procedures in med school

[cartoondoc]

I was just reading the blog of this med student who was talking about how she's on her ob/gyn rotation and thus perfecting her pap smears. I got to thinking about how satisfying it was when I finally perfected my pap smear technique. And then I realized: that didn't happen until residency.

It then occurred to me that I didn't learn how to do ANYTHING in med school. I didn't learn how to suture, I didn't learn how to put in IVs, I didn't learn how to hear a murmur... nothing. (I did learn how to draw blood though... not that drawing blood is at all challenging. Oh, and take a blood pressure. And put in Foley catheters. Hmm, maybe I went to nursing school by accident.) All this really makes me wonder what the hell was I doing during my clinical years?

Probably the biggest shocker of all is that I made it through four years of med school without ever doing a rectal exam. It wasn't like I avoided them or anything. I simply was never asked to do one.

Somehow I seem to fly under the radar. When I complained about how I didn't get to do many procedures during med school, other people in my class said they did tons. So... who knows. It's kind of like how I never was asked to read anything written by Shakespeare during my 20 years of formal schooling.

That's one reason why, even though it was horrible, I'm glad I did my internship at a county hospital. Patients can't say to you "Have you done this before?" or "Can't the attending do this procedure?" if they're unable to speak English.

Do you feel like your med school gave you a lot of procedure time? Or were you like me and spent most of your clinical years standing around and looking dumb?

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[Jolie South]

I just started rotations this spring, but since I've been on surgery, I've done a lot. We had to get signed off on suturing, Foley insertion, and NG insertion. I did that plus got to scope people and remove cerumen on ENT, did plenty of DREs on urology, and did several I&Ds in the ER.

 

[TexasPhysician]

I have done plenty of procedures in medical school. I've really enjoyed inserting chest tubes and doing steroid injections.

 

[45408]

Didn't learn how to hear a murmur? Didn't you do a cardiac exam on hundreds of patients? There are a lot of murmurs that I would've never heard if I hadn't done peds cards (got to hear AI, ASD, VSD), but it's hard to go even a day at the VA medicine clinics without hearing a murmur.

Anyways, things I did do a fair amount of - intubation, PAP smears, delivering babies, suturing, staple removal, IVs, placed a few Foleys, lots of blood pressures, etc. I never did a central line, chest tube, art line, joint aspiration or injection.

 

[ABRuniverse]

I heard a murmur while shadowing...

 

[Tiger26]

-few central lines
-few art lines
-did 4 or 5 colonoscopies
-lots of suturing
-few LPs
-Lots of intubations
-Lots of IVs
-Many deliveries
-1 amputation
-1 thoracic epidural
-lots of I&Ds

 

[45408]

-few central lines
-few art lines
-did 4 or 5 colonoscopies
-lots of suturing
-few LPs
-Lots of intubations
-Lots of IVs
-Many deliveries
-1 amputation
-1 thoracic epidural
-lots of I&Ds

Whoa! You lucky dog!

 

[cartoondoc]

I'm not saying I never *heard* a murmur. I'm just saying that during med school, I didn't feel competent at identifying and categorizing them because I hadn't heard enough of them.

 

[MossPoh]

Hmmm. We are assigned a preceptor our second semester. That combined with our normal clinical learning center stuff I've already been exposed to our practiced a ton of crap. We also have a program/website for our pdas and what not that we HAVE to log all procedures, histories, etc. on. I guess I feel fairly lucky?

 

[Medstudent85]

I'm a first year medical student, and so far I've done
Blood pressure
Physical and History
Deliver 1 baby
IV
Draw blood

All you gotta do is ask.. not sure why you didn't do anything, maybe you don't like patients. Have you considered path or rads?

 

[Mr hawkings]

I'm a first year medical student, and so far I've done
Blood pressure
Physical and History
Deliver 1 baby
IV
Draw blood

All you gotta do is ask.. not sure why you didn't do anything, maybe you don't like patients. Have you considered path or rads?

