How do I get more than a scut Medicine experience and get to do procedures?

[medicgal]

---

Members don't see this ad.

I'm an MS III on my 2nd month of a three month medicine rotation, and I feel like while the scut I am doing as made me learn (ie going to get a CT read and then I sit with the radiologist have him explain what he/she sees and why), but I haven't been able to do any procedures...

I bet it is the same at a lot of hospitals where the nurses and other staff do the IVs, blood draws, foley insertion ect, as it is where I am doing my rotation...SO HOW DO I GET THIS EXPERIENCE AND NOT END UP DOING THREE MONTHS OF SCUT?

I have been able to see a central line, a paracentesis, many piccs put in, and two knee aspirations, but I want to get more hands on experience. Most of the time an order gets put in and then a couple of hours later, I'm sent over to make sure the nurse/whomever is responsible has completed the task, so I feel like I have NO TIME to even try and get hands on experience.

Any helpful tips of how I can get more experience doing IVs, blood draws, ect would be great!!! I did ask when the above procedures were being completed if I could do it, but a lot of the times, the interns hadn't had much experience either so were given first dibs because they had quotas to fulfill.

 

[AmyO]

What do you consider scut? It's not really "scut work" IMHO if you are learning something from it. A lot of the procedures you mention (blood draws, IVs, foleys) are typical nursing duties and are considered scut by residents and some medical students. It is good to get some experience doing IVs, foley insertions (you should be able to get a lot of foley insertions on your surgery month if you get in the OR early while they are prepping the pt), & blood draws but it's not your main duty as you won't be doing this much as a physician. You could probably get a lot of IV insertions in pre-op. If you get in good with the nurses, simply ask them to page you when then they have IVs that they need put in, etc. As an MSIII, you aren't going to be doing tons of procedures especially during medicine. During surgery, you might get the chance to put in a central line or chest tube but it depends on your preceptor. Residency is where you are going to get to hone your skills as far as procedures go (from what I've heard). If you are especially interested in procedures, you might try doing some sub-i's your 4th year in more procedure-oriented fields. Good luck w/ your medicine clerkship!

 

[SouthernSurgeon]

I'm an MS III on my 2nd month of a three month medicine rotation, and I feel like while the scut I am doing as made me learn (ie going to get a CT read and then I sit with the radiologist have him explain what he/she sees and why), but I haven't been able to do any procedures...

I bet it is the same at a lot of hospitals where the nurses and other staff do the IVs, blood draws, foley insertion ect, as it is where I am doing my rotation...SO HOW DO I GET THIS EXPERIENCE AND NOT END UP DOING THREE MONTHS OF SCUT?

I have been able to see a central line, a paracentesis, many piccs put in, and two knee aspirations, but I want to get more hands on experience. Most of the time an order gets put in and then a couple of hours later, I'm sent over to make sure the nurse/whomever is responsible has completed the task, so I feel like I have NO TIME to even try and get hands on experience.

Any helpful tips of how I can get more experience doing IVs, blood draws, ect would be great!!! I did ask when the above procedures were being completed if I could do it, but a lot of the times, the interns hadn't had much experience either so were given first dibs because they had quotas to fulfill.

1) Agree with below, some of the things you say you are really hoping for are things most consider scut.

2) For some of the procedures:
-Paracentesis - you've seen a few of these procedure. So, next time a liver patient comes in, ask your senior resident if you can tap them (if needed). Unless they are mean or don't like you, I think they'll let you do it. It's an easy procedure, and by February I'm sure the interns are ok with letting you have one (not the most glorious procedure in the world)

-Central line - this one requires more trust from the team. I'd imagine on a general medicine service (i.e. not ICU) they are uncommon enough that the residents want the experience and/or may be hesitant to let a 3rd year try. You're more likely to get a chance on surgery or fourth year if you do a sub-I in the ICU.

 

[Anka]

Just a comment from a resident, but feel free to ignore it if you like -- I think it's great you want to do procedures. Too often, I've tried to get students involved in drawing blood, placing IVs and foleys, and had them tell me that I was scutting them out later, and that these were things they were going to learn during residency if they needed to. Medical school is a great time for learning just about anything you can -- including the things the RNs are going to be calling you about because they can't do it (or "I don't feel comfortable enough that this patient needs a foley, and I'm not going to put it in because it's my license if I do and the patient gets an infection"). In which case, you're the one who will be putting it in.

