Concerned about procedural skills

[rd31]

Hey everyone,

I'm wondering what level of procedural ability will be expected of us as new interns. I have pretty limited skills. In medical school I've done only a handful of ABGs, a couple IVs (I'm bad at these), and one central line. I have NEVER intubated or done thora/paracenteses.

How bad of a shape am I in? Is there ample time for learning during intern year or are we expected to come in with some level of skill? I ask because I can intervene and try to pursue rotations or shadow where I can maximize practicing some techniques.

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[gutonc]

Hey everyone,

I'm wondering what level of procedural ability will be expected of us as new interns. I have pretty limited skills. In medical school I've done only a handful of ABGs, a couple IVs (I'm bad at these), and one central line. I have NEVER intubated or done thora/paracenteses.

How bad of a shape am I in? Is there ample time for learning during intern year or are we expected to come in with some level of skill? I ask because I can intervene and try to pursue rotations or shadow where I can maximize practicing some techniques.

Do you know which end of the stethoscope goes in your ears and which one goes on the patient?

If the answer to this question is "yes" then you'll get a "Meets Expectations/At Expected Level" on your first rotation review.

If the answer to this question is "no", have you considered ortho?

 

[drfunktacular]

As long as you can feed and toilet yourself and make it through your first week without crying (publicly) you'll be fine

Many (most?) IM residents cannot properly do a thora, joint tap, or intubation competently without supervision even when they graduate

Para, ABG, and LP you need to learn pretty early in internship though. You'll do a LOT of those as an intern & resident. Central lines will mostly be done by your upper levels at first, as they want to get signed off early in the year. You can learn later on ED or ICU rotations


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[gutonc]

Here's a slightly less smart ass remark.

I went to one of those schools where you learned by doing. I can still put in an IV on an IV drug using vasculopath just by throwing an angiocath at them from across the room..that's how many of them I did as a med student. But beyond that, I think I'd probably done 1 central line (with a surgery resident guiding my hand), maybe one or two para/thora/LP and dropped 2 tubes (because we had to do a month of Anesthesia). I actually did more bone marrow biopsies as a med student than any other procedure (I differentiated early).

I then showed up at a residency program where the med students weren't allowed to do procedures...at all. No IVs, no ABGs, no anything. They were smart as hell but that quip about the stethoscope up above is based on a real experience. And these kids match well and go on to do great things. As a resident at this place I learned the relevant procedures early (nothing like starting intern year in the MICU) and did fine. I have a good friend who made it through residency with a grand total of 1 central line, no intubations, no A-lines, 1 US-guided paracentesis and that was pretty much it other than LPs (which she did a lot of).

Bottom line is that, if you have intentionally pierced the skin of no patients as a med student, you will still probably survive as a resident.

 

[Raryn]

Really, the only skill I think would be nice to have when you start residency is the ability to tie a knot. It's the one part of the central line I don't want to bother teaching

(I've placed a grand total of 6 peripheral IVs as a medical student and zero as a resident. If it gets to the point the nurse is asking me to obtain access on a patient, I'd tell her to go get an ultrasound and a central line kit, because I'm not screwing around with that. Gutonc nonwithstanding, I doubt there's many doctors outside of anesthesia that are any better at placing IVs than almost any floor nurse)

 

[Bostonredsox]

Really, the only skill I think would be nice to have when you start residency is the ability to tie a knot. It's the one part of the central line I don't want to bother teaching

(I've placed a grand total of 6 peripheral IVs as a medical student and zero as a resident. If it gets to the point the nurse is asking me to obtain access on a patient, I'd tell her to go get an ultrasound and a central line kit, because I'm not screwing around with that. Gutonc nonwithstanding, I doubt there's many doctors outside of anesthesia that are any better at placing IVs than almost any floor nurse)

/nod. If I'm called for access it is going in there jugular. If they don't want a line I suggest to them they call anesthesia.

 

[disorder]

Really, the only skill I think would be nice to have when you start residency is the ability to tie a knot. It's the one part of the central line I don't want to bother teaching

(I've placed a grand total of 6 peripheral IVs as a medical student and zero as a resident. If it gets to the point the nurse is asking me to obtain access on a patient, I'd tell her to go get an ultrasound and a central line kit, because I'm not screwing around with that. Gutonc nonwithstanding, I doubt there's many doctors outside of anesthesia that are any better at placing IVs than almost any floor nurse)

I agree. It's one thing I've been telling my interns to do/practice, because, I hate jumping in there to tie the knot for them. At LEAST know how to perform an instrument tie. However, I must say, even though I've practice one-handed ties here and there I still suck at them.

 

[jdh71]

What so hard about showing someone how to do an instrument tie?

 

[jdh71]

I'll tell you.

Nothing.

 

[jdh71]

I can teach a procedure and do teach procedures but the time it takes drives me nuts right now.