Whoa.In first year? i'm jealous.

 

[KeyzerSoze]

I'm a first year medical student, and so far I've done
Blood pressure
Physical and History
Deliver 1 baby
IV
Draw blood

All you gotta do is ask.. not sure why you didn't do anything, maybe you don't like patients. Have you considered path or rads?

The OP is a resident already, and how did you deliver a baby as an M1?

 

[MilkmanAl]

All you gotta do is ask

Being a med student is pretty much your ticket to whatever.

 

[Jolie South]

Being a med student is pretty much your ticket to whatever.

For real. The worst that you'll ever hear is "no."

 

[psipsina]

We definitely do alot. I've done male and female genital exams (including uretheral swabs - ouch!!), rectals, foleys, IVs, placed and pulled chest tubes, pulled pacer wires, bedside wound vac changes, suturing. I've also gotten to first assist on some pretty awesome operations in the OR and done some awesome stuff in there (like sew GI and vascular anastomoses). I haven't got to intubate or do LPs yet but many of my classmates have.

 

[Tiger26]

Whoa! You lucky dog!

Yeah, being at Community as a med student was the equivalent to being at the mothership as a 4th year surgical resident.

Since there were only 3 med students in the entire hospital it was like the docs/nurses having a new puppy around there--"oh, you're a med student, let me show you how to do this baller procedure. want to help?"

 

[Conqueror]

I have done quite a lot of procedures in medical school (MS4 now).

Have sewn/stapled a whole lot (ie, large mastectomy incisions, large spine cases, craniotomies, etc)
Lots of IJs and Cordis lines
Some PEGs
A few bronchoscopies
Delivered a few babies and a lot of placentas
Have first-assisted on at least 75 surgical cases, including under the microscope
Intubating
Pap/Pelvic exams
IVs and blood draws
A million foleys
LPs
A couple chest tubes
Joint injections
Cleaning out ears

Not that I'm 100% proficient at everything on that list, but I've done a LOT of hands-on stuff in med school. If you show the interest they will let you fly.

 

[obiwan]

Yeah, I always thought that I would have done a lot more procedures by this time since i'm about to graduate but i have been able to do some central lines and LP/A line attempts and some of the more basic foleys and suture removals and things of that sort... hopefully i get through residency withot having to do any pelvics because i think i did one exam in 2 months of obgyn

 

[MossPoh]

The OP is a resident already, and how did you deliver a baby as an M1?

Could be the level of participation as well. I mean, I've reduced multiple fractures, dislocated shoulders and a dislocated elbow but I didn't really consider myself "doing" it since I was just following step by step orders with the doc watching me like a hawk and guiding me. As a premed I got to do an NG tube pretty much start to finish. It was more because the woman was nuts and spitting blood at people, so the doc didn't really want to do it. Sadly, much of this "practice" is on people who really have nowhere else to go for their treatment, but that has pretty much been the history of medicine.

 

[dantt]

I've also gotten to first assist on some pretty awesome operations in the OR and done some awesome stuff in there (like sew GI and vascular anastomoses).

Vascular anastomoses?? Your attending must be nuts. I've seen attendings go and re-tie omentum that residents have done perfectly.

 

[DeeJay2728]

I'm in the middle of first semester and I've already assisted in a C-section (with a surprise, the patient had multiple tumors on her uterus (one was the size of a baseball)), and two hysterectomys. The doc is also teaching us how to do epidurals. I go to school in Mexico... as long as you are willing to learn, they'll teach you anything!!!

We get to go to the hospital in the fist semester, and that is where we learn how to take vitals, clinical history, suture, iv's etc.

 

[psipsina]

Vascular anastomoses?? Your attending must be nuts. I've seen attendings go and re-tie omentum that residents have done perfectly.

