MS2 - Bad at delicate procedures?

[moy505]

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So as an MS2, I always thought of myself as someone with decent manual dexterity until we had an "IV lab" at my school. It was just a one hour lab, but I learned that Im not good at doing IV's. Would really appreciate if some of you could answer my questions below so i can get a better idea if anesthesia is a field that I can pursue.

1. I consider alines, central lines, IVs to be delicate procedures, since they require good manual dexterity and finesse. How hard/stressful is it to get good at these procedures?
2. What happens if you get a patient and you simply cannot get an IV on them? Do they have another doctor/nurse/resident come in and do it? Could an anesthesiologist be fired if they suck at doing IVs?
3. I was diagnosed with anxiety in med school which is currently being controlled by meds/therapy. What are the most anxiety provoking parts of the job?
4. Could one find a job where they simply intubate and pass gas? Do CRNAs do that or are they also required to do the delicate procedures?

Obviously from my questions, I think that the delicate procedures are the most anxiety provoking part of the job but perhaps there are other things that I am not considering.


I realize that intubations also require good hands, but atleast I can see what I am doing. Unless using ultrasound is common, doing a central line or IV causes me more concern because you just have to feel for it on larger patients.
Thank you.

 

[AKMD_1984]

Ultrasound?

 

[deleted171991]

I was diagnosed with anxiety in med school which is currently being controlled by meds/therapy. What are the most anxiety provoking parts of the job?

Most of the residency and a good part of the job. Find a different specialty. One would argue anything that's acute care medicine is out. You will have serious problems in residency.

What does your psychiatrist say?

 

[BLADEMDA]

So as an MS2, I always thought of myself as someone with decent manual dexterity until we had an "IV lab" at my school. It was just a one hour lab, but I learned that Im not good at doing IV's. Would really appreciate if some of you could answer my questions below so i can get a better idea if anesthesia is a field that I can pursue.

1. I consider alines, central lines, IVs to be delicate procedures, since they require good manual dexterity and finesse. How hard/stressful is it to get good at these procedures?
2. What happens if you get a patient and you simply cannot get an IV on them? Do they have another doctor/nurse/resident come in and do it? Could an anesthesiologist be fired if they suck at doing IVs?
3. I was diagnosed with anxiety in med school which is currently being controlled by meds/therapy. What are the most anxiety provoking parts of the job?
4. Could one find a job where they simply intubate and pass gas? Do CRNAs do that or are they also required to do the delicate procedures?

Obviously from my questions, I think that the delicate procedures are the most anxiety provoking part of the job but perhaps there are other things that I am not considering.


I realize that intubations also require good hands, but atleast I can see what I am doing. Unless using ultrasound is common, doing a central line or IV causes me more concern because you just have to feel for it on larger patients.
Thank you.

Even a stupid Chimpanzee can learn to do a procedure if given enough attempts. Like that Chimpanzee you too will be able to place an IV decently after most residency programs. Over my career I have found that if one embraces their area of weaknesses and works diligently over several years, if not longer, that area becomes a core strength. While you may never become the Tom Brady of IV placement I'm certain that like the chimpanzee you can learn to do the task with a high success rate over time.

Don't run away from IV placement- look to do them over and over again. I guarantee you will get better at it.

 

[BLADEMDA]

 

[deleted171991]

Except the OP will be more like this:

 

[BLADEMDA]

Except the OP will be more like this:

That chimp looks my surgeons when I "delay" their cases by more than 5 minutes in the morning.

 

[nimbus]

Go learn from the real experts, preop nurses who start 20 IV’s/day on anxious dehydrated patients.

 

[jeesapeesa]

So as an MS2, I always thought of myself as someone with decent manual dexterity until we had an "IV lab" at my school. It was just a one hour lab, but I learned that Im not good at doing IV's. Would really appreciate if some of you could answer my questions below so i can get a better idea if anesthesia is a field that I can pursue.

1. I consider alines, central lines, IVs to be delicate procedures, since they require good manual dexterity and finesse. How hard/stressful is it to get good at these procedures?
2. What happens if you get a patient and you simply cannot get an IV on them? Do they have another doctor/nurse/resident come in and do it? Could an anesthesiologist be fired if they suck at doing IVs?
3. I was diagnosed with anxiety in med school which is currently being controlled by meds/therapy. What are the most anxiety provoking parts of the job?
4. Could one find a job where they simply intubate and pass gas? Do CRNAs do that or are they also required to do the delicate procedures?

Obviously from my questions, I think that the delicate procedures are the most anxiety provoking part of the job but perhaps there are other things that I am not considering.


I realize that intubations also require good hands, but atleast I can see what I am doing. Unless using ultrasound is common, doing a central line or IV causes me more concern because you just have to feel for it on larger patients.
Thank you.

1. just practice. most incoming interns have never placed an IV unless they were paramedics/nurses before. by CA1 you should be able to place a-lines and central lines without much difficulty. the rest of your residency just learn to become faster. like people have said...monkey skills. these should be no big deal as an attending.

2. if you can't get an IV then depending on the procedure....a dying pt vs an elective hernia etc just weigh your options. i don't think i've cancelled a case because i couldn't get an IV. i don't know about others here.

3. if you can't control your anxiety to the point where it interferes with decision making then anesthesia isn't the field for you. you can be an anxious person but if you're good and can do your job pretty well you're fine -- but this will take a toll on you in the long run, like anything in life i guess.