Your ability to place IVs, draw blood will get you out of trouble as a doctor. Furthermore, you're ability to do these things smoothly are often the only thing the ancillary staff has to evaluate you (they can't evaluate you on your knowledge of the intricacies of medical management, because it's not really in their scope of practice). So, if you can put in IVs and draw blood smoothly and without complaint when you have to, don't feel the need to give them a hard time about it (because you're fast at it and comfortable with it), and interact well with the patient while you're doing it... they'll think you're a better doctor than the guy who "can't even put in an IV".

Finally, I'd discourage you from thinking of the other things you're doing as scut. Try to think of it as a learning opportunity, and learn as much as you can from it. In the example you gave about going down to radiology to get a CT scan and then sitting with the radiologist doing the read, that's a great learning opportunity. The example about chasing down nurses to draw blood is a harder one, but honestly you're going to be spending a lot of your career getting other people to do things, and learning effective ways of doing it is probably worthwhile. Now, imagine how great it will be when you actually know how to draw blood, and can just do it while the RN isn't even looking! BTW, if I were you I'd invest 10-15 minutes into drawing blood with the nurse the next time that task comes around. By the second or third time, you should try it yourself before getting the nurse. It will probably only be 5-10 times before you're fast enough at it that it will save you time.

Best wishes,
Anka

 

[bjackrian]

BTW, if I were you I'd invest 10-15 minutes into drawing blood with the nurse the next time that task comes around. By the second or third time, you should try it yourself before getting the nurse. It will probably only be 5-10 times before you're fast enough at it that it will save you time.

Great advice overall. Just be careful with this part as some school/attendings/residents have strict policies about supervision of students even for routine blood draws. I have been chewed out by a resident for drawing blood on a patient even though I was successful on the first attempt because there was supposed to be a licensed person in the room during any "procedures" at that hospital, and they counted blood draws as a procedure.

 

[medicgal]

thanks everyone! I guess scut to me is having to call to see if patients have gone down for certain procedures, asking the patient what meds they need for discharge, grabbing charts, putting papers in charts, ect, but I never considered blood draws, foleys ect as scut!

I will talk to the floor nurses and find out the blood draw schedule. Plus, having them page me is a great way to see blood draws, and something I didn't think about at all. I know someone will have to be present when I do the draw, but that's fine with me!! Plus, I'll go to the basement where the IV nurses have their offices and see what they will let me do as well. thanks for the advice.

 

[LadyWolverine]

I feel for you, OP. I felt that the majority of my medicine rotation was scut. As a matter of fact, I felt like the majority of the interns' and residents' day was comprised of scut. It didn't matter how nice the team was or how much responsibility I was given for any said patient, the pleasantness of other people never made up for the fact that we passed the buck on pretty much anything and everything. The patient needs a paracentesis/thoracocentesis? Call an IR consult so we don't hit a solid/hollow organ. The patient needs a bronch? Call an pulm consult. Let EM or OB/GYN do the pelvic. Need a bladder eval? That's Uro. The patient needs a FNA and cytology/biopsy? Call path. The patient needs something imaged and read? Call radiology. The patient needs an echo or a cath? Call cardiology. The patient needs an I&D? Call surgery. Can't decide which ABX to use? Call an ID consult. The patient has a rash? Consult Derm, ID, and Rheum.

Sigh. I hated rotating on the general internal med service because I felt like we never did ANYTHING except for calling consults and waiting for notes/recs from charts/images. All of the cool procedures seemed to get pawned off on the subspecialties/IR/surg/nursing staff.

I agree that going down to radiology/cardiology to read an image/echo etc. is VERY important, and a GREAT learning experience - but realize that if you think this is super-cool, maybe you should consider a career in radiology or cardiology.

Most of my day on IM was tracking down nurses, walking patients to get their O2 sats, calling consults, waiting for lab results, calling the lab/path for readings/analyses that weren't up yet, getting records from other hospitals, writing discharge summaries and Rx's, calling family members/nursing homes for more H&P info, dropping images off at radiology, and scheduling outpatient clinic appointments that, half the time, they might show up to (I hated scheduling substance abuse appointments, because one of our psych attendings is one of the best in the biz, and he'd bend over backwards to accomodate them, and then these people wouldn't even show up. SO disrespectful, it makes me sick). I liked going down to the ED and doing the H&Ps and then writing preliminary orders, but by that point, the EM docs had pretty much finished working them up and already had a DDx and a set of labs/exam results/images on the way, which eliminated a lot of the "fun" work. And after that, it was really hard to get one of the housestaff members to sit down with me and go over his/her thinking/A&P, etc. On rounds (at certain places and with certain attendings) we actually had to learn/read/know stuff because we were constantly pimped - that was nice because I felt like I was learning. But the rest of the day was really just scut. It didn't matter how they packaged it with a pretty red ribbon or whatever - scut is scut.

