first day in the ER

[Nvr Ending Jrny]

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ok so i volunteering in the ER for the first time today and all i can say is "wow". I've never seen so much going on at once. To say that doctors/med students are talented is SUCH an understatement. I saw 6 or 7 med students take care of these couple of trauma cases with no direction from a doctor. it was nuts how good they were.

anyways the reason im saying this is cause i don't understand at what point med students learn all this stuff? like if the first two years are science related crap. and then 3rd year you start rotation, then at what point do u learn before u actually do hands on stuff?

that might be an incredibly ignorant question for me to ask but im sorry i just don't know. i assume they do a lot of observing during maybe year 1 and 2? then maybe they observe in the beginning of rotations? obviously the 4th year med students help the 3rd years as well but i just was wondering if there was a set time to learn this stuff?

also im sure my comment up there about how good the doctors/med students will come as no suprise to any of you. i of course knew that all of long but it's whole other thing to see it first hand. last semester i volunteered in a nursing unit and although they are very talented as well it's totally different (much slower paced).

 

[jlee9531]

most med schools have doctoring skills classes starting from the first year where you interact with patients and learn slowly how to do all this stuff....so by the end of the 2nd year you have a good sense of all this stuff.

 

[UCSBMed1]

Maybe I'm not the best person to answer this question, since I am only in my h*llish first year, but from my understanding, med school's first two years are where you learn the "science" behind medicine. Therefore, most of the concepts, disease processes, and pharmacology are learned here, and tested on at Step I.

Now the last two years are the integration between the science and the clinical aspects. Here is where you learn how to apply all those concepts you learn, as well as learn several new ones that were not applicable to the first two years' course of study.

My theory is that over the course of the first two years, you actually learn a lot of the reasoning behind why doctors do what they do to treat patients. In addition to learning the science, you also learn how to interview, take histories of, and perform a physical exam on patients. Using these skills, and new ones that only a clinician can teach you (residents and attendings) you are pretty well prepared for what you'll see as a med student. Remember, there are (at least at my school) countless shadowing experiences, as well as clinical exposure with preceptors to learn more.

Don't worry, by the time you reach your third year, you won't be "totally" clueless, but there will be a lot of stuff you don't know, and that is okay. Thats what the last two years are for, anyway. Good luck!

 

[stomper627]

Originally posted by UCSBPre-Med1

Don't worry, by the time you reach your third year, you won't be "totally" clueless, but there will be a lot of stuff you don't know, and that is okay. Thats what the last two years are for, anyway. Good luck!

Dont plan on knowing too much on that first rotation....Rotations are SO much better than class....but you learn very quickly to answer questions with "I dont know".
stomper

 

[Nvr Ending Jrny]

thanks for replying. every now and then i stop and think "do i have what it takes". for some people im sure this question never pops up in their head and for others im sure it pops up 10 times as much.

i still can't do any work after being in the ER. im not like shaken up or anything but I just keep thinking about what the doctors/med students were doing. like some of the stuff they did i didn't even know was done. like maybe i shouldn't be writing this hear but we're all adults.....they put a tube in a guys penis. i didn't even know that was possible to do in a quick minute. im sure the majority of u knew that was, but i think im a bit less exposed to medicine then the average SDNer.

other stuff i saw was like them using the weirdest techniques to figure out what was broken and and how severely.
plus i saw them putting some tube thing in the guys nose (for oxygen i assume), and stitching up his groin, giving him morphine through the groin area, etc.
also one doctor had the guys arm held up during the entire time because it was severely damanged (arteries, tendons, bones, everything).
then there was the doctors and nurses making phone calls to the OR, radiology, etc
it was just so intense and i wasn't really even apart of it

i apologize if i wrote something i shouldn't have here. i figure it's okay to talk about what we see in volunteering as long as the identity of the patient and hospital is never mentioned. am i right? if not i will quickly delete this post

 

[skypilot]

I think it's a good post. Gives you a good picture of what went on. Certainly isn't in violation of anyones confidentiality.

 

[DoctorDoom]

Don't worry, the students just seem to know exactly what they are doing, but they have to check with attendings, who also have strengths and weaknesses. You'll have plenty of time to learn everything, mostly starting with your introductory classes and rotations in 2nd or 3rd year of medical school. These skills are built over time.

Also, you actually can learn a lot right now. That tube being inserted into a penis? Ask a med student (or nurse or doctor) about it and ask how they do it and why. Was that tube in the nose really for oxygen? You are there now, use the time. You'll learn a lot and know whether you have what it takes for yourself.

Good Luck!

 

[Doctor Wyldstyle]

As a third year, alot of what they said is true...but you really dont know what you are doing in there when you first get in. Trauma is intense. Alot of pressure because of the value of timely managment. We look like pro's but in reality, we learn on the job...alot by trial...and trial...and in some cases, error. As an integral part of the team of healthcare professionals, yes your actions are checked by others to some extent. Nevertheless, to walk into a situation and have no clue is the norm on any rotation. What happens is you use your first two years of clinical skills theory, practice, and basic sciences and apply them with intuition and logic if possible.

If you really want to know what's going on in that Trauma room or ER, go borrow Surgery Recall... a small pocket book that can fit in your whitecoat and is easy to read with pictures. You'll impress the attending and maybe score some rapport.

wyldstyle
third year med student
Saint Louis University

 

[Tas]

Are you volunteering in the ER? or are you working there?

