Procedure Heavy 3rd Year Rotations

[FarmerToDoctor]

I am interested in IM and doing a possible fellowship in Critical Care or Cardiology. I’m drawn towards procedures but surgery isn’t my interest. What 3rd elective rotation would you recommend that is procedure heavy?

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[hellosnd]

Gas

 

[cantankerous]

Dental School

 

[AlbinoHawk DO]

Nobody will let a third year do procedures

 

[DrJackRyan]

I disagree on the above comment - I did intubations and some central lines while at a community hospital without an affiliated residency as a third year student. Obviously you'll have to get lucky finding a preceptor that will teach and let you do procedures but I think you're much more likely to get to do procedures if at either a rural hospital or small-ish community hospital without a residency.

 

[FarmerToDoctor]

I disagree on the above comment - I did intubations and some central lines while at a community hospital without an affiliated residency as a third year student. Obviously you'll have to get lucky finding a preceptor that will teach and let you do procedures but I think you're much more likely to get to do procedures if at either a rural hospital or small-ish community hospital without a residency.

This is what we’ve been told by our 3rd and 4th years. Most were able to do procedures after watching them a few times.

 

[DO2015CA]

I disagree on the above comment - I did intubations and some central lines while at a community hospital without an affiliated residency as a third year student. Obviously you'll have to get lucky finding a preceptor that will teach and let you do procedures but I think you're much more likely to get to do procedures if at either a rural hospital or small-ish community hospital without a residency.

Intubation attempts fine. But no way am I having a 3rd year do central lines. Even if it is guiding things down the wire

 

[AlbinoHawk DO]

Intubation attempts fine. But no way am I having a 3rd year do central lines. Even if it is guiding things down the wire

Yeah, perhaps in anesthesia with a glidescope they'd allow it, but a central is madness. I've personally witnessed a 3rd year IM resident kill someone when they created a massive pneumothorax. No way I'd let a 3rd year med student do it. In my med school I don't know anyone that was allowed to do one and we rotated at community programs without residents

 

[hellosnd]

Yeah, perhaps in anesthesia with a glidescope they'd allow it, but a central is madness. I've personally witnessed a 3rd year IM resident kill someone when they created a massive pneumothorax. No way I'd let a 3rd year med student do it. In my med school I don't know anyone that was allowed to do one and we rotated at community programs without residents

My third year anesthesia preceptor let me try DL intubation, central lines, and a lines. In hindsight, it was an amazing experience but also wild the that was allowed to happen.

 

[AlbinoHawk DO]

My third year anesthesia preceptor let me try DL intubation, central lines, and a lines. In hindsight, it was an amazing experience but also wild the that was allowed to happen.

to be fair, I never did anesthesia in medical school, so maybe them gas badasses roll different

 

[Neopolymath]

Nobody will let a third year do procedures

I did intubations, pivs, abgs, art lines, central lines, thoras, paras, joint injections etc etc as a third year. Did more as a fourth year including various gyn stuff, excisions, biopsies. Did some chest tubes and more.

 

[hellosnd]

to be fair, I never did anesthesia in medical school, so maybe them gas badasses roll different

Yeah, that doc was super confident and knew he could probably salvage any situation

 

[AlbinoHawk DO]

I did intubations, pivs, abgs, art lines, central lines, thoras, paras, joint injections etc etc as a third year. Did more as a fourth year including various gyn stuff, excisions, biopsies. Did some chest tubes and more.

Wow, must be a regional thing then. I asked all my friends trained in the west coast if they had this experience and they said the most they did was suture in closing for the surgeon

 

[DOVinciRobot]

Intubation attempts fine. But no way am I having a 3rd year do central lines. Even if it is guiding things down the wire

I would maybe let them try a femoral. But only if the student had shown greater than usual aptitude. Our students don’t get much hands on experience most of the time all I let them do is close skin.

Of course it would depend on which attending is staffing it. Some are more uptight than others and only want residents to do the procedures

If we are doing a port removal in the OR I’ll let them do that from skin to skin.

 

[CanIBeAnonymous]

Nobody will let a third year do procedures

I've done intubations, central line, umbilical vein cath in the STU and NICU and a lateral canthotomy in the ED, a bunch of lesser invasive procedures during 3rd year. Depends on your institution, number of residents 'in-line,' etc

Maybe it was because I was older and had a work history in a dextrous field? *shrug* I have an openly expressed interest in EM/Crit Care so may be why folks were more willing as well.


Would love to put in a chest tube, maybe next year

 

[FarmerToDoctor]

I’ll be doing my 3rd year rotations in the intermountain region at community hospitals and clinics that lack residents. Thank you for everyone that’s commented. You have definitely given me food for thought and it seems that GAS might be a great elective to do during 3rd year.