He saved the easiest part for me, had me rest my hand on his, watched and narrated my every move etc. This was also towards the end of a 3 month long surgery rotation. I had first assisted on two major vascular surgeries due to weird circumstances and I guess he was confident in me. It was pretty awesome to get to sew with 6-0 tho!! We have a few attendings that are very confident in their ability to gauge and supervise a medstudents and others that don't let PGY-3's touchy (CT surgery ) For the most part when you start they treat you like a killer bee and as you prove yourself they gradually give you more and more to do. Some people never get past retracting, others get to do some pretty durn awesome stuff.

 

[dantt]

Heh maybe I did my surgery rotation at a very protected location. Our 9 month CT fellow has not moved past suctioning yet.

 

[psipsina]

Heh maybe I did my surgery rotation at a very protected location. Our 9 month CT fellow has not moved past suctioning yet.

I think CT surg is extra special in this regard. My institution is incredibly hands on which is one of the main reasons I chose it. Many residents who came from outside medschools have commented that M3s are treated like interns, in return we get to do some really cool stuff, but we're also getting our butts kicked.

 

[mikethomp]

Still telling lies huh MEDSTUDENT? Man you just won't learn... your going to be a terrible physician.

 

[njbmd]

I was just reading the blog of this med student who was talking about how she's on her ob/gyn rotation and thus perfecting her pap smears. I got to thinking about how satisfying it was when I finally perfected my pap smear technique. And then I realized: that didn't happen until residency.

It then occurred to me that I didn't learn how to do ANYTHING in med school. I didn't learn how to suture, I didn't learn how to put in IVs, I didn't learn how to hear a murmur... nothing. (I did learn how to draw blood though... not that drawing blood is at all challenging. Oh, and take a blood pressure. And put in Foley catheters. Hmm, maybe I went to nursing school by accident.) All this really makes me wonder what the hell was I doing during my clinical years?

Probably the biggest shocker of all is that I made it through four years of med school without ever doing a rectal exam. It wasn't like I avoided them or anything. I simply was never asked to do one.

Somehow I seem to fly under the radar. When I complained about how I didn't get to do many procedures during med school, other people in my class said they did tons. So... who knows. It's kind of like how I never was asked to read anything written by Shakespeare during my 20 years of formal schooling.

That's one reason why, even though it was horrible, I'm glad I did my internship at a county hospital. Patients can't say to you "Have you done this before?" or "Can't the attending do this procedure?" if they're unable to speak English.

Do you feel like your med school gave you a lot of procedure time? Or were you like me and spent most of your clinical years standing around and looking dumb?

I hate to be harsh but... medical school does not "give you" anything. It's your job to demand and to learn what you need. Any third-rate physical exam book will let you know that you "need" to learn to do a complete physical exam (yes, it includes a rectal exam and other procedures). If you read the book and saw that you needed specific skills, you demand that you are taught these skills. If you hang back and wait for someone to "ask you" to obtain your medical education, then you didn't take advantage of the opportunities that are there. If you "stood around" then you contributed to your poor training. My guess is that you would buy a car with no engine or a house with no roof.

The next thing is that it's your responsibility as a physician /medical student to do everything that is clinically necessary to give your patients the best care possible whether or not they "speak English". Even more offensive is your statement that your patient couldn't object because they couldn't speak English. Since when did the language of a patient deny them the right to refuse care?

If a patient objects to you performing a specific procedure because you have "never done this before", then you provide a more experienced person and learn from that encounter so that you can perform the procedure (with supervision) the next time. In short, you take advantage of every learning experience that you can find on every level. Every person has a first time doing everything.

You could have practiced rectal exams on cadavers in the gross anatomy lab if you couldn't find a patient. There are even simulators in many medical schools for pelvic exams, rectal exams, breast exams, starting IVs, and drawing blood. Most nursing schools have these types of simulators too. There are videos available, that explain how to perform exams too.

I know for sure that you are not an intern (and were not a medical student) on any of my services because you would not have gotten away with "standing around" for any learning opportunity. You owe your patients the respect of shoring up your deficiencies as soon as possible because to provide poor medicine is worse than no medical care at all.

