guidelines for invasive procedures by students?

[tc]

I was surprised to find that we have no written policy or formal training requirements for lumbar punctures and comparably risky procedures. Basically, fresh 3rd year students can do LPs on any patient as long as the resident allows.
The issue came up regarding a student who was ordered by a resident to do an LP on an uncooperative pediatric patient with suspected meningitis. The student had seen two LPs, but never done one. (The student refused. No, it wasn't me.)

Does your school have a written policy, training requirements or restrictions on procedures performed by students? Are 3rd year students allowed to do heart transplants if the surgeon allows? (Sorry - just taking the argument to a logical extreme.)

Surely there is some formal policy at most schools. Yes?

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(Sorry, cross-posted in "Allopathic")

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[Neurogirl]

Haven't you heard the old saying, "see one, do one, teach one"? Assuming the student was supervised (a 3rd yr should NOT be expected to fly solo), he/she should have tried to perform the LP. As a 3rd yr, I did LPs, delivered babies and assisted in surgery...no I never performed surgery, but I know of others who did (with the surgeon supervising of course). As a general rule, all students must be supervised but there are no restrictions on which proceedures may or may not be attempted. I know it's scary to perform a proceedure for the first time, but how else are you going to learn?

BTW, although an LP LOOKs risky, it's actually a relatively benign proceedure, much less risky than say a central line or chest tube placement.

Finally, I know it sounds insensitive but your friend needs to "suck it up" and do what they're asked to do. A VERY IMPORTANT part of becoming a physician is learning how to control your fear and perform...in often less than optimal situations.

 

[doughboy]

Unless that student is not a "hands on" person, he just passed up a great experience. Procedures can be watched a zillion times but unless you get your hands dirty and get to do one, you'll never really learn to do them. Would you rather sit at the table and write SOAP notes all day along with H&P's, I think not. Like neurogirl says, suck it up.

 

[Winged Scapula]

I do not know our formal policy but would have to side with the above 2 respondents. Students HAVE to DO procedures to learn to do them; there is NO substitute for hands-on experience.

That said, I'm not sure doing your first LP on a squirmy uncooperative sick child was the wisest move on the part of the resident. I try and get the students here to do procedures as often as I can - mostly things like suturing, putting in Foleys, NGTs, etc.

If your friend is uncomfortable doing procedures she/he should speak up, especially if he or she feels the situation is inappropriate. However, he/she should "suck it up" (in the words of another) because the opportunity to do an LP as a student is fairly rare and turning down procedures and tasks is considered poor form (even if its a distasteful task).

Hope this helps.