

Okay so the doctor AND the pre med took a risk. And yes, an attending takes a risk when they allow a medical student to do a procedure. Medical student. Look at your own words, we are taking about a pre med who may or may not have even taken anatomy yet.

There's a massive difference, and the World's Greatest Intubation Jockey undoubtedly had classroom time where they were walked through the procedure in the very least and also had other relevant classes such as anatomy. They may have also practiced on simulation dummies or as someone else mentioned, cadavers.

Again, there's a huge difference between a pre med and medical student.

 

[Ashley1989]

I'm a Premed and an AEMT. Can you stomach the thought of me intubating patients?

Nice to meet you. I know that as an AEMT you know all about the various scopes of practice that are dependent on certification, state, etc.

Since you know this already, you should also know that if it is within your scope of practice then you have had the necessary practice and training, tested, proved to be competent, and now are certified.

The question really is, is it in your scope of practice? Could you perform the procedure without being sued for negligence and assault? If it is within your scope then you have been trusted to intubate and proven competent so there is no problem. If it is not within your scope then is it really that surprising, considering they emphasize this a lot in our EMT classes, that it is a problem?

This is not about what you think you can do, or should be entitled to do. This is about what you are legally allowed to do based on your proven competency and certification. You're an AEMT you should know this.

 

[Disinence2]

1) You would be shocked how many pre-meds include their participating in some minor procedure in their application.

2) Unless they were credentialed to perform said procedure, their chanced of getting in were severely diminished.

3) My experience with pre-meds who have followed me is that even if you want them to do something trivial they refuse. Even stuff like, "hey hand me that" is accompanied by some hesitation. This is normal.

4) Even in the OR intubation's have the capability of going horribly horribly wrong, with catastrophic results.

 

[hiyaman]

When I shadowed all I got to do was hold papers for the physician i was following. That and have great conversations with everyone 😀.

 

[Gut Shot]

I think I missed a part of your story. Why would the pre-med pushing the drug have led to crashing and coding?

Because the needle wasn't satisfactorily positioned after all, despite following protocol and having no indication otherwise. The drug went into circulation rather than the spinal canal.

Fortunately they revived her and she woke up in the ICU.

 

[Gut Shot]

Much of the story is murky. I'm assuming it was actually an epidural. Slamming the local anesthetic into an epidural, even one which seems to have "passed" its test dose is not wise. I always administer a bolus in aliquots over several minutes. It doesn't take much IV bupivicaine to cause a seizure, arrhythmia, or arrest.
You don't test a spinal.

Cheers!

I'm fairly certain the guy who did it would now be in agreement with you.

 

[The Imprisoned]

Yes I'm applying this cycle and no I did not include it on my application. I figured it would not have much benefit compared to other aspects of the application and there is some (I don't know if it's high) probability that it might get some adcoms upset similar to the people here on sdn.

That being said, although some will disagee I don't believe that it is as big of a deal as it has been made out to be on this thread. The anesthesiologists that I shadowed were very well trained and both had done their residences at Dartmouth. From what I gathered in surgery, as well as what you can read about the responsibilities of the anesthesiologist, is that the anesthesiologist is in charge. He or she is the be all end all that gives the final green light for surgery. They (at least the ones I was with) know what they are doing and everyone in the operating room knows this. If the anesthesiologist says I can intabate and I am under their close supervision, I found that no one questions this. One of the surgeons who watched me do it even asked me "how much did they pay you for that" to which the anesthesiologist responded "he gets free lunch". Again, #my2¢

It is kind of a big deal (and by kind of a big deal, I mean a HUGE deal) that the physician is allowing someone with NO training perform an unauthorized intubation. A "noobie" is an MS1/2, NOT a pre-med. Shame on the physician who let you do this. I for one agree with most of the posters here in saying that this is completely unethical with regards to the patient. Once again people seem to forget that these are ACTUAL patients that physicians are treating, and a small lapse in judgement could easily have huge consequences.

There is a difference letting a pre-med shadowing listen to someone's heart, or observe - however it is another matter entirely of letting them perform a procedure, imo.

Just my 2 cents.

 

[Doctor246853]

Emotional much? Medicine is a teaching profession and the only way to educate the next generation of physicans is to let noobies like us get our hands dirty every once in a while.

Idiot. If anyone in this thread believes that a premed incubated anything, then they too are idiots.

 

[PlatypusMD]

Idiot. If anyone in this thread believes that a premed incubated anything, then they too are idiots.

I don't know...I see premeds incubating test tubes all the time