Not a Lot of Student Procedures?

[Pam_Beesley]

Hi,
I am on my home rotation and they really do not give any procedures to students. I'm hoping to get at least one lac repair before the end of it, but I definitely won't be getting anything else. Will this be an issue for aways? I do get a ton of ultrasound which is awesome. I do think I'm getting a lot differential/thought process wise too and am starting to feel more confident.

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[Dr Mantis Toboggan]

Your home program seems pretty lame. No splinting, IVs, abscess drainage, nothing else?

I guess all you can do is study up on these procedures until you get your shot. You can buy pigs feet at the grocery store and practice all manners of sutures (mattress, running, corners) at home. I’d do that until I was totally comfortable.

 

[Pam_Beesley]

I got to do an IV and ABG in a past shift. When I go to nights, I may start asking to start some of my own IVs. I’ve done that a few times. I know we are going to do a more formal suturing and ultrasound guided IV training session. Students from the past have done just fine with aways and matching, so I probably shouldn’t worry too much.

Your home program seems pretty lame. No splinting, IVs, abscess drainage, nothing else?

I guess all you can do is study up on these procedures until you get your shot. You can buy pigs feet at the grocery store and practice all manners of sutures (mattress, running, corners) at home. I’d do that until I was totally comfortable.

 

[WilcoWorld]

Hi,
I am on my home rotation and they really do not give any procedures to students. I'm hoping to get at least one lac repair before the end of it, but I definitely won't be getting anything else. Will this be an issue for aways? I do get a ton of ultrasound which is awesome. I do think I'm getting a lot differential/thought process wise too and am starting to feel more confident.

This may sound like patronizing, but it's not.

The set up for the procedure is 95% of success. Be proactive in doing the set-up (gather supplies, set up/arrange monitoring, position the patient) you get the vast majority of the learning that's to be had. Also, if I walk in and you've got the patient fully prepped - I'll probably give you first crack at the procedure.

 

[DwightKShruteATTRM]

Hi,
I am on my home rotation and they really do not give any procedures to students. I'm hoping to get at least one lac repair before the end of it, but I definitely won't be getting anything else. Will this be an issue for aways? I do get a ton of ultrasound which is awesome. I do think I'm getting a lot differential/thought process wise too and am starting to feel more confident.

Always the Padawan, never the Jedi.

 

[Tiger26]

With med students, I need to see some motivating action since it's a lot of extra work to supervise them doing a procedure. Get everything set up so I can just walk in the room. Know the relevant anatomy and be able to answer basic pertinent questions about the procedure.

Also, nurses do procedures too. If they can't get them, they ask the doctor. They might not be as exciting, but they all have learning value.

One procedure I can't emphasize enough is doing an ultrasound guided IV. If you can do them well, you can do any needle guided ultrasound procedure and they're a great way to practice with minimal patient risk. After becoming good at them, doing a central line has become kind of a joke.

 

[Pam_Beesley]

With med students, I need to see some motivating action since it's a lot of extra work to supervise them doing a procedure. Get everything set up so I can just walk in the room. Know the relevant anatomy and be able to answer basic pertinent questions about the procedure.

Also, nurses do procedures too. If they can't get them, they ask the doctor. They might not be as exciting, but they all have learning value.

One procedure I can't emphasize enough is doing an ultrasound guided IV. If you can do them well, you can do any needle guided ultrasound procedure and they're a great way to practice with minimal patient risk. After becoming good at them, doing a central line has become kind of a joke.

We’re doing special practice with the ultrasound guided IVs, so I’ll be sure to keep practicing them. I’ve placed one successfully. I’m not at a residency program, so there just haven’t been many procedures to go around over my 5 shifts. They haven’t done any central lines, and surgery often handles lacs. I’ll be sure to work on getting patients prepped and getting the supplies for all procedures to show initiative. I’ve been watching videos for the big procedures and have stuff to practice suturing at home. Thanks for the advice!

 

[GonnaBeADoc2222]

Don't worry too much about procedures. Anyone can be taught a lac repair, IV insertion, central line, etc. You'll get more than your fill soon enough.

What is much harder to teach and gain competency at is clinical judgement and the approach to the ED patient. A junior resident who's really good at this is a huge asset.

Work on that.

 

[Pam_Beesley]

Don't worry too much about procedures. Anyone can be taught a lac repair, IV insertion, central line, etc. You'll get more than your fill soon enough.

What is much harder to teach and gain competency at is clinical judgement and the approach to the ED patient. A junior resident who's really good at this is a huge asset.

Work on that.

I really feel like I am getting solid experience with that. This makes me feel a lot better.

 

[RustedFox]

We’re doing special practice with the ultrasound guided IVs, so I’ll be sure to keep practicing them. I’ve placed one successfully. I’m not at a residency program, so there just haven’t been many procedures to go around over my 5 shifts. They haven’t done any central lines, and surgery often handles lacs. I’ll be sure to work on getting patients prepped and getting the supplies for all procedures to show initiative. I’ve been watching videos for the big procedures and have stuff to practice suturing at home. Thanks for the advice!

