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JETER

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    I have a question that I am hoping someone might help with. I am a pre-med (actually a PhD candidate in Chemical Engineering). I have worked as a health tech at a VA hospital for over 2 years. I work in the OR, and I catch on pretty quick. When I first started there, I was a volunteer. Then an employee. After a bit, I started spending a lot of time in the OR rooms (esp. Ortho lines). I have read all three volumes (an older edition) of Campbell's Operative Orthopaedics, and started to ask a lot of questions. Before I knew it, I was scrubbing in on the cases. After a year or so of holding limbs, I started to learn how to perform the procedures. I was allowed to cut, suture, drill, cut, hammer, burn, and just about every part your typical ortho procedure. I had to demonstrate that I knew the anatomy well as well as having a solid background in what was going on before I was allowed to do this. In addition, I have assumed the role as scrub tech on various general surgery cases as well.

    Sounds like a great background for a future orthopod. However, I realize that I have zero hours of formal medical training. I would like to mention this experience in my essay and interviews, but I do not know if I should.

    Does anyone know about the ethics involved in this? I really feel like I am in a bind. Thank you.
     

    DrDre'

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      I don't think there are any ethical issues here. If you were performing these procedures under the guidance and license of a physician, it's legal.


      I think it could be a great essay idea. The most important thing is to describe the exp, how it affected you, made you fall in love with medicine, whatever BUT not sound arrogant or like a know-it-all- that will be a death sentence.


      Others with more exp may have a more wizened interpretation of this situation.



      Good luck
       

      kinetic

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        This thread made me cringe. There's no love lost between me and orthopods, but I can certainly imagine them getting bent out of shape with someone who had no formal medical training performing their procedures, regardless of whether it was under supervision. I'm tired of all these threads where people essentially thumb their noses at physicians; seems to me like the big chumps were us, who went through training for nothing. Every time I turn around, someone is posting that nurses, PAs, or (now) PhDs are doing physician activities with or without supervision and getting paid just as much without the liability, time investment, or debt.

        I'm sure you're a nice guy, but I'm still irritated with this thread.
         
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        JETER

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          kinetic,

          I have no clue how I made the impression that I was "thumbing my nose" at the medical community, or implying that physicians are "chumps." I respect their work greatly. I think that it should say something that I have invested seven years of education in a program (engineering) and still wish to become a medical doctor. I have quite a bit of experience with orthopaedics, and from what I DO know about the profession, I know I would love orthopaedic surgery as a career.

          I work at a teaching hospital. The medical staff enjoys teaching. In my own free time, I study pharmacology, anatomy, human biochemistry, etc. Nothing too serious because I am very busy with work and research. But I do invest my time to learn what I can about the profession. With this basic knowledge, I am awarded with instruction in the OR. I know that it is very different, but some parallels can be drawn here with third year med students.

          I apologize for irritating you. I am not trying to be arrogant or bash doctors in any way. I agree with you, that physician activities should remain the responsibility of physicians.

          I know that something is not "right" with me being able to do this. I do not want to get my hospital or the surgeons who I work for into any trouble for giving me this experience. But it has been a great experience, and I think that I can say that after all my time here, I have a valid understanding of at least the surgical profession. All I wanted to know is if I can mention these things. I have no problem saying that I have "observed" hundreds of operations in the last two years, if this would be a wiser decision. I was just asking for some feedback from people like you who have many years of experience.
           

          Mirror Form

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            JETER said:
            Sounds like a great background for a future orthopod. However, I realize that I have zero hours of formal medical training. I would like to mention this experience in my essay and interviews, but I do not know if I should.

            Does anyone know about the ethics involved in this? I really feel like I am in a bind. Thank you.

            Jeter, welcome to medical education. Most third year medical students have like one 60 minute session on how to suture, and are then thrown into the OR. The vast majority of surgical teaching in medical school gets done just like you described. Since all of your "procedures" were done (I'm assuming) under the supervision of teaching attendings, then there is no ethical conflict. The teaching attending is allowed to let anyone he/she deems appropriate to participate in the operation.
             

            FliteSurgn

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              One of my colleagues at the WFMC told me that some of the older attending surgeons have surgical assistants that basically do the case or talk the resident through the case. These assistants have no formal training and were just the product of OJT over the years. When it gets to a critical point, the assistant calls the attending to come scrub.

              When we heard this some of us couldn't believe that this happens at such a "World Famous" institution, but it has been confirmed by other sources.
               

              tussy

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                Anyone can be taught to perform an operation. The real skill and art of surgery is decided who needs the operation and what operation they need. That is what you spend all those years training for.
                 

                fourthyear

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                  I have to wonder how you fit in time to read all three volumes of Campbell's Orothopedics in 2 years while working on a pHd in Chem Engineering and volunteering at the hospital and spending all that time in the OR - you're either extremely smart or never sleep or are stretching the truth a bit. Sorry, but these texts take quite a lot of time to read and it sounds like you have other work that's quite challenging too, so I'm not sure how you do it all. If you really have done all this, ortho programs will love you - the research background will be something they like too. I think you should definitely mention your experience in the OR - even if you keep it vauge and let them assume you mostly observed and maybe sutured a bit or made and incision or two here or there, you show huge interest in medicine by taking this opportunity to spend so much of your time in the OR and being excited to do a few parts of the procedures.

