ED Procedures for Med Students

[Perfect Hair Day]

Aloha everyone, and Happy New Year

I haven't done my EM rotations yet, but I want to watch some videos to familiarize myself with procedures that are done in the ED so that I can assist/do when needed on my rotations. I wanted to touch base with the forum and get a sense of what procedures I should keep in mind. Could we put together maybe a top 10 or top 20 list? Off the top of my head, I'm thinking definitely venipuncture and maybe abscess I+D, lumbar puncture, intubation & central line, wondering what else is out there though.

Thanks

PHD

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[deleted480308]

Aloha everyone, and Happy New Year

I haven't done my EM rotations yet, but I want to watch some videos to familiarize myself with procedures that are done in the ED so that I can assist/do when needed on my rotations. I wanted to touch base with the forum and get a sense of what procedures I should keep in mind. Could we put together maybe a top 10 or top 20 list? Off the top of my head, I'm thinking definitely venipuncture and maybe abscess I+D, lumbar puncture, intubation & central line, wondering what else is out there though.

Thanks

PHD

splinting, suture a laceration

 

[FantasticDoctorFox]

I did each of these at least once during my EM sub-Is this year. Obviously, some of them I did much more often (lac repair, splinting, US guided IV, abscess I&D) but I don't think any of them are too terribly uncommon for students to have the opportunity to do or at least assist with with in the ED.

1. Basic splinting
2. Basic lac repair
3. IV placement, + ultrasound guided IV placement
4. Abscess I&D
5. Arthrocentesis, esp. knee
6. LP
7. Chest tube
8. NG tube placement
9. Intubation
10. ABG & art line placement
11. Central line
12. Foley placement
13. Paracentesis
14. Shoulder dislocation reduction
15. Digital nerve block
16. Nasal packing

Also would recommend reviewing a FAST exam. Hope you have fun, OP!

 

[rbnsafsadgf]

MS4 procedures: I&D, laceration repair, FAST on stable pts, IV start, foley, & NGT if you want to

resident procedures: intubations, central lines, chest tubes, LPs. no way a MS4 will do these with any junior residents around in my shop.

students who show interest can assist closely with resident procedures.

YMMV, ask your senior resident on shift at your site.

 

[gro2001]

I would split possible EM procedures into several categories:

1) Procedures I commonly let students do. While I wouldn't expect a sub-I to know all the nuances or necessarily be completely profficient in these by the time the sub-I begins, I would expect them to have a significant amount of familiarity with them so that my teaching/supervision can focus on the finer points. If the student has never done one by the time they start their sub-I, I would be very surprised. If they were very bad at these (ie: required explanation of basic technique/concept, unable to satisfactorily perform the procedure in a straightforward situation, etc) I would be a little disappointed.

• Basic laceration repair
• Abscess incision and drainage
• Peripheral IV placement
• ABG collection and analysis

2) Procedures I sometimes let students do. These would be procedures that students may have had a chance to perform or at least observe before, but not necessarily. I would not expect a student to necessarily be familiar with the technique, but I would expect the student to have read up on the concept and be able to explain the technique, indications, and complications in broad strokes. In the right setting (appropriate patient, department isn't going to hell, student is making a good impression otherwise) I would let a student perform this procedure under close supervision. I would expect most of the teaching to focus on the bread and butter of the technique. If the student had the bread and butter technique down already and this allowed me to offer some advanced tips, I would be impressed.

• Lumbar puncture
• Joint dislocation reduction
• Paracentesis
• Arterial line placement
• IO placement
• Splinting

3) Procedures I rarely let students do. The stars would have to align just right for these. It would have to be the combination of a rock star student, well suited patient, my availability, generous junior residents who would not give me the evil eye for giving these to a med student, lack of nursing supervisors (ie: night shift). If the student knew the technique, indications, contraindications, and complications, I might let them try. If they did not, I would not judge them for it, but probably not let them try.

• Endotracheal intubation
• Central line placement
• Chest tube placement

4) Procedures I would not let any student perform under any circumstances. My expectation would be for students starting a sub-I to know that these procedures happen and why, but that's about it.

