how comfortable should I be with procedures going into residency?

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Fungi121

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I'll be an intern next year in emergency medicine, and I'm still trying to get the hang of intubating, IVs, art lines, LPs, and procedures in general. I didn't really get a TON of exposure to them during my rotations to the point where I feel comfortable .

How comfortable should I be with these things prior to going to residency? Or are these things you spend your intern year learning?
 
You will learn all that stuff in residency.
With each passing year it seems that med students are allowed to do less and less.

If you get the chance to place IVs, I would work on that.
 
The most important things for a new intern to be successful are: good attitude and good fund of knowledge.

If you're the intern who thinks you know more than your attending a few months into residency, you'll be considered intractable.
 
The only procedures that your should be somewhat comfortable with is suturing (simple interrupted) and speculum exam (though, not so much a procedure). Knowing how to do a peripheral IV (like, actually knowing) can be a bonus in some situations. Certain procedures can be hard enough to come by for residents, so students are at a disadvantage. I do recommend an anesthesia rotation as a student. No one will expect you to be competent or "comfortable" with intubation as an intern, but it would be nice to have at least some experience with manual ventilation and and the mechanics of ETI.
 
Fungi121 said:
I'll be an intern next year in emergency medicine, and I'm still trying to get the hang of intubating, IVs, art lines, LPs, and procedures in general. I didn't really get a TON of exposure to them during my rotations to the point where I feel comfortable .

How comfortable should I be with these things prior to going to residency? Or are these things you spend your intern year learning?
Click to expand...

Little to none. Besides suturing, my attendings assumed that I knew little to nothing about the main procedures of EM, and thought me from the ground up. I'm guessing it's like that at most places, as most medical students are sent in to do central lines or called upon to intubate patients.
 
Just wanted to give a plug to the sentiment that I wish I had been better at peripheral lines before starting residency and then I wish I would have gotten better at Ultrasound guided peripheral lines in residency.
 
No reason you can't get good at them after residency. I did my first US guided peripheral without training just the other day. I mean, it's pretty much like a central line only fewer steps. Hold US in left hand. Put IV In with right hand. Watch it go in on US. See flash. Advance catheter. Get CTA chest that x-ray techs wouldn't do with that 22 gauge on their thumb.
 
A peripheral us guided if is much much harder then central line. Its easy to penetrate the back wall. Pretty easy to get flash but tons of my classmates couldn't thread the angiocath. It takes practice. I did somewhere between 100-200 during residency and now feel proficient.

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The White Coat Investor said:
No reason you can't get good at them after residency. I did my first US guided peripheral without training just the other day. I mean, it's pretty much like a central line only fewer steps. Hold US in left hand. Put IV In with right hand. Watch it go in on US. See flash. Advance catheter. Get CTA chest that x-ray techs wouldn't do with that 22 gauge on their thumb.
Click to expand...

I certainly agree with that. I just wish I was an ace at them now.
 
shoal said:
A peripheral us guided if is much much harder then central line. Its easy to penetrate the back wall. Pretty easy to get flash but tons of my classmates couldn't thread the angiocath. It takes practice. I did somewhere between 100-200 during residency and now feel proficient.

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Click to expand...

Wondering where you found the time to do 200 PIVs in residency. US guided PIV is a skill I'd like to have, but I just haven't had time to do more than a few...I guess if I did a dedicated US month, maybe.
 
filhodeinferno said:
Wondering where you found the time to do 200 PIVs in residency. US guided PIV is a skill I'd like to have, but I just haven't had time to do more than a few...I guess if I did a dedicated US month, maybe.
Click to expand...
I every day or two will get you there. I'm probably around 200 as well, but it's still pretty rare I have to throw one in.
 
We were way understaffed on nursing and often had trouble with lines in diabetic, dialysis patients. So I ended up having to do lines on these patients 1-2 times per shift.
Now as an attending, I've put in 1 line in 6 months. But we have far fewer dialysis pts at my first job.

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I get asked to do about 2-3 a week at my ER. They aren't that easy though...I am only at about a 75% success rate. And I have done between 50-100 of them.

One of my least favorite procedures. Plenty of setup time. Essential the same as a CVC. And in the end you get a....peripheral IV (that may infiltrate in the next 12 hours).
 
I'm about halfway through residency and I'd estimate that i've done 100+. Patient population generally has bad veins AND our nurses give up a little to quickly. Usually 1 per shift at our main site (less now that I'm no longer an intern), 0-1 per week at the community site. We even do them occasionally in the trauma bay 'cause the surgery residents don't do them (obviously these are in noncritical patients). Having done 1000+ peripheral IVs in previous life, I'd say US guided IVs are much easier to learn and perfect than usual peripheral IV. Took me 10-20 US guided IVs to get the hang of it compared to probably 50-100 of usual peripheral IVs. Hitting central veins w/ US guidance is cake compared to peripherals.
 
Fungi121 said:
I'll be an intern next year in emergency medicine, and I'm still trying to get the hang of intubating, IVs, art lines, LPs, and procedures in general. I didn't really get a TON of exposure to them during my rotations to the point where I feel comfortable .

How comfortable should I be with these things prior to going to residency? Or are these things you spend your intern year learning?
Click to expand...

Don't worry about that. There is no really good way to get familiar with this stuff before you start. If anything, get a set of CEME's board review lectures and start listening to them on your commute. That will help you on your annual tests as well as the boards.

Towards the end of your intern year consider an airway course.
 
Can anyone comment on what anatomy they felt has been super useful? I feel like that was probably one of my weaker areas but I'm just wondering where more detail has actually been useful in the ER setting

thanks!
 
TooMuchResearch said:
If our good nurses can't get ultrasound guided peripheral access, I'm not either.
Click to expand...

That's how I've felt as well. I guess I haven't done many because our nurses are pretty aggressive, and they are also trained at US guided PIVs....so usually if they can't get them, we do something more invasive if really needed. I'm going to have to start finding time/ways to practice them, though.
 
filhodeinferno said:
That's how I've felt as well. I guess I haven't done many because our nurses are pretty aggressive, and they are also trained at US guided PIVs....so usually if they can't get them, we do something more invasive if really needed. I'm going to have to start finding time/ways to practice them, though.
Click to expand...

I just don't think it's a high yield place to spend my learning time.
 
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