4. i don't work with CRNAs yet so i don't care. they can stay far away. that last question was somewhat weird. "intubate and pass gas". if you're interested in anesthesiology there's way more to it than that. it's a great field if it fits your life style expectations. if you want a 9-5 with weekends off there are jobs for that...surgery centers/mommy track/part time academics.

i don't think i would do anything else with regards to choosing another field in medicine. look into the other forums (derm, path, rad onc, etc) if you're interested since i can't really give my opinions about those.

 

[zizzer]

I felt bad at IVs nearly all of CA-1 year. You will work your way around that. You should be considering the anxiety part more, because that's a big part of the job. I'm not saying you can't do it, but just consider whether a field like this is something you would want to do.

 

[26B]

IVs are a skill that come with practice. This is even more true for ultrasound-guided IVs, since you need hand-eye coordination and manual dexterity in both hands for that.

I wouldn't worry about it at all as a med student. If you choose to do anesthesiology, you WILL be good at IVs after about 6 months of CA-1 year.

 

[Dejavu]

After about 200 or so, you’ll be fine.

Not much help. Sorry.

That’s why it’s called ‘learning’ a new skill. If you were already good, it would be called ‘reviewing ‘.

As has been said, relax. By the end of your training, you will know stuff.

There is no substitute for experience. You sure can’t legislate it. One particular anesthesia organization is trying just that.

 

[WholeLottaGame7]

Go learn from the real experts, preop nurses who start 20 IV’s/day on anxious dehydrated patients.

Your preop nurses must be better than ours. Ours blow multiple attempts and call for help when there are targets everywhere. Sometimes they call for help without even trying because the patient tells them "they are a hard stick."

 

[nimbus]

Your preop nurses must be better than ours. Ours blow multiple attempts and call for help when there are targets everywhere. Sometimes they call for help without even trying because the patient tells them "they are a hard stick."

Yes they’re good. They rarely call but when they do, I always roll the ultrasound.

 

[Beeftenderloin]

When I struggled with procedures early on CA1 year there was this one attending who would always say “don’t sweat it, you’ve got 3 years to learn how to (insert procedure)”.

Although it shouldn’t REALLY take that long to learn most procedures, it was reassuring for a new trainee.

 

[rakotomazoto]

Getting good at IV's will come with time and experience, but legit anxiety? I would recommend against this field, it's chill until the patient is actively dying (massive air embolism, surgical intern stabs a major vessel and the patient loses 2L of blood in a minute or two are two easy examples that come to mind from my CA1 year) or things like the awake C section patient has a full-on panic attack and tries to run out of the room a few minutes after the baby comes out. Yeah, plenty of times it all works out, but this is acute care medicine and things can go from fine to terrible in no time.

There are people who can manage their anxiety and still perform well under stress, but many of the people that I have personally talked to who switched out of anesthesiology to another field cited feelings of dread/anxiety of something terrible happening during cases as a primary reason why they switched.

 

[deleted697535]

I would also advise against this speciality if you are very anxious. It's all well and good until **** hits the fan and it will. People will die in front of you.
Luckily or no some ppl can move on from that. For others they cant and it harms them a lot

 

[Nivens]

I have never met an MS2 (or 3, or 4) who was good at procedures. Not a single one. I've met a few that *thought* they were good at procedures, though. So long as you aren't one of those, we can teach you IVs.

 

[AKMD_1984]

1. Meditate. Go find a nice park. Go for walks. Go alone. Sit on a quiet bench and take deep breaths. It will help you develop temperament and manage anxiety. If you are anxious when the patient is crashing, and a few discrete and confident actions or therapies are needed, your mind needs to be clear. It cannot be muddled with fear of failure and anxiety.
2. A lot of anxiety is caused by fear. Fear of unknown. Fear of failure. Fear of unknown is corrected by acquiring knowledge, so it can be used. Fear of failure is corrected by recognizing that ALL of have failed repeatedly on our paths to become anesthesiologists. We will continue to fail. Get used to it. Get used to not having everything being perfect all the time. Get used to not having things in control. Get used to being a doctor.
3. Exercise, study, be humble and ask for help. Ask one of your attending to mentor you and guide you. Do not be afraid of criticism. Its their way of caring for you so you don't cause disasters 3 years later.
4. Use the ultrasound for difficult A lines or IVs.

Good luck

 

[AKMD_1984]

I still miss many IVs. So do many anesthesiologists. There are a billion reasons why this happens. Mostly obese patients. Many patients with poor volume. Vasculopaths. Renal failure patients. Valves.
List goes on.
There are many reasons why IVs can be difficult.

 

[nimbus]

I have never met an MS2 (or 3, or 4) who was good at procedures. Not a single one. I've met a few that *thought* they were good at procedures, though. So long as you aren't one of those, we can teach you IVs.

Au contraire. There are several medical students on SDN who by self report are good at intubation.

 

[Nivens]

Au contraire. There are several medical students on SDN who by self report are good at intubation.

Sure. But what are they intubating?

 

[IMGASMD]

I am actually pretty good at CABGs and i didn’t even do a surgical residency.

 

[Mman]

So as an MS2, I always thought of myself as someone with decent manual dexterity until we had an "IV lab" at my school. It was just a one hour lab, but I learned that Im not good at doing IV's.

No MS2 is "good" at doing IVs. It takes years to get good at it and lots of practice. Fortunately in anesthesia as a resident you have asleep patients in front of you that you can frequently practice starting an extra IV on.