• Resuscitative thoracotomy
• Cricothyroidotomy
• Lateral canthotomy
• Transvenous pacing
• Any of the group 3 procedures on children

In general, I would require a student to have at least some grasp of technique, indications, contraindications, and complications of a procedure, and ideally have observed at least one before I let them perform one. Based on that, and the categories I outlined above, I would recommend familiarizing yourself with those aspects, starting with category 1, then working your way down to categories 2 and 3.

By the end of a sub-I my expectation would be that they would be able to describe the basic technique, indications, contraindications, and complications for all of these procedures.

 

[alpinism]

There's no reason why med students can't do supervised tubes and lines provided:
1) they know how to do the procedure and 2) they had a chance to practice in SIM lab beforehand.

Honestly every 4th year should get at least one intubation and central line during their rotation. If not the residency either doesn't see enough sick patients or doesn't know how to teach med students. Either way its not a place I would trust to train emergency medicine physicians.

 

[surely]

There's no reason why med students can't do supervised tubes and lines provided:
1) they know how to do the procedure and 2) they had a chance to practice in SIM lab beforehand.

Honestly every 4th year should get at least one intubation and central line during their rotation. If not the residency either doesn't see enough sick patients or doesn't know how to teach med students. Either way its not a place I would trust to train emergency medicine physicians.

I did three 4th year EM rotations, none of which had me do an intubation or a central line, and I would trust all 3 places to train emergency medicine physicians. Remember, in July and August, prime 4th year EM rotation season, there are fresh interns who need those procedures more than the medical students do.

 

[deleted547339]

I did three 4th year EM rotations, none of which had me do an intubation or a central line, and I would trust all 3 places to train emergency medicine physicians. Remember, in July and August, prime 4th year EM rotation season, there are fresh interns who need those procedures more than the medical students do.

I would routinely throw my Med studs lines and tubes....

 

[TheComebacKid]

3) Procedures I rarely let students do. The stars would have to align just right for these. It would have to be the combination of a rock star student, well suited patient, my availability, generous junior residents who would not give me the evil eye for giving these to a med student, lack of nursing supervisors (ie: night shift). If the student knew the technique, indications, contraindications, and complications, I might let them try. If they did not, I would not judge them for it, but probably not let them try.

• Endotracheal intubation
• Central line placement
• Chest tube placement

I agree with you that I would pretty much rarely let a med student ever do any of these procedures. But what does nursing have to do with it? I could care less with what nursing supervisors think. Sorry, but if you are a nurse you get zero say in terms of who gets to do what procedure in the department. At the end of the day, that is at the discretion of the attending. If I am giving a "higher level procedure" to a med student, I will always run it by the attending first and make sure they are on board with it. The nurses don't factor in.

 

[Vandalia]

I agree with you that I would pretty much rarely let a med student ever do any of these procedures. But what does nursing have to do with it? I could care less with what nursing supervisors think. Sorry, but if you are a nurse you get zero say in terms of who gets to do what procedure in the department. At the end of the day, that is at the discretion of the attending. If I am giving a "higher level procedure" to a med student, I will always run it by the attending first and make sure they are on board with it. The nurses don't factor in.

You are going to be in for a shock once you hit the "real world." There are a lot of hospital politics that you are shielded from as a resident. (Or at least should be in a decent program.)

 

[KGflyboy]

At my hospital neither nurses nor administration determines which procedures students perform. I'm actually perplexed now. Who here has ever been told they could NOT let a student perform a procedure by a non-physician? Can you elaborate with examples? I'm not doubting you... Just curious. I don't think it is normal at most places, but I'd like some other people to clarify.

 

[Psai]

You are going to be in for a shock once you hit the "real world." There are a lot of hospital politics that you are shielded from as a resident. (Or at least should be in a decent program.)

???

 

[Rendar5]

I’m also not sure what supervisors have to do with your procedures. I’ve never had one weigh in on such a topic ever.