 

[Neopolymath]

Wow, must be a regional thing then. I asked all my friends trained in the west coast if they had this experience and they said the most they did was suture in closing for the surgeon

In academic settings the residents all had their numbers and were competent super early (IR and surg services especially). Then I got more in community settings with old attendings who trained the old way aka students actually had responsibilities lol.

It was a good mix for sure. Plenty of didactic but also went into intern year having already been responsible for a real workload so it wasn't a crazy transition like the local MD students.

 

[Kardio]

Some students get thrown bones and offered procedures because they’re charming and likable. For the rest of us - demonstrating competence, having some confidence, and actually asking for a chance when the opportunity presents itself usually does the trick. Lots are too scared to ask.

 

[MedicineZ0Z]

Yeah, perhaps in anesthesia with a glidescope they'd allow it, but a central is madness. I've personally witnessed a 3rd year IM resident kill someone when they created a massive pneumothorax. No way I'd let a 3rd year med student do it. In my med school I don't know anyone that was allowed to do one and we rotated at community programs without residents

Why is it madness? I did lines as a student and resident with progressively less supervision.

And I did at least 40-50 airways on my gas rotation in med school. Going to 4-5 rooms every morning isn't too tough, assuming the local culture is friendly to that.

 

[CanIBeAnonymous]

Throughout my first year of rotations what I learned is a lot of people don't fully know what they're doing, sorta winging it, and the body can take way more of that error than you can imagine - I think students are afraid to step up to do these tasks because they think one minor error is going to kill the patient if they're anything less than perfect with the procedure.

 

[AlbinoHawk DO]

Why is it madness? I did lines as a student and resident with progressively less supervision.

And I did at least 40-50 airways on my gas rotation in med school. Going to 4-5 rooms every morning isn't too tough, assuming the local culture is friendly to that.

For a med student it is. The liability is high if any procedure goes down to ****. As a resident, you need it

 

[MedicineZ0Z]

For a med student it is. The liability is high if any procedure goes down to ****. As a resident, you need it

A resident with 0 exp is like a student with 0 exp. Liability is the same. I agree it depends if you need it, so you see if that person is going into a field where they may need it.

 

[AlbinoHawk DO]

A resident with 0 exp is like a student with 0 exp. Liability is the same. I agree it depends if you need it, so you see if that person is going into a field where they may need it.

liability is not the same. you are putting someone with a license by the medical board to do a procedure. a medical student has no license and the liability is greater when you go to a courtroom and try to justify that you let a student do it

 

[MedicineZ0Z]

liability is not the same. you are putting someone with a license by the medical board to do a procedure. a medical student has no license and the liability is greater when you go to a courtroom and try to justify that you let a student do it

What you're saying has no actual legal basis other than you want to believe that.

The odds of you actually going to trial over something like that is incredibly low as well. Your carrier would settle for the same amount regardless of who was doing the procedure. If you were doing direct hands on supervision, the settlement would probably be the same as if you caused the issue doing it solo.

My main argument though, is that doctors love to pull up liability as a reason for something but don't actually have correct legal citations to support it.

 

[AlbinoHawk DO]

What you're saying has no actual legal basis other than you want to believe that.

The odds of you actually going to trial over something like that is incredibly low as well. Your carrier would settle for the same amount regardless of who was doing the procedure. If you were doing direct hands on supervision, the settlement would probably be the same as if you caused the issue doing it solo.

My main argument though, is that doctors love to pull up liability as a reason for something but don't actually have correct legal citations to support it.

I would love to see your legal citations

 

[MedicineZ0Z]

I would love to see your legal citations

lol you're the one making the claim dude. Burden of proof is on you.

 

[AlbinoHawk DO]

lol you're the one making the claim dude. Burden of proof is on you.

You brought up the idea of legal citations and that I was wrong. I was willing to accept your claim because I thought you had some form of evidence, but I'm guessing you just made stuff up and tried to say "legal citations" to give it some credibility. If we're talking about a first claim, you were the first to say there is no difference between letting a legally licensed trainee and a medical student do something

 

[Mad Jack]

Intubation attempts fine. But no way am I having a 3rd year do central lines. Even if it is guiding things down the wire

Same. I've seen residents do serious damage screwing up a central line. Would be extremely hard to explain in a malpractice claim. Central lines are a procedure with amongst the highest complication rates when compared against other common procedures

https://www.nejm.org/doi/full/10.1056/nejmra011883#:~:text=More%20than%2015%20percent%20of%20patients%20who%20receive%20these%20catheters%20have%20complications.&text=Mechanical%20complications%20are%20reported%20to,in%202%20to%2026%20percent.

 

[Mad Jack]

lol you're the one making the claim dude. Burden of proof is on you.

There are plenty of law offices that have a notabke portion of their malpractice cases revolving around central lines in big metros. The combination of high risk procedure+low experience operator is a very well known cause of procedure error to the point that many hospitals have special line teams to mitigate the legal risk of them. To shrug it off as not a big deal is just factually incorrect.