To medical students: Please don't be the OP here. Step up and demand the most for your tuition dollars. You can't afford to graduate from medical school without getting the most for your money. After all, when you are writing that loan repayment check for the next 20 years, you have to make sure that you received your money's worth of education.

 

[ArcGurren]

I hate to be harsh but... medical school does not "give you" anything. It's your job to demand and to learn what you need. Any third-rate physical exam book will let you know that you "need" to learn to do a complete physical exam (yes, it includes a rectal exam and other procedures). If you read the book and saw that you needed specific skills, you demand that you are taught these skills. If you hang back and wait for someone to "ask you" to obtain your medical education, then you didn't take advantage of the opportunities that are there. If you "stood around" then you contributed to your poor training. My guess is that you would buy a car with no engine or a house with no roof.

The next thing is that it's your responsibility as a physician /medical student to do everything that is clinically necessary to give your patients the best care possible whether or not they "speak English". Even more offensive is your statement that your patient couldn't object because they couldn't speak English. Since when did the language of a patient deny them the right to refuse care?

If a patient objects to you performing a specific procedure because you have "never done this before", then you provide a more experienced person and learn from that encounter so that you can perform the procedure (with supervision) the next time. In short, you take advantage of every learning experience that you can find on every level. Every person has a first time doing everything.

You could have practiced rectal exams on cadavers in the gross anatomy lab if you couldn't find a patient. There are even simulators in many medical schools for pelvic exams, rectal exams, breast exams, starting IVs, and drawing blood. Most nursing schools have these types of simulators too. There are videos available, that explain how to perform exams too.

I know for sure that you are not an intern (and were not a medical student) on any of my services because you would not have gotten away with "standing around" for any learning opportunity. You owe your patients the respect of shoring up your deficiencies as soon as possible because to provide poor medicine is worse than no medical care at all.

To medical students: Please don't be the OP here. Step up and demand the most for your tuition dollars. You can't afford to graduate from medical school without getting the most for your money. After all, when you are writing that loan repayment check for the next 20 years, you have to make sure that you received your money's worth of education.

A. The statement I've bolded might be the most disgusting thing I've ever heard.

B. njbmd, kindly shut up. I know you like to flaunt your status as an attending and whatnot but my GOD you're so full of yourself. Nobody likes your condescension.

Anyway... I feel for you OP because a lot of this is out of your control sometimes. I've done some procedures (foley, sutures, etc) as an MS2 so far but the only reason I've been given the opportunity to do it is because my med school is poor and the med students are basically the b*&ch-work backbone of the school. We can't afford fifty nurses for the OR or whatever to do this kind of thing so we end up doing the work interns do. I know people who go to more highly priced and highly "valued" medical schools like JHU and the like who have never done anything beyond holding retractors in the OR... that's the price of a "better" medical education sometimes... not saying this is always the case so don't kill me people.

 

[KeyzerSoze]

A. The statement I've bolded might be the most disgusting thing I've ever heard.

B. njbmd, kindly shut up. I know you like to flaunt your status as an attending and whatnot but my GOD you're so full of yourself. Nobody likes your condescension.

It may be disgusting, but more importantly it's also completely impractical.

 

[Lacheln]

I hate to be harsh but... medical school does not "give you" anything.

...

You could have practiced rectal exams on cadavers in the gross anatomy lab if you couldn't find a patient.

Hahahahahahaha, you hate to be harsh...hahahahahahha....ah, sorry, you almost had me. You are so much more human in forums other than allo...have med students so deeply pissed you off that you save your special brand of patronizing omphaloskepsis just for us?

It is completely ridiculous to suggest that a student go use a cadaver for a rectal. Having had my fingers in both living and dead rectums, I'd have to say that's akin to suggesting I swap tapioca with roast beef for my next taste test.