                  Don't worry about Kinetic, he's always pissed off at the whole world. Posts all the time, but hardly ever a word of encouragement to anyone.
                   

                  Mirror Form

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                    tussy said:
                    Anyone can be taught to perform an operation. The real skill and art of surgery is decided who needs the operation and what operation they need. That is what you spend all those years training for.

                    Yep, and don't forget knowing how to handle every complication, abnormal anatomy, peri-op care, etc. . . .

                    there's a reason that it takes a long time to become a surgeon!
                     

                    hans19

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                      was a black laboratory assistant to Dr. Alfred Blalock that helped pioneer the field of Cardiothoracic surgery, during the years that segregation was rife in the South. He taught for many years, first at Vanderbilt then at Johns Hopkins. Though he never had any formal medical training, but he trained the likes of Denton Cooley in operative technique. His portrait supposedly hangs in hall that honors the great surgeons of Hopkins.

                      Moral of the story: So what if Jeter is not a doc or medstudent? He obviously has an interest in orthopedics.
                      His enthusiasm in the field has earned him the opportunity to participate in some cool cases. Which is more than I can say for a lot of us jaded medstudent/residents.
                      Some of you guys need to get off of JETER's back.
                      Best of luck to you, man, if you decide to go to medschool.

                      -Hans
                       
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                      JETER

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                        fourthyear said:
                        I have to wonder how you fit in time to read all three volumes of Campbell's Orothopedics in 2 years while working on a pHd in Chem Engineering and volunteering at the hospital and spending all that time in the OR - you're either extremely smart or never sleep or are stretching the truth a bit. Sorry, but these texts take quite a lot of time to read and it sounds like you have other work that's quite challenging too, so I'm not sure how you do it all. If you really have done all this, ortho programs will love you - the research background will be something they like too. I think you should definitely mention your experience in the OR - even if you keep it vauge and let them assume you mostly observed and maybe sutured a bit or made and incision or two here or there, you show huge interest in medicine by taking this opportunity to spend so much of your time in the OR and being excited to do a few parts of the procedures.

                        Don't worry about Kinetic, he's always pissed off at the whole world. Posts all the time, but hardly ever a word of encouragement to anyone.

                        Fourth year,

                        Thanks for the support.
                        To address some of your questions: I don't sleep much. I work from about 5:00A to anywhere after midnight. Except for the comatose sleep ritual on friday night, that is about it. I started to read the orthopaedics handbooks two years ago. I enjoy reading, so it is not so much a burden on me. Since I start at 5, and most cases don't go until after 8, this gives me a lot of down time in the OR. I have many admin duties, but this is usually done in about half an hour. So, I get paid to read for about three hours a day. And, I guess that I have stretched it a bit. The orthopods in my OR do not work much on hands, feet or spine, so I have just skimmed these subjects (I know that spines esp. is a large part of the practice). Omitting these things, I guess that I have read word-for-word about 60-70%. I don't pretend that I understand everything that I read. But I try to focus on what makes sense. I enjoy reading about things that I can experience in the OR, so I focus on the arthroplasty techniques, fractures, and everything else that I have some experience with. It makes it so much easier to both learn and understand when you can see the applications.

                        I do not know that I want to go into orthopaedics. It is just that this is what I have the most experience in. I love research too. And with my chemical kinetics background, anesthesia seems amazing. I have found the entire field of medicine to be awesome, and I hope that I just get the chance to pursue it. And all I can do is learn, get some experience, and try.

                        Blade and Hans --

                        Thanks for the good words. The support and encouragement is well received. Thank you. Good luck to both of you.
                         

                        zensurg

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                          i hope that recounting your experience as a workaholic is worth all the effort you put into avoiding any semblance of a life. if you really enjoy it all so much, great, but find some real hobbies man. take it easy, they don't let you skip post-graduate years and you'll see it all over again, and again, and again.
                           

                          LuckyMD2b

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                            hans19 said:
                            Moral of the story: So what if Jeter is not a doc or medstudent? He obviously has an interest in orthopedics.
                            His enthusiasm in the field has earned him the opportunity to participate in some cool cases. Which is more than I can say for a lot of us jaded medstudent/residents.
                            Some of you guys need to get off of JETER's back.
                            Best of luck to you, man, if you decide to go to medschool.

                            -Hans

                            The only question that I have is professional liability. I don't think there is anything wrong with the Docs allowing a non-residant/med student doing a procedure, but aren't they putting their necks on the line if there is any type of complication.

                            Before I was a med student I got the chance to hold retractors and cut sutures on a couple of gen surg. cases, but I didn't think I should mention it on interviews etc. because I didn't want to get the doc; who was an amazingly cool guy; in trouble for trying to help me learn and become interested.

                            Is there any medico-legal issues with letting just anyone do stuff on a case.
                             

