Please tell me it gets better...

[Back34]

---

Members do not see this ad.

So we're in the middle of orientation and we did the ATLS exams today. Did the practical session and was a total soup sandwich. Forgot some vital things, went out of order, nervous as hell, etc. I knew it was a disaster, but when I point blank asked the proctor if I passed, he said "you failed" and I near sh-- myself. I went to speak to the overseer of the course regarding when I could retest and he allowed me to try again with a different proctor. Was a little more solid with that one but was told "I could probably fail you, but I won't;" talk about a gift.

Anyway, this isn't the way I foresaw myself starting off internship. I really have no question, but am just looking for a little reassurance that with time and practice, this stuff becomes second nature. My confidence is totally shot and the real thing starts next Friday.

 

[JackBauERfan]

So we're in the middle of orientation and we did the ATLS exams today. Did the practical session and was a total soup sandwich. Forgot some vital things, went out of order, nervous as hell, etc. I knew it was a disaster, but when I point blank asked the proctor if I passed, he said "you failed" and I near sh-- myself. I went to speak to the overseer of the course regarding when I could retest and he allowed me to try again with a different proctor. Was a little more solid with that one but was told "I could probably fail you, but I won't;" talk about a gift.

Anyway, this isn't the way I foresaw myself starting off internship. I really have no question, but am just looking for a little reassurance that with time and practice, this stuff becomes second nature. My confidence is totally shot and the real thing starts next Friday.

those acls and atls classes aren't easy for anyone who just graduated med school, and also if you have been out of any of the core rotations for the past few months. I think most people go into these classes thinking that just that one day of review and that one day of testing is it, but you should really look over the material beforehand. Did you get a chance to read any of the material before? Even if you did, some of those proctors are REALLY strict, and some are pretty leniant (helpful). Also I think out of all of them the ATLS is the toughest (I've only done the ACLS, PALS, Neonatal ALS ove the past few years); but I'm going on what I've read and talked to folks about. ATLS does cover a LOT of info.

So, I'm in your same position schooling wise, so can't be much help to your question about will time make it second nature, but I think it should, otherwise I've made a wrong assumption about what should be learned in residency haha.

 

[DrQuinn]

Fear not, my brothah (as Desmond on LOST would say).

When we took ATLS when we started our program, one of our residents failed both the written AND the practical. I can tell you we were ALL nervous about the practical, and I felt that I wasn't adequately prepared for it. Honestly I didnt' read the ATLS textbook before hand.... We had just started our residency, and being the very first class, we just wanted to hang out with each other. So all I remember about ATLS was my killer hangover.

Regardless, it is a hard class, and the practical is nerve-wracking. I have seen some of the sharpest interns and residents forget the easiest and simplest things (i.e. vitals, or rechecking after an intervention), when I teach ATLS.

This WILL come to you. Just give yourself a few months as an intern... or just running a few trauma alerts. It'll become second nature to you, and before you know it, you'll become an ATLS instructor!

One thign I would recommend, and I tell this to all my residents, is if you're going to read the ATLS book, JUST READ THE ASSESSMENT CHAPTER. It is probably the highest yield section of that book and you can read it in like 10-20 minutes.

Q

 

[Back34]

Guys, many thanks for the responses and the assurance. I think you totally hit the nail on the head as far as doing the reading beforehand. We were given the books a few weeks ago, skimmed it once or twice, and went in totally unprepared. I thought it was gonna be something like BLS, where you can pass by basically doing nothing. Man, was I wrong. Yes, definitely will put some more time in. Thanks.

 

[DrQuinn]

Guys, many thanks for the responses and the assurance. I think you totally hit the nail on the head as far as doing the reading beforehand. We were given the books a few weeks ago, skimmed it once or twice, and went in totally unprepared. I thought it was gonna be something like BLS, where you can pass by basically doing nothing. Man, was I wrong. Yes, definitely will put some more time in. Thanks.

Fear not!

one other thing I should warn you... when it gets to about Nov-February, be prepared for the intern blues. I had it myself, and have seen it in the vast majority of the other residents at my program. I think its because you lose the "gung-ho-ness" of becoming a new doctor. It can be a pretty rough time. But by the end of spring (April/May) you start getting your energy back.

Don't say I didn't warn you!

And don't worry about not reading up on the books. it happens.
Q

 

[BKN]

Fear not!

one other thing I should warn you... when it gets to about Nov-February, be prepared for the intern blues. I had it myself, and have seen it in the vast majority of the other residents at my program. I think its because you lose the "gung-ho-ness" of becoming a new doctor. It can be a pretty rough time. But by the end of spring (April/May) you start getting your energy back.

Don't say I didn't warn you!

And don't worry about not reading up on the books. it happens.
Q

Actually I think the big slump occurs in EM2 winter; "I'm only half done?!😱 "

 

[Tater]

Also I think out of all of them the ATLS is the toughest (I've only done the ACLS, PALS, Neonatal ALS ove the past few years); but I'm going on what I've read and talked to folks about. ATLS does cover a LOT of info.

I've had my *ss handed to me on the practical as well. I'm sure its not appropriate to say what my scenarios were, but they were not anything close to what I've seen before, even for my time in El Paso. Add proctors coming from Shock Trauma, and the factor goes up a tad. I passed the first time around, but it still lit a fire to get a little more geared up for what is to come. From my own standpoint, I think there are patient distracting injuries and intern distracting injuries as well!