I'm loving surgery so much more because it's a lot of the same types of people, but you actually get to DO STUFF in addition to managing their medical conditions. It's a foley/IV/rectal exam/ABC playground. Plus, at least where I've rotated, you've gotten to do a helluva lot more than play human retractor/organ holder/skin "suture-er" all day. Maybe that's just part of being a medical student, but still, it has to be somewhat representative of real life.

 

[njbmd]

I'm an MS III on my 2nd month of a three month medicine rotation, and I feel like while the scut I am doing as made me learn (ie going to get a CT read and then I sit with the radiologist have him explain what he/she sees and why), but I haven't been able to do any procedures...

I bet it is the same at a lot of hospitals where the nurses and other staff do the IVs, blood draws, foley insertion ect, as it is where I am doing my rotation...SO HOW DO I GET THIS EXPERIENCE AND NOT END UP DOING THREE MONTHS OF SCUT?

I have been able to see a central line, a paracentesis, many piccs put in, and two knee aspirations, but I want to get more hands on experience. Most of the time an order gets put in and then a couple of hours later, I'm sent over to make sure the nurse/whomever is responsible has completed the task, so I feel like I have NO TIME to even try and get hands on experience.

Any helpful tips of how I can get more experience doing IVs, blood draws, ect would be great!!! I did ask when the above procedures were being completed if I could do it, but a lot of the times, the interns hadn't had much experience either so were given first dibs because they had quotas to fulfill.

Actually, when I was a medical student, all I had to do was ask the person doing the procedure to "talk me through". I snagged plenty of procedures by just asking. This happened most at night so you may have to stick around after hours but the rewards were loads of central lines, IVs and even placement of a ventriculostomy tube. The worst that can happen is that they say, "no" but if you keep on asking, you start to hear some "yes" answers too, especially from the attendings.

 

[Regnvejr]

To get experience, go to small places. Small medical schools, small residencies, community rotations. That's where things are done by whomever is closest, and you are not watching from 3rd row.

 

[Dral]

Try to get a rotation at a VA. You'll be doing procedures till your heart's content. heheh.

 

[MeowMix]

hey, I'm still trying to get more procedures and less scut, and I'm an intern.

central lines, chest tubes, etc. are often just not common enough that we're going to give them up to med students. Sorry - that's just the way it is at some hospitals. We work hard for the procedures we do get. Be patient, be interested, and you will get whatever you can.

 

[lord_jeebus]

Perhaps this goes without saying, but for any procedure you've already seen and would want to try, read up on the technique and major complications - your team may be more inclined to let you have a try if you can talk the talk.

 

[Sophie]

One of my classmates who wanted more blood draws sat by a patient we had just ordered stat labs on and waited for the phlebotomist to show up. He then asked if it'd be cool for him to go along with him to all of his other patients and do some of the blood draws. The phlebotomist was more than happy to let him, and the resident was fine with him going. He came back an hour or so later with lots of blood draws under his belt.

 

[ooglygoo]

I second the comment about going to more rural areas for a more hands-on experience. You are perhaps more appreciated as a medical student in a rural area, and are seen as a "junior colleague" rather than merely a student. I spent 5 days in the summer between MS I and II in a rural area with two emerg docs. At any one time, it was me, the doc, and a few nurses.

We ran the emerg dept. I would choose a case from the pile, go see the patient myself, do the history and whatever rudimentary physical I was able to do, go back and report to the doc, he'd come and see the patient, then him and I would chat (and he would teach me clinical pearls, how to read x-rays, etc.) and he'd give me the prescription to give to the patient along with any explanation needed. Unassisted, I would do suturing, foreign body extraction from eyes, throat swabs, and I did a cast. There was an MS II student who had been there for a month, and he was even more autonomous, signing simple prescriptions and doing first assist on traumas, etc. Even the bus ride home was eventful: An inebriated gentleman tripped and split his head open on one of the seats. Another passenger and I somehow calmed him down and convinced him that we needed to patch up the gushing would in the back of his head! Before the police/ambulance came, we had managed to bandage the wound - despite the ancient and grossly ill-equipped first aid kit!

I am definitely not one of the "stronger" students in my class, and I learned a lot on that brief experience.

I'm from Canada, so perhaps the medical culture is different here? Across the country there seems to be a huge emphasis on getting med students, and 3rd and 4th year students in particular, doing a lot clinically.