Essential Clinical/ Procedural Skills for 3rd Year?

[deleted645092]

I’ll be starting 3rd year rotations in July, and while I got to see some of what 3rd years do, with varying levels of participation, as a medical scribe during undergrad, I’m not exactly sure of what procedural skills might be expected of me. Are there any specific skills, outside of being able to take a history, formulate a basic differential, and present to my preceptors, that I should have down cold or at least be able to perform under supervision on day 1 of rotations? Some skills that the administration at my school has recently added to our curriculum include;

-BLS and ACLS certification.
-Placing IVs and drawing blood.
-Intubation (Does anyone even let 3rd years intubate ?)
-Chest tube placement.
-Basic suturing and surgical knot tying.
-Central line placement.

Obviously I’ve only done these things on models, but does the fact that I have at least had minimal training in them mean that a preceptor might allow me to do some procedures, or god forbid, expect me to be able to?

---

Members don't see this ad.

 

[FindMeOnTheLinks]

you should be BLS certified, and familiar with ACLS but not ACLS certified
all the other stuff is good to be familiar with, but no way would anyone expect you to know how to do them cold on day 1 of MS3. If you ask your preceptors to show you first, then you can do the next one, you will probably get to do most of this.

 

[TypeADissection]

There is zero chance that anyone is going to let you do a chest tube or central line as a MS3. Nobody expects you to know how to do this. You should know the steps and more importantly the indications for it. My main goal for all MS3s coming into the service is good basic two hand knot tying and a good instrument tie along with vertical/horizontal mattress. If you can do that by the end of your rotation then you’re doing alright. Cheers.

 

[deleted645092]

Thanks all, I appreciate it. What you've all said has been pretty consistent with what I expected up until this year. The administration at my school has been pushing more of these clinical skills workshops, saying that rotating students from previous classes thought it would be useful. However, they don't do anything with us about actual indications and standards of care around these things, but rather the procedure itself using models.

 

[doyouhaveaflag]

People at my school did all of these except chest tubes in M3, but not everyone did all of them. It was really dependent on what rotations people got, who they got paired with, and time of year (ie: did the interns already do a bunch of them). People who rotated on anesthesia did a lot of intubations, IVs, and some central lines. Some people on ICU and EM also did central lines. Everyone sutured and knot tied on surgery.

A lot of my fellow M3s also did paracentesis, thoracentesis, and lumbar punctures. Paracentesis was probably the most common procedure given our patient population.

However, given the inconsistency between our experiences, no one was expected to be competent at them by the end of the year.

 

[mimelim]

There is zero chance that anyone is going to let you do a chest tube or central line as a MS3. Nobody expects you to know how to do this. You should know the steps and more importantly the indications for it. My main goal for all MS3s coming into the service is good basic two hand knot tying and a good instrument tie along with vertical/horizontal mattress. If you can do that by the end of your rotation then you’re doing alright. Cheers.

I recognize that I may be an anomaly. But, I have had MS3s put in lines. Certainly not on their first day and certainly wouldn't let everyone do it. But, motivated MS3? Sure, no problem. They tag along the first time, help me setup the second time, do everything but the stick the third time and if there is a 4th+ time, they as re likely going to at least attempt it.

So, not zero chance...

 

[TypeADissection]

I recognize that I may be an anomaly. But, I have had MS3s put in lines. Certainly not on their first day and certainly wouldn't let everyone do it. But, motivated MS3? Sure, no problem. They tag along the first time, help me setup the second time, do everything but the stick the third time and if there is a 4th+ time, they as re likely going to at least attempt it.

So, not zero chance...

I stand corrected. I also did get a chance to do central lines when I was a MS3-4 but it's because they knew I wanted to do surgery and knew the steps. And it was exactly in the same sequence as you described. Good or bad, not every med student will get this opportunity unless they show appropriate initiative and skill. But yes, not a zero chance.