 

[gro2001]

At my hospital neither nurses nor administration determines which procedures students perform. I'm actually perplexed now. Who here has ever been told they could NOT let a student perform a procedure by a non-physician? Can you elaborate with examples? I'm not doubting you... Just curious. I don't think it is normal at most places, but I'd like some other people to clarify.

I did not express myself clearly. I assumed everyone was on the same page. I think at least some of the attendings will understand what I mean.

I did not mean that a nurse (supervisor, or the one primarily responsible for the patient) would determine which procedure is performed by whom. Nor did I mean that nurses at places I've worked at would generally have a problem with something like that. I have known some (albeit a small minority) of nursing supervisors to be somewhat annoying about policies (or lack there of) when anything out of the ordinary would happen. It would certainly be out of the ordinary to see a medical student intubating a patient, for example. That's not an every day occurrence in the department. So there are one or two of them that would, if I did something like that while they were around (ie: let a medical student intubate), would make a point of having a passive aggressive conversation with me if I was aware of some credentialing policy or other, or possibly send an email to my boss to "clarify", or something else that was annoying but all in the name of patient safety of course. I don't expect this would result in anything bad happening to me per se, but it would be annoying. I would never let the potential for some annoyance to keep me from doing what's right for a patient or resident education, both of which are more important than me not being annoyed. But a student getting a chance to intubate is low enough on my priority list, that I would factor in the presence of an annoying administrator into my decision. As I said, the stars have to align just right.

I do want to address the couple of residents who seem shocked that I would involve a nurse in decision making. Unless I am misunderstanding your comments, it seems like you are surprised an attending would consider the opinion of a nurse before performing an invasive procedure on a patient. If I misunderstood what you mean, I apologize. If I understood you correctly though, I would urge you to re-examine your stance on that. First of all, because nurses are independent healthcare professionals with whom we work as part of a team, and it would be ****ty if a team member felt like their opinion did not matter. That does not mean that your opinion and the nurse's has to carry the same weight when it comes to decision making. Of course not. You are the doc, the buck rests with you. But if the ultimate medicolegal responsibility and extent of training were all that mattered, I would never involve residents in decision making either. After all, the buck stops with me as the attending an I know better, right? But that would probably make me a terrible attending to do shifts with, and I don't want that. I also want to benefit from a more trusting relationship with the nurses, where they would feel comfortable bringing up something if they felt I was making an error. I also want to benefit from their point of view since they are the ones who have way more eyeball time with the patient. I am in and out of the room seeing patients in every corner of the department, they are sitting and watching 4-5 patients, walking them to the bathroom, etc. They may sometimes have things to add for consideration. So yeah, if I am going to perform a big procedure on a patient, I will take 30 seconds to chat with the nurse about it, get their take.

Even if you don't believe any of the practicality arguments, just believe me that nurses can make your life a lot easier or harder, depending how much they like you.

 

[nlax30]

I pretty much agree with gro2011’s list and think that’s a pretty appropriate way to approach procedures for med students.

I certainly agree with things such as intubation and central lines in the ED not being generally appropriate for med students. Yes I believe they should get exposure to those sort of procedures but in more controlled environments like on stable patients in the OR such as during an anesthesia rotation.

In general the lines and tubes done in the ER are done on critically ill/crashing patients and a poorly done intubation is a quick way to kill someone.

 

[gamerEMdoc]

Id agree with that above list except intubation. We routinely let students intubate. Maybe not the crashing patient thats poorly preoxygenated, but an effectively preoxygenated patient gives you plenty of time, and the advent of video laryngoscopy really allows for close supervision and assistance.

All really depends on the resident that the student is working with. Some residents are more willing to give up procedures than others.

 

[engineeredout]

I think Gro2001 has come up with as solid of a list as anyone could.

 

[deleted547339]

I did not express myself clearly. I assumed everyone was on the same page. I think at least some of the attendings will understand what I mean.