And definitely, definitely look at that ATLS book. That course is too difficult and too expensive to go into it blind. (Here, the docs taking it had to pay $792 to get certified.)

 

[docB]

Actually I think the big slump occurs in EM2 winter; "I'm only half done?!😱 "

That's true. The thing that pulled me out of it was realixing that the remainder was mostly EM. Only a few ward blocks left.

 

[docB]

The other thing that pulled me out of the blues was moonlighting. Throughout residency I was so tired and cranky that I went on autopilot a lot. Once I was moonlighting I started recasting every patient in terms of "How would I handle this at Moonlight General?" I started getting invested in stuff again rather than just being a conduit for information. Doesn't work for everyone but it helped me.

 

[CS_22]

I've had my *ss handed to me on the practical as well. I'm sure its not appropriate to say what my scenarios were, but they were not anything close to what I've seen before, even for my time in El Paso. Add proctors coming from Shock Trauma, and the factor goes up a tad. I passed the first time around, but it still lit a fire to get a little more geared up for what is to come. From my own standpoint, I think there are patient distracting injuries and intern distracting injuries as well!

And definitely, definitely look at that ATLS book. That course is too difficult and too expensive to go into it blind. (Here, the docs taking it had to pay $792 to get certified.)

Its all good. I failed the stupid @ss written test by 1 question today, so I get to go retake it some time in the next couple of weeks. I read WAY to much into some of the questions...

Somehow, though, I passed the practical. Go figure.

 

[Tater]

Its all good. I failed the stupid @ss written test by 1 question today, so I get to go retake it some time in the next couple of weeks. I read WAY to much into some of the questions...

Somehow, though, I passed the practical. Go figure.

That is another very good point. I think those questions are designed so that the more you know, the worse you'll do. I guess it was kind of nice to miss a question for the exact same reasons the ED attending missed them, but I barely passed that sucker myself. The path of least resistance is what the book says to do. Always go with the book, whether you believe the answer is truly correct or not.

 

[Back34]

How typical is it for medical students to take ATLS/ACLS? It seemed like everybody I spoke with during the class had had it before (in medical school).

 

[12R34Y]

How typical is it for medical students to take ATLS/ACLS? It seemed like everybody I spoke with during the class had had it before (in medical school).

Not common for anyone other than physicians to take ATLS since only physicians can take it and get certified. Otherwise you can only audit it and not get the cert.

tons of people can take ACLS. lots of medical schools put their students through it. it's not as tough.

later

 

[turtle md]

I took ACLS during 4th year. ATLS was during orientation for residency. Definately a much harder course. As long as you learn the algorithms, trauma doesn't involve much thinking, just following pre-ordained pathways. I think there is more thought for ACLS, just less pathways to memorize. It does start to get easier as you see more "real-life" cases. It is kind of difficult to go through a routine where someone is exsanguinating when it is only an actor trying to act severely hypotensive. Plus, as a first year, you won't be running many traumas, so you will get to be involved and learn from the upper years.

 

[Back34]

Plus, as a first year, you won't be running many traumas, so you will get to be involved and learn from the upper years.

That's actually pretty reassuring. I had visions of myself being thrown in there on day 1 running the trauma codes.

 

[JackBauERfan]

That's actually pretty reassuring. I had visions of myself being thrown in there on day 1 running the trauma codes.

at u of alabama-birmingham, the main campus in bham did not get acls, but the branch campus in huntsville did. So my thinking is that it is very dependent on whoever is in charge of student clinical supervising whether this happens or not. ATLS is not done at any of the places I know of, I think it is a residency thing. But you can sit in and take part, just no certification.

 

[ER-ER-Oh]

Don't worry, it'll get worse before it gets better, but it does get better. I passed ACLS easily, but then the first code I went to on my second day of work last July I ended up being the first doc there. I kind of froze at first, got all lost in my head, just kept thinking A B C's, A B C's,....and kind of stumbled my way through it, complete with asking the nurse what the dose of Epi was for christ's sake. I could feel the eyes rolling behind my back for two weeks. But after the 3rd code I ran it was like everything else we've come through to get this far; you worry, worry, worry, wondering if you've got what it takes, doubting yourself. Then BOOM! you've got it, and it's ok again, you've gotten past yet another hurdle. Wrap yourself in your insecurity and keep going through those things in your head, or with a friend.

 

[Sheerstress]

In my experiences, the ATLS practical experience depends largely on the person evaluating you. I once had one guy who ignored some of my key interventions, let a patient tank twice because of it (he said I had not rechecked a chest tube hookup or given blood products, when I had done both), and then flunked me because I didn't do something he actually blocked me from doing (intubating the patient from the beginning). Other instructors aren't as bad, but each has his or her own little nuances that they may want you to demonstrate.

Don't let any of this get to you, just STICK to the basic overall algorithm, and be thorough in your assessment and re-assessments.

If you still fail the first practical and need more practice, I found "Trauma One!", a trauma simulator, to be great at going over the process again and again with many different patients and situations. You can get it here (I don't work for the company 😉 ):

http://www.madsci.com/