The foley catheter ( the most likely type of tube to place in the penis ) is no problem (usually 😉 to place, although enlarged prostates can be a real hassle...)

The tube in the nose, if it was very flexible, about 4-6 inches long and about 1/4" in diameter and had a beveled edge was probably a naso-pharyngeal(sp?) airway and is commonly used to secure the airway on patients who's gag reflex is still intact or who's jaw is too screwed up to use an oral airway...

All this stuff you'll learn in your own time 🙂

If you spend much time in the ER, these things will become second nature to you - although.... if you are like me, you will NEVER cease to be amazed at what the medical profession truely is and at the miracles that can happen with and without our help!

Never lose that feeling! Best of luck to you.

 

[Nvr Ending Jrny]

thanks for the replies. I had another day vounteering in the ER today. It was once again very intense and I really don't feel like im doing a damn thing (mainly cause im not in comparison). Along with wanting to help people, not having to worry about my financial future, learning something new all the time (mainly cause u have to), there's one more reason i want to be a doctor: that feeling i had in the ER trauma room watching all those doctors/med students doing their "thing". Amazing.


One last question: What exactly is an attending? That one car accident victim that I mentioned before was being worked on my med students but one of them looked double the age of everyone else and seemed to know a lot more. Was he probably the attending?

 

[hilikus]

isnt the attending the dr. in charge? i dont think he's a med student

 

[Doctor Wyldstyle]

The attending is the doctor in charge. The health field is like military with the attending that night at a high rung in the ladder. Next is the residents who he's in charge of. Then the interns which are basically first year residents who in their first year are required to rotate thru different services of their residency. As med students, often you'll report to the interns if not the residents, and if neither are around, you report straight to the attending! Talk about pressure sometimes.

Maybe the older guy was the intern/resident/attending physician.

 

[ecranda]

I am so glad you are getting this experience. It is wonderful. The best part is that it helps you to get in serious touch with your human side. I work at the big inner-city trauma center in my state and it has been the best experience I have had! You are able to see the worst cases and realize how much of an impact you can have on people's lives. It is very hard at times, because of the intensity. I have found myself coming home several nights worrying about the patients. But, it has allowed me to appreciate life. You are able to be there with their families and talk to patients. Right now you feel like you are not doing much, but after a little while you will be able to feel like you have a bigger part. The best thing I am able to do is talk to patients when they are waiting and doing things for them to make them more comfortable. They also LOVE to get warm sheets, since the ER is chilly. One thing I can advice is getting to know the residents. They will answer your questions and also let you follow them around to other parts of the hospital. Just be as helpful as you can and they will love that you are there. So, enjoy this experience. It is something few people get to do, but is one of the most rewarding in my opinion.

Good luck! Have fun!

 

[g3pro]

Originally posted by Nvr Ending Jrny
like maybe i shouldn't be writing this hear but we're all adults.....they put a tube in a guys penis. i didn't even know that was possible to do in a quick minute.

oh, see, now i am really confused. they put a tube in a guy's penis??? i thought they put those in women's penises! 😛

 

[trauma_junky]

This is were your experiences set you apart from the number people. My buddy took 3 attempts to get in, and did above average in his first 2 years. But in year 3 & 4, he took off. What did he do you ask? He was a paramedic.

 

[beanbean]

Some of the people you think are med students are probably residents (meaning they have graduated from med school and are now doing training in the field of their choosing). Depending on the hospital you can often tell who is who by the length of the white coat; however, other people besides doctors wear white coats so this is only a general guideline. Often the med students wear short white coats and the residents wear long white coats. Some attendings wear long coats; others wear no coat at all.

Although the majority of the first two years involves learning the science behind the art, there is still time spent learning clinical skills such as how to perform physical exams. At UConn, each student spends one afternoon a week with a primary care physician starting at the beginning of the first year and sees patients independently and with the physician. Many schools give students clinical time during the first two years. You can also tailor your electives during the first two years to give you some exposure to clinical environments.

Have a great time in the ER. It is my favorite place to be! You will be amazed at how much you will learn. Don't be a pest in the middle of things, but get to know a few people and ask questions. Many med students/residents/nurses will be happy to expalin stuff for you.

 

[Nvr Ending Jrny]

thanks for all the replies. This week sure has been CRAZY. I was in the ER three days this week and each time was an experience to say the least.

I do think the people I saw in the ER were med sudents because I asked the radiologist that was in there if they were and he said "yeah all those people right there are med students", but I don' tknow if he knew that for a fact. By the way everyone in the ER was wearing scrubs and no white coats. I guess they take their coats off when they're actually doing stuff? I dunno

People always tell me to get to know the residents or med students so I can ask them questions when they're not busy, but they're ALWAYS busy. When I'm around them they are always doing a million things and there's no chance in hell i'm going to even think asking them something that might break their concentration.

When the ER has a trauma they page the radiology department in the ER so that they can send someone over to take xrays. What is the position of that guy that they send over? is he a physician? I've never seen him look at the xrays, he just takes the xrays and he always calls the med students and resident "doc". I really doubt a doctor would call a fellow doctor "doc", but maybe that's just me?

 

[Tas]

if it's like it is around here, he's a radiology Tech

I *think* it might be a 2 year program at a vocational school. Where they are trained how to take xrays of various body parts according to what a doctor wants and what a machine can do, etc etc...

but where I work isn't a training hospital, so it could be different there.