I did not mean that a nurse (supervisor, or the one primarily responsible for the patient) would determine which procedure is performed by whom. Nor did I mean that nurses at places I've worked at would generally have a problem with something like that. I have known some (albeit a small minority) of nursing supervisors to be somewhat annoying about policies (or lack there of) when anything out of the ordinary would happen. It would certainly be out of the ordinary to see a medical student intubating a patient, for example. That's not an every day occurrence in the department. So there are one or two of them that would, if I did something like that while they were around (ie: let a medical student intubate), would make a point of having a passive aggressive conversation with me if I was aware of some credentialing policy or other, or possibly send an email to my boss to "clarify", or something else that was annoying but all in the name of patient safety of course. I don't expect this would result in anything bad happening to me per se, but it would be annoying. I would never let the potential for some annoyance to keep me from doing what's right for a patient or resident education, both of which are more important than me not being annoyed. But a student getting a chance to intubate is low enough on my priority list, that I would factor in the presence of an annoying administrator into my decision. As I said, the stars have to align just right.

I do want to address the couple of residents who seem shocked that I would involve a nurse in decision making. Unless I am misunderstanding your comments, it seems like you are surprised an attending would consider the opinion of a nurse before performing an invasive procedure on a patient. If I misunderstood what you mean, I apologize. If I understood you correctly though, I would urge you to re-examine your stance on that. First of all, because nurses are independent healthcare professionals with whom we work as part of a team, and it would be ****ty if a team member felt like their opinion did not matter. That does not mean that your opinion and the nurse's has to carry the same weight when it comes to decision making. Of course not. You are the doc, the buck rests with you. But if the ultimate medicolegal responsibility and extent of training were all that mattered, I would never involve residents in decision making either. After all, the buck stops with me as the attending an I know better, right? But that would probably make me a terrible attending to do shifts with, and I don't want that. I also want to benefit from a more trusting relationship with the nurses, where they would feel comfortable bringing up something if they felt I was making an error. I also want to benefit from their point of view since they are the ones who have way more eyeball time with the patient. I am in and out of the room seeing patients in every corner of the department, they are sitting and watching 4-5 patients, walking them to the bathroom, etc. They may sometimes have things to add for consideration. So yeah, if I am going to perform a big procedure on a patient, I will take 30 seconds to chat with the nurse about it, get their take.

Even if you don't believe any of the practicality arguments, just believe me that nurses can make your life a lot easier or harder, depending how much they like you.

Dude, you work in a malignant place. Justify it however you like, but a nurse manager passive aggressively sending an email to the medical director/chair about you letting a medical student do a supervised procedure sounds miserable. The fact that this is even a consideration confirms this. Don’t get me wrong, I’m a team player and think the world of our nursing staff, but if they mentioned who should be doing a procedure, I would privately let them know that they are entirely out of line.

And where I trained, if I had an intern around, I gave them the tube; if not, it was a Med stud who wanted to do EM; if none around, I did it. Now a crashing asthmatic or someone with severe metabolic derangement or critical hypoxia or oropharyngeal cancer, etc, yea, that’s my tube - but I would routinely give up the ODs and septic but not dying, etc. I think if the Med students aren’t getting tubes, the patient population likely isn’t all that sick.

 

[gamerEMdoc]

Yep. Most senior residents just give away routine tubes if there is a junior or student around. There's no point in doing another routine basic intubation when you are a 3rd year resident. And if a 3rd year resident needs the practice with basic intubation cases that late in residency, they went somewhere where there aren't enough sick patients.

 

[enalli]

What are these overabundant "basic" tubes that everyone is giving out to med students? Thinking back to the recent intubations where I have been present, there was always some technically-complicated or time-sensitive aspect that would have made them inappropriate for a medical student.

 

[Rendar5]

What are these overabundant "basic" tubes that everyone is giving out to med students? Thinking back to the recent intubations where I have been present, there was always some technically-complicated or time-sensitive aspect that would have made them inappropriate for a medical student.

