med student provide anesthesia

[baily34]

I was just looking at Washington University in Saint Louis Anesthesiology website describing their med student rotation. Take a look at the last sentance, "By the end of the rotation, the student should be able to independently (under supervision) provide anesthesia for uncomplicated surgical procedures."

Just curious what CRNA's would think of this statement as they often site studies showing their independence on uncomplicated procedures.

http://www.anest.wustl.edu/educationtraining/medicalstudents/Default.aspx

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[jwk]

I was just looking at Washington University in Saint Louis Anesthesiology website describing their med student rotation. Take a look at the last sentance, "By the end of the rotation, the student should be able to independently (under supervision) provide anesthesia for uncomplicated surgical procedures."

Just curious what CRNA's would think of this statement as they often site studies showing their independence on uncomplicated procedures.

http://www.anest.wustl.edu/educationtraining/medicalstudents/Default.aspx

"Under supervision" is the key word here - I would hope they're not left unattended, since doing so would constitute billing fraud.

 

[cfdavid]

I think I first drove a car when I was about 10 or so. Maybe a little younger. However, I was sitting on my Dad's lap while on a family vacation in the country (I didn't know, but his hands were on the wheel too, but I couldn't see them). I told all my friends that I drove a car, though.

Then, when I was 15 I did the real deal for my drivers permit. Forget about the guy who's foot was resting steadily on the emergency brake to my right.....

I think their curriculum guide could be better worded for lots of reasons.

 

[countingdays]

I think you are reading too much into it and all they really mean is that students should learn more than just tubing.
Putting on monitors, choosing induction agents, intubating, turning on volatile, adjusting flows, etc. without being told or helped, under supervision, is performing independently from a med students point of view.

 

[periopdoc]

I was just looking at Washington University in Saint Louis Anesthesiology website describing their med student rotation. Take a look at the last sentance, "By the end of the rotation, the student should be able to independently (under supervision) provide anesthesia for uncomplicated surgical procedures."

Big difference between being able to and being allowed to.

If you ever take the time to read them, you will see that med stud goals and objectives are often worded in this manner.

The G&O for my ICU Sub-I said that I should be able to independently evaluate and manage septic and critical post-op patients in the ICU etc, but none of my orders were processed until cosigned by the resident and officially the nurses never took action on them until they were cosigned and processed.

- pod

 

[235750]

In a few hours, I'm going to independently (under supervision)perform a colonoscopy. Honestly, I think that is too much for a med student.

I could not imagine providing anesthesia, that's insane

 

[periopdoc]

In a few hours, I'm going to independently (under supervision)perform a colonoscopy. Honestly, I think that is too much for a med student.

In today's environment, maybe that is getting to be the case. It used to be that med studs did a lot more, but the medico-legal and compliance issues have really forced med studs into the world of the theoretical rather than the practical. That isn't entirely bad. More time to learn.

In med school, I did an open appy, multiple simple ORIFs, vasectomies, 1st assisted multiple knee and hip replacements, multiple obstetric ultrasounds etc. All closely supervised of course. I did several anesthetics with residents watching over me, but didn't get to learn as much of the pharm etc as I wanted to.

Trust your attendings. They will have a close eye on you and won't let you get in over your head, and have fun with the colonoscopies.


- pod

 

[Ronin2258]

I remember my Anesthesiology rotation a 4th year. With the past as a tech, attendings were impressed I was able to run a diagnostic/leak check on a machine without help. I was double checked, of course, but still, not a skill you normally have.

As for the practical of providing anesthesia during that time: I did a spinal case with just the attending watching about a week into the rotation. He only gave advice and talked through as I placed the spinal, gave a light sedation, and monitored the patient. Taught all the way about balancing sedation and extra pain meds as the patient needed it, and physiology behind it. Stayed with me until we got the patient to PACU. Patient was aware, was more than accepting of the situation, and was quite pleasant throughout the entire procedure (and yes, I was introduced as a student.)

Ballsy? You bet.

Was it nerve-rattling for me? Absolutely.

Ego boost that an attending would let me do that? F**K YEAH!

Would I do it without an attending behind me even if I make it into CA-1 slot? Oh, HELL no!

The idea is to see if you are confident, not cocky. Confident is to realize you have the skills and understanding to do the job. Cocky is when you think you skills are perfect and nothing will go wrong. "No Fear" in this profession kills quickly.

Yes, the attending was minimal in hands-on, and I got to show him I could do the work. Although more than a few times, I must have looked at him like a deer in headlights when he said, "Go ahead." But he was always there, making sure I wasn't boxing the patient, and pimping me on the whys and the physiology.

I agree with periop: If the attending trusts you with a task, trust your attending will stop you before something bad will happen. And don't forget to ask questions if you are unsure of how to proceed. Enjoy.

 

[buntybrown]

I did one month at a place with no residency, just -ologists and CRNAs. Nevermind by the end of the month, by the end of the first week, I was managing cases independently. Mind you, by "independently" I mean every intubation was monitored by the CRNA and the -ologist, and I certainly needed help with a good number of them. My room setup was also double-checked before the start of every case, and I was never, never, never, ever left in a room alone even for a nano-second. Should also mention that I was not allowed to physically draw up meds, but I talked through which ones I would use, they're appropriate dosing, and how to draw them up/mix them.

it was a big deal though, as there were a couple of tricky intubations that I handled with confidence (not cockiness) and preparedness that helped me snag a great letter from the chairman.

i'm sure this type of hands-on, closely monitored approach is all they're referring to.