How does the Clinical/Hands on learning work in Med School?

[surftheiop]

I posted this in the psychiatry forum where I had a thread going but is probaly more appropriate here.
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Something I was thinking about today, made me curious about how med school works.

How do they structure the first time you do something that is painful to patient/ could cause harm/ etc?

Ie. the first time you put an IV in a vein. Do you do it to yourself, some other med student or you just do it on a patient with someone watching you waiting to save the day if you screw it up and stab out through the other side of the vein?

I guess i dont really know much about the clinical learning in med school.

Personally that is one of the things that scares me most about the prospect of becoming a doctor, the chance that I mess up (specifically the first time I try something) and hurt someone.

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[EpiPEN]

So, first they train you on how to talk to a patient. Then they bring in standarized patients in for you to get some practice both talking and some physical exams. Then they have dummies where you practice your more invasive exams. Then you watch doctors show you how it's done. Then you see doctors/nurses do it to patients. Then you get a chance to try it out under a doctor supervision. Then you eventually learn to do it on your own and how to deal with all the things that come up.

but know that there is usually somethere to back you up if you need help.

 

[surftheiop]

I posted this in a couple other forums but then realized this is probaly the best one to get good answers in
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Something I was thinking about today, made me curious about how med school works.

How do they structure the first time you do something that is painful to patient/ could cause harm/ etc? (Even if its something that will later be trivial for you seems it must be hard to do the first time)

Ie. the first time you put an IV in a vein. Do you do it to yourself, some other med student or you just do it on a patient with someone watching you waiting to save the day if you screw it up and stab out through the other side of the vein?

I guess i dont really know much about the clinical learning in med school.

Personally that is one of the things that scares me most about the prospect of becoming a doctor, the chance that I mess up (specifically the first time I try something) and hurt someone.

 

[Dr Roboto]

Most likely you'll also have a chance to pair up with a classmate to practice.

 

[psychforme]

Things you can do on fellow classmates:
Draw blood
Palpate
Auscultate

Things you can't do on fellow classmates:
Lumbar puncture
Neurosurgery


Grey zones:
palpate the prostate
genital exams
female boob palpation

 

[brucecanbeatyou]

Personally that is one of the things that scares me most about the prospect of becoming a doctor, the chance that I mess up (specifically the first time I try something) and hurt someone.

You probably will hurt someone by practicing procedures going into medicine, there's no way around it except to get over that fear and to just do it, cause you're going to have to sometime. Focus on the procedure, not the fear of the procedure.

You do practice some things on other students or even yourself, like drawing blood, and there are other tools that medical schools use to help.

The first is patient simulators, so at least you get some practice first. You can intubate, draw blood, put in catheters (I think), and inject fluids. Here is a good video that introduces those. While the video is for nursing people, it works to get to see the simulator.

http://www.youtube.com/watch?v=KCeULhtNx3k

Another is standardized patients - these are people from the community who are paid to show you how to do procedures (from the basic run over to more invasive stuff like a pelvic exam, prostate exam, or whatever). This way, the "patient" expects a little pain, and while you still don't want to cause them pain, you are in a situation where the patient can guide you in what you are doing, so you do it right when you have a real patient.

And let's face it, no matter how much training you have, everyone makes mistakes, including doctors. You will probably hurt someone inadvertantly if you become a doctor. But you will help a lot more people than you hurt.

Also, a lot of procedures just plain hurt (spinal tap, etc.) no matter how they're done, so you're going to have to be willing at some point to cause pain, albeit the least amount possible, for the greater good.

 

[URHere]

For essentially painful things like learning to draw blood, suture, etc. we go through workshops on the skills before doing anything else. For drawing blood, this involved pairing up with classmates and sticking each other while an experienced phlebotomist/doctor/etc took us through the process. For suturing, we practiced on pig ears. For trach tube placement, we practiced on our cadavers during gross anatomy. For some bigger procedures (central lines, etc), our school teaches through vivisection (we use anesthetized animals, usually pigs). As others have said, less invasive skills are practiced in clinical skills classes, and then later practiced again with standardized patients or the pelvic/urogenital/rectal exam dummies.

That being said, there is always the first time we do the procedure on a human being. This usually involves a preceptor or clinical advisor talking you through the procedure (usually after demonstrating it). For me as a first year, these procedures were things like surface lidocaine injections, removing stomach tubes, dressing wounds, removing epidurals, or doing deep tissue sutures during surgery. The more complex procedures generally wait until later in training.