Gcs 8 head injury is good case for them or an intubation for likely future deterioration

 

[gamerEMdoc]

What are these overabundant "basic" tubes that everyone is giving out to med students? Thinking back to the recent intubations where I have been present, there was always some technically-complicated or time-sensitive aspect that would have made them inappropriate for a medical student.

Anyone you can effectively pre-oxygenate.

 

[GonnaBeADoc2222]

There's no reason why med students can't do supervised tubes and lines provided:
1) they know how to do the procedure and 2) they had a chance to practice in SIM lab beforehand.

Honestly every 4th year should get at least one intubation and central line during their rotation. If not the residency either doesn't see enough sick patients or doesn't know how to teach med students. Either way its not a place I would trust to train emergency medicine physicians.

First year attending here.

I did my my home sub-I at a place where I didn't get any tubes or central lines. I enjoyed it very much, however and learned a lot. I did not train there but I know if I did, I'd have the same competence as I do now. As a sub-I / intern, I think your main job is to learn how to effectively talk to patients, other members of the healthcare team and how to practice basic medicine. I can teach a procedure to anyone, you don't have to be a doc to magically be able to perform procedures. Personally, in order for me to give a student a tube or a line I would have to know the student reasonably well (have worked more than 1 shift with them) in addition to the aforementioned criteria. These are dangerous procedures with high potential morbidity and should never be approached with the attitude that "this is going to be routine."

Honestly, if a student wants to be a valuable asset, they should spend time suturing in the sim lab so that when they arrive on shift they can suture with minimal supervision. A student who can do this would be so money in my opinion.

Not sure why there was so much flak directed at the person who mentioned taking nursing views into consideration. Yes, you "know more" and the buck stops with you, but you'd be wise to choose your battles with nursing wisely. Believe me, when there's a doc the nurses hate, everyone knows it, and they can make your job much more difficult.

Regarding above comments about airway management, I would caution residents about handing these off haphazardly. Some tubes are easier than others, but I try not to think of any intubation as "basic." This is the most critical procedure we perform. Can't get the LP?...who cares? Can't get the central line?...place an IO or run peripheral pressors. Lots of times, performing procedures on admitted patients in the ED (LPs, parcentesis, even a lot of central lines [no reason why peripheral pressors can't be used and a central line placed in the unit] ) are basically a favor to the admitting team. When you RSI someone, however, you literally have the patient's life in your hands, and they will die or suffer CNS damage if you mess it up. I did 100+ tubes in residency and still get amped up before I intubate. I used to wonder why my fellow residents (PGY2s and 3s) were giving up tubes to paramdeic students, etc. Junior residents should have priority at tubes, but in my opinion, no one but the most senior of residents about to graduate should hand off a tube to a student - every single one you do will improve your skills.

 

[BJJVP]

Dude, you work in a malignant place. Justify it however you like, but a nurse manager passive aggressively sending an email to the medical director/chair about you letting a medical student do a supervised procedure sounds miserable. The fact that this is even a consideration confirms this. Don’t get me wrong, I’m a team player and think the world of our nursing staff, but if they mentioned who should be doing a procedure, I would privately let them know that they are entirely out of line.

I get where you are coming from. But in my experience with multiple different hospitals, everything Gro2001 says is not too far off from reality. I don't think the nurses can determine who gets to do procedures, but multiple emails to the directors, especially if there has been a procedural complication, will force you to explain yourself to the chairperson/director. The chairperson/director will only defend you to a point. This is especially true if you are new to a facility and/or you are an outlier in your clinical practice patterns. I am definitely not saying this is right or ideal. However, in certain circumstances (for example a med student intubating), it can be a real consideration.

 

[deleted547339]

I get where you are coming from. But in my experience with multiple different hospitals, everything Gro2001 says is not too far off from reality. I don't think the nurses can determine who gets to do procedures, but multiple emails to the directors, especially if there has been a procedural complication, will force you to explain yourself to the chairperson/director. The chairperson/director will only defend you to a point. This is especially true if you are new to a facility and/or you are an outlier in your clinical practice patterns. I am definitely not saying this is right or ideal. However, in certain circumstances (for example a med student intubating), it can be a real consideration.