Surgery often handles lacs?
Explain, please. I have never seen a GS resident (or general surgeon, for that matter) come to the ER for lac repair.

 

[Dr Mantis Toboggan]

Serio. That sounds amazing (at this lazy point in my career).

Surgery often handles lacs?
Explain, please. I have never seen a GS resident (or general surgeon, for that matter) come to the ER for lac repair.

 

[Pam_Beesley]

Surgery often handles lacs?
Explain, please. I have never seen a GS resident (or general surgeon, for that matter) come to the ER for lac repair.

The ED handles simple lacs, but surgery residents come down for anything that meets trauma criteria which seems to be applied liberally at this hospital. They care for that patient until discharge regardless of what they are there for. If that patient has a simple lac, surgery still will do it. Other case I saw was because the lac was more complicated. OMFS happened to be in house, so they came down and did it. Anything that is in a cosmetically sensitive area seems to go to surgery. This is just my experience from my surgery rotation and a handful of ED shifts, but other people agree with this assessment.

 

[Psai]

The ED handles simple lacs, but surgery residents come down for anything that meets trauma criteria which seems to be applied liberally at this hospital. They care for that patient until discharge regardless of what they are there for. If that patient has a simple lac, surgery still will do it. Other case I saw was because the lac was more complicated. OMFS happened to be in house, so they came down and did it. Anything that is in a cosmetically sensitive area seems to go to surgery. This is just my experience from my surgery rotation and a handful of ED shifts, but other people agree with this assessment.

If I were them I'd be like the ed should be able to handle a lac repair thank you for the interesting consult, signing off.

 

[Dr Mantis Toboggan]

I work in the sticks and often times people don’t want even to be transferred for Plastics when they obvi need it.

“Sir, we need to transfer your daughter. She’s 5 years old with multiple large dog bite lacerations to the face. She needs a facial surgeon.”

“Nah, we trust you doc.”

Wtf.

 

[DrMcCoyDO]

The ED handles simple lacs, but surgery residents come down for anything that meets trauma criteria which seems to be applied liberally at this hospital. They care for that patient until discharge regardless of what they are there for. If that patient has a simple lac, surgery still will do it. Other case I saw was because the lac was more complicated. OMFS happened to be in house, so they came down and did it. Anything that is in a cosmetically sensitive area seems to go to surgery. This is just my experience from my surgery rotation and a handful of ED shifts, but other people agree with this assessment.

Wow, that’s a bummer. I mean, as a student, you don’t need to be doing lacs and other procedures constantly, but you should at least get a chance to dip your toes in the water.

 

[gamerEMdoc]

Crazy. Cant even get lac repairs on rotation? That’s not good. There are a few procedures I dont let students do (central lines is pretty much the only one I can think of) and even then some of our attendings let students do them. Students often get pulled into intubations (unless there is a new intern around who wants the experience in july/Aug). If Im doing an IO, it’s the students if there is one around. US, detal blocks, abscesses, lacs, ortho stuff... thats all very common ED stuff, I have to think your experience in your home rotation is not a common occurance at many residency sites.

 

[Pam_Beesley]

I’m rotating at a site without residents if that makes more sense.

 

[Pam_Beesley]

I’m confident I’ll get my feet wet on aways. I just don’t want to arrive on aways and find out I’m expected to have beautiful lac repairs. I’m practicing at home a lot, but it’s not the same.

 

[gamerEMdoc]

Is it at a place that doesn’t typically have students? You’d think without residents around, there would be more procedures, not less.

 

[Pam_Beesley]

Is it at a place that doesn’t typically have students? You’d think without residents around, there would be more procedures, not less.

They have students frequently but not always. Some of this with the lacs may just be bad luck on my part. I feel confident that I’ll get at least one before the end of the rotation. Some of the attendings let students do more than others. They’re going to do some more big training days, so maybe we will get to do more after that. Over all, I’m loving the rotation. They dive into our thought process and assessment/plan way more than anything I did in third year.

 

[BoardingDoc]

I work in the sticks and often times people don’t want even to be transferred for Plastics when they obvi need it.

“Sir, we need to transfer your daughter. She’s 5 years old with multiple large dog bite lacerations to the face. She needs a facial surgeon.”

“Nah, we trust you doc.”

Wtf.

In that exact scenario? I would refuse to do the repair. They can get transferred or they can AMA. Obviously there is some wiggle room depending on degree of injury, location, timing etc... But if I have a kid with a severely mangled face from a dog bite, they're going to see plastics. I have neither the expertise and time to provide the desired outcome, nor am I obligated to do so.

 

[Dr Mantis Toboggan]

Yeah me too. It’s just blows my mind that some people have to be convinced, especially if it’s their kid.

In that exact scenario? I would refuse to do the repair. They can get transferred or they can AMA. Obviously there is some wiggle room depending on degree of injury, location, timing etc... But if I have a kid with a severely mangled face from a dog bite, they're going to see plastics. I have neither the expertise and time to provide the desired outcome, nor am I obligated to do so.