                            JETER

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                              zensurg said:
                              i hope that recounting your experience as a workaholic is worth all the effort you put into avoiding any semblance of a life. if you really enjoy it all so much, great, but find some real hobbies man. take it easy, they don't let you skip post-graduate years and you'll see it all over again, and again, and again.

                              While I appreciate your advice and concern for my wellbeing, I see this as being a quite presumptuous statement. I think that there is a strong difference between a 'workaholic' and a hard worker. And in addition, I have several hobbies. I work out, lift, shoot pool, teach swimming lessons, I am a Mason, and I participate in several activities which give a flavor and 'semblance' to my life. Please ask before you become so presuming about my life.
                              HOWEVER, I do appreciate constructive criticism, and would like to know your experience with this, if possible. Would you suggest that I quit the job and the studying. From my own personal experience, if I am not active, then I turn into a bum. There is little gray area between lazy and over-achieving for me. I think that is the whole ADHD thing.
                               

                              DoctorDoom

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                                kinetic said:
                                Like I said, that makes all the rest of us who went through training look like chimps.

                                Really? Hmmm, I just think of it as an interested young guy who got a chance to do some stuff, not that he was going to go operate and replace us. But I think I get where you are coming from.

                                I don't think there is an ethical issue here Jeter, and it should make for a good essay/interview discussion point about why you want to go into medicine.
                                 

                                JETER

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                                  [
                                  QUOTE=DoctorDoom]Really? Hmmm, I just think of it as an interested young guy who got a chance to do some stuff, not that he was going to go operate and replace us. But I think I get where you are coming from.

                                  I don't think there is an ethical issue here Jeter, and it should make for a good essay/interview discussion point about why you want to go into medicine.
                                  [/QUOTE]

                                  Dr. Doom,

                                  Thanks for the support
                                   

                                  Vukken99

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                                    i dont think it is right for the patients sake to have without formal medical training to perform those things you had mention....

                                    Only Physicians without proper mode of conduct would do that...

                                    Everyone involved in healthcare should be placed according to their level of proven training. As an attending I would not allow that type of disorderly conduct to occur in the OR, and I would not be associated with such physicians.

                                    i don't think they represent a good example of professionalism...

                                    I called them PseudoPhysicians...wannabes.....

                                    If you want to do all those things you want to do please do it elsewhere in some undeveloped country where they still practice rudimentary medicine with very poor outcomes.

                                    These are the kind of things the Chairman of Surgery Department should make as a policy. Allow only those with adequate training to be involved in assisting surgical procedures. either medical students, residents, fellows or nurses. Other than these should not be allowed to get involved in the actual procedure. It is not morally ethical for the patient....
                                     

                                    JETER

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                                      Vukken99 said:
                                      This thread indicates how low and stupid we had become as a profession.

                                      it is like having a monkey to assist a procedure.

                                      What a dreaded situation we live in....

                                      Vukken,

                                      While I take offense at being called a monkey, I tend to agree with you. In no way should I be doing the all the things that I do in the OR. I would become very upset if I learned that a non-medically trained (at least not formally, I need to add) was assisting in my operation. IF I become an attending, I would not allow this depth of activity from an untrained person. However, the teaching that was given to me from the OR table is something that had such an impact on my life that it has changed my career goals, and I would certainly put into practice this aspect.

                                      The purpose of this thread was to ask this body of professionals what your opinions were of me mentioning this in an interview/essay. I think that I will err on the side of caution, and just mention the everyday things that I do that don't cross over any lines (i.e., hold retractors, position limbs, etc). I hope that you realize that I am not trying to justify my position, or even say that it is ok. I doubted the ethics, and from my inquiry, I have discovered that my concerns are shared by others (e.g., you and kinetic), and the last thing I want to do is create any waves on my path to becoming a physician.
                                       

                                      monkeyman

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                                        First of all I have to say that Vukken dude is completely manic in his posts. Take your lithium and calm down Vukken.

                                        What is the difference between a first year med student assisting in a case and an undergrad assisting in a case? I mean, if you are going to use appropriate level of training as a prerequisite to assisting in surgical cases, you can't necessarily lump all med students together. First year med students are really no different than an undergrad in my opinion. As well, first year residents are participating in major portions of cases without as much exposure as the OP seems to have, and there are no ethical issues with that. Most consent forms ask for consent to do the procedure by the attending and assistants. There is no requirement for MD by all participating.

                                        I did a bunch of surgical cases before medical school, and I wrote about it in my essay. It was the topic of conversation on almost all my interviews, and the deans loved it. So I say use it to your advantage. It shows interest, and it is something most people are not lucky enough to have done before school.

                                        And one more thing to Vukken. Read your posts out loud before hitting the "Submit Reply" button. This isnt Morse code we are communicating with here (Vukken here, STOP. Can't think straight, STOP. Completely crazy, STOP). Your posts should resemble spoken language to a degree, and while English may not be your first language, at least make an attempt to work on it. If you were to present to my hospital speaking the way you write, you would quickly be admitting to the psych floor.
                                         
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