I never said it can’t be a consideration, I just mean to say that I’m not willing to work at a place where it’s a consideration. I’m not saying I don’t do things to make nursing happy, but if I was looking over my shoulder thinking nursing staff would be emailing my supervisor (and/or that person would care), I’d be out.

 

[BJJVP]

if I was looking over my shoulder thinking nursing staff would be emailing my supervisor (and/or that person would care), I’d be out.

I don't blame you for feeling that way. Actually, I agree wholeheartedly with you. My point was that it is a rarity to find an ED where you could be completely immune to that sort of thing. Of course, being in a single ED for a long time and earning the nurses trust and support helps.

 

[Vandalia]

At my hospital neither nurses nor administration determines which procedures students perform. I'm actually perplexed now. Who here has ever been told they could NOT let a student perform a procedure by a non-physician? Can you elaborate with examples? I'm not doubting you... Just curious. I don't think it is normal at most places, but I'd like some other people to clarify.

I did not express myself clearly. I assumed everyone was on the same page. I think at least some of the attendings will understand what I mean.

I did not mean that a nurse (supervisor, or the one primarily responsible for the patient) would determine which procedure is performed by whom. Nor did I mean that nurses at places I've worked at would generally have a problem with something like that. I have known some (albeit a small minority) of nursing supervisors to be somewhat annoying about policies (or lack there of) when anything out of the ordinary would happen.

That is exactly what I meant as well. I have never had anyone directly step in and say that a medical student could not perform a procedure. I also doubt it would ever be an issue at a university teaching hospital.

However, in the community, nursing administrators can be incredibly annoying about things that are unusual, and/or are in their fiefdom. In addition, in some states by law or at facilities by policy, there is "whistleblower protection" for reports of issues that could compromise patient care. So yes, it has happened at a facility that recently started hosting students, that a medical student doing a procedure resulted in a report of infection control violations, a provider doing a procedure without privileges, and whatever else they could think of. These were quickly dismissed, but were a bit of a pain to deal with.

This goes back to the fundamental point that led to this thread on the thread: as a student, at a facility not affiliated with a medical school, you are likely to be able to do more at night than during they day when administrators are floating around.

Here is an idea of the mindset involved: At our 350+ bed facility a couple of years ago, a nurse in infection control heard that a couple of people - not all involved in patient care - called in for time off because their kids had a "stomach flu." She thought this was evidence of an outbreak and demanded we completely close down the facility. To repeat what I said, there is a lot of nonsense going out there that you are probably not exposed to as a resident (or an attending, if you are lucky.)

 

[Rendar5]

I would still have to disagree with you that you need to be careful about procedures and teaching students at community hospitals. I have worked at several community hospitals with different CMG’s and have never had any issues arise over this because I am still in the room directly supervising. And I have also had to nursing supervisors bringing up annoying stuff all the time as is their nature. However, if they would go so far as to try and dictate supervised procedures that I already am privileged to do by the hospital in contract, it would be a really malignant environment and I would really never want to work at such a place. Such places are the exception, not the rule in community practice. If someone wants report an infection control issue, then that really has nothing to do with the medical student doing the procedure, but rather the supervisor of the procedure.

 

[Menander's Bust]

At Florida Hospital students cannot be first assist on any surgery by hospital policy and at another hospital they cannot even scrub in technically. It is an ACHA issue. The hospital gets dinged if ACHA sees them allowing this, at least here. ACHA created the opioid crisis by mandating strict pain management so why not try to ruin medical education next.

 

[Atlas Shrugged]

Can’t scrub??? Wtf? How does LCME allow a hospital like this to accept students.


Sent from my iPhone using SDN mobile

 

[Janders]

Gro2001's list is solid, though I'd bump CVL into the #2 zone as I routinely let MS or PA students who were doing a good job on clerkship do CVL if they had specific interest and wanted to to EM or something similar.

They better be able to recite to me the entire procedure if they want to do it though.