 

[Droopy Snoopy]

Some things are best done in an ICU or setting the first time. Controlled environment, capable staff, patient sedated. Medicine hurts though, people know this. People also know coming to a teaching hospital that they'll probably be seeing lots of newbies, but even rotations in private clinics and such you'll be surprised how many people will let you do pretty much anything to them.

 

[Law2Doc]

I posted this in the psychiatry forum where I had a thread going but is probaly more appropriate here.
-------------------------------------------------------------------

Something I was thinking about today, made me curious about how med school works.

How do they structure the first time you do something that is painful to patient/ could cause harm/ etc?

Ie. the first time you put an IV in a vein. Do you do it to yourself, some other med student or you just do it on a patient with someone watching you waiting to save the day if you screw it up and stab out through the other side of the vein?

I guess i dont really know much about the clinical learning in med school.

Personally that is one of the things that scares me most about the prospect of becoming a doctor, the chance that I mess up (specifically the first time I try something) and hurt someone.

Med schools start you slow. Usually clinical learning in your first year is about learning how to talk to patients, get a history, ask sensitive questions. Second year is about examination -- you learn what things to do in an exam to help you form a good differential diagnosis and rule out certain things. Some things are done on classmates, for other things, particularly the more invasive (rectal/genital/breast), many schools use hired standardized patients for you to learn on. Some schools will have workshops where you learn how to give injections, suture (often on meat or fruit) and put in IVs (sometimes on classmate volunteers), but more often a lot of this this is learned on real patients. Some places have dummies on which you can try putting NG tubes, foleys or doing arterial sticks, but I think this is not universal.

In third year rotations, as well as sub-internships in fourth year, you will be part of teams in various specialties. This is where you will learn a lot of your clinical skills. The first time or two, an intern, resident, or PA will show you. Notwithstanding that, you will still end up sticking some unfortunate patient way too many times before you get it, probably cause a nasty bruise. At places with better ancillary support (really good nurses), a lot of this training will unfortunately end up happening during your internship year, where you have less supervision. As a med student you will rarely be left totally unsupervised.

More than a few central lines by inexperienced folks end up becoming pneumothoraxes which require chest tubes. Happens. You will cause pain in med school. You will probably make some conditions a lot worse in residency. You only get better by being bad at the start, and improving with experience.

 

[surftheiop]

You probably will hurt someone by practicing procedures going into medicine, there's no way around it except to get over that fear and to just do it, cause you're going to have to sometime. Focus on the procedure, not the fear of the procedure.

You do practice some things on other students or even yourself, like drawing blood, and there are other tools that medical schools use to help.

The first is patient simulators, so at least you get some practice first. You can intubate, draw blood, put in catheters (I think), and inject fluids. Here is a good video that introduces those. While the video is for nursing people, it works to get to see the simulator.

http://www.youtube.com/watch?v=KCeULhtNx3k

Another is standardized patients - these are people from the community who are paid to show you how to do procedures (from the basic run over to more invasive stuff like a pelvic exam, prostate exam, or whatever). This way, the "patient" expects a little pain, and while you still don't want to cause them pain, you are in a situation where the patient can guide you in what you are doing, so you do it right when you have a real patient.

And let's face it, no matter how much training you have, everyone makes mistakes, including doctors. You will probably hurt someone inadvertantly if you become a doctor. But you will help a lot more people than you hurt.

Also, a lot of procedures just plain hurt (spinal tap, etc.) no matter how they're done, so you're going to have to be willing at some point to cause pain, albeit the least amount possible, for the greater good.

thanks, and to clarify- I didn't mean I was scared of neccesarily causing someone pain if its a naturally painful thing. Im scared of causing someone unneccesary harm. Anyhow thanks for the descriptions, for some reason I had this idea that the first time you tried any of this stuff it was just going to be a doctor telling you what to do on a real patient.

 

[Law2Doc]

...for some reason I had this idea that the first time you tried any of this stuff it was just going to be a doctor telling you what to do on a real patient.

Oh, it will be. You don't get to practice central lines, arterial sticks, aspiration of joints, intubation, chest tubes, foleys, NG tubes, LPs, and most of the other procedures more involved than IVs on classmates or standardized patients. Some schools may have dummies you can try this on, but in most cases it will be you, a supervising doc, and a patient (victim).

 

[JackInTheBox]

@1:13

[YOUTUBE]http://www.youtube.com/watch?v=v4sYggXMDFE[/YOUTUBE]

 

[surftheiop]

lol I started cracking up at the scrubs clip, not sure if i should have because for all i know it might be true