And honestly the key is to have enough time to stand next to them for the 17 forevers it will take them to do their first CVL

 

[Menander's Bust]

Can’t scrub??? Wtf? How does LCME allow a hospital like this to accept students.


Sent from my iPhone using SDN mobile

It’s a community hospital and it’s Med students not residents who can’t scrub. My school model pairs us with an individual physician the entire rotation. We go wherever he or she goes and this one of a couple of hospitals this guy does procedures at.

 

[Iamcanoehead]

Years ago, I was working as a nursing supervisor. I thought the medical students and docs could easily sort out what was appropriate procedure wise. There was one exception, when they decided to practice intubating on a dead body, and family wasn’t present. I felt it was disrespectful, and legally, there was no consent possible.

 

[deleted547339]

It’s a community hospital and it’s Med students not residents who can’t scrub. My school model pairs us with an individual physician the entire rotation. We go wherever he or she goes and this one of a couple of hospitals this guy does procedures at.

You should talk to your clerkship director. I went to a med school with a similar model (maybe the same school?). This is a “never event.” If you have a preceptor that can’t teach you, your medical school has an obligation to pull you from that preceptor and you have an obligation to not take no for an answer. Missing out on procedures at some of his or her sites is not “good enough.” You’re paying a quarter million dollars for your education and you’re not getting what you’re paying for.

 

[wareagle726]

I must have gotten lucky as an M4 but I got to do at least 15 CVLs, Intubated probably more than that, a few chest tubes, a few a-lines, and some other stuff. All of it was under attending or upper level supervision too. I will say, however, one of those rotations was at a community hospital without an ED residency but all board certified EM docs and I was the only student so that was a huge part of it.

 

[The White Coat Investor]

I must have gotten lucky as an M4 but I got to do at least 15 CVLs, Intubated probably more than that, a few chest tubes, a few a-lines, and some other stuff. All of it was under attending or upper level supervision too. I will say, however, one of those rotations was at a community hospital without an ED residency but all board certified EM docs and I was the only student so that was a huge part of it.

There's no knowledge difference between an MS4 in April and an intern in July. Might as well get going learning what needs to be learned. Silly to act otherwise or set up policies that way. It's all a continuum between being a complete fool and being competent to practice without supervision. Over the course of 7+ years you move along it, sometimes ahead of peers, sometimes behind, but by the time you come out the far end of the pipeline you're usually good to go. There really are no hard lines at any point. Nothing special about July 1.

 

[wareagle726]

There's no knowledge difference between an MS4 in April and an intern in July. Might as well get going learning what needs to be learned. Silly to act otherwise or set up policies that way. It's all a continuum between being a complete fool and being competent to practice without supervision. Over the course of 7+ years you move along it, sometimes ahead of peers, sometimes behind, but by the time you come out the far end of the pipeline you're usually good to go. There really are no hard lines at any point. Nothing special about July 1.

I disagree completely. On July 1 I started getting paid...very special

 

[KinesiologyNerd]

I disagree completely. On July 1 I started getting paid...very special

That feeling wears off July 1 at 8:05am

 

[gamerEMdoc]

That feeling wears off July 1 at 8:05am

Hahaha. By 0810, its "I'm way to underpaid for this"

 

[wareagle726]

That feeling wears off July 1 at 8:05am

Man, they let y'all sleep in the first day lol

 

[Mr. D.O.five]

At Florida Hospital students cannot be first assist on any surgery by hospital policy and at another hospital they cannot even scrub in technically. It is an ACHA issue. The hospital gets dinged if ACHA sees them allowing this, at least here. ACHA created the opioid crisis by mandating strict pain management so why not try to ruin medical education next.

Hope this isn't considered a an old thread bump, but I wanted to update that Florida Hospital (now called Adventhealth Orlando) does allow M3s to be first assist IF there are no residents or surgery PAs around. Source: Did my 3rd year at this hospital system at 3 of their locations and I was first assist for at least 1 surgery in each of those hospitals.

 

[Dave1980]

thread was dead for 2.5 years. how is this not an old thread bump?!?!? some people have no sense lol