Unless we are just talking about the ability to locate the orifice by sight. In which case I'd suggest a mirror and some alone time.

 

[ArcGurren]

It may be disgusting, but more importantly it's also completely impractical.

That too, not to mention everyone else in your class will hate you when the bowel contents spill out of your cadaver. *vomits*

Watch, I'm sure she'll come back with "oh that was just an example, you guys are so literal" blah blah.

 

[ChimpanzeeMinky]

If you guys keep up these great retorts, maybe we'll all be lucky enough that she doesn't come back at all!

 

[divinemsm]

...ummmmm.....the OP is an attending now. She was just surveying...jeez....

 

[sideways]

Hahahahahahaha, you hate to be harsh...hahahahahahha....ah, sorry, you almost had me. You are so much more human in forums other than allo...have med students so deeply pissed you off that you save your special brand of patronizing omphaloskepsis just for us?

It is completely ridiculous to suggest that a student go use a cadaver for a rectal. Having had my fingers in both living and dead rectums, I'd have to say that's akin to suggesting I swap tapioca with roast beef for my next taste test.

Unless we are just talking about the ability to locate the orifice by sight. In which case I'd suggest a mirror and some alone time.

 

[ar2388]

i dont know guys.. after they sawed our cadavers in half straight down the middle we definitely did mock rectal exams just to get a feel for how it angles and whatnot.

 

[Hoju]

i dont know guys.. after they sawed our cadavers in half straight down the middle we definitely did mock rectal exams just to get a feel for how it angles and whatnot.

Awesome, rectal exams on a sawed-in-half rectum.

 

[cartoondoc]

Actually, there was one guy in my class who used to practice rectal exams on the cadaver. He was really enthusiastic and used to do it daily. I'm sure he got very good at it.

Come to think of it, I don't think he was actually in my class.

I think he just wandered in from the street.

Was that you, njbmd? (If so, you need to trim your ear hair. Seriously.)

 

[nlax30]

Actually, there was one guy in my class who used to practice rectal exams on the cadaver. He was really enthusiastic and used to do it daily. I'm sure he got very good at it.

Come to think of it, I don't think he was actually in my class.

I think he just wandered in from the street.

Was that you, njbmd? (If so, you need to trim your ear hair. Seriously.)

That first part could be a Jack Handy quote.

 

[KeyzerSoze]

Awesome, rectal exams on a sawed-in-half rectum.

Awesome band name.

 

[auburnO5]

You could have practiced rectal exams on cadavers in the gross anatomy lab if you couldn't find a patient.

 

[Hoju]

Awesome band name.

Woah, your right. It's gold!

 

[deleted116380]

MS2 here and I got to do some parts in a CABG...held open the ribcage so the surgeon could cauterize the left side and he let me cauterize the right. Then I had to use a couple huge tweezers and pull back some tissue for him to cut through to the heart...I had to pull the pericardium back after that while he was cutting along it, lol. Awesome.

 

[dr zaius]

You could have practiced rectal exams on cadavers in the gross anatomy lab if you couldn't find a patient.

Would that even help at all? Just based on the way the cadavers look from that aspect I can't imagine it being a good simulation of a live rectal exam. I haven't experienced any of my digits in a cadaver so I can't really compare.

 

[MossPoh]

Would that even help at all? Just based on the way the cadavers look from that aspect I can't imagine it being a good simulation of a live rectal exam. I haven't experienced any of my digits in a cadaver so I can't really compare.

Everyone is different, but from my experience it was the whole process leading up to the rectal that was trickiest. Early on, you're still filled with that nervous "I don't think I belong here" feeling since the only thing that separates you from some schmuck off the street is a few months of basic science classes and a white coat with some patches on it. Well, that, and the fact that a large percentage of the population has probably never put their finger there on a middle-aged man which adds to the awkwardness of the situation.

 

[Fromss]

That's one reason why, even though it was horrible, I'm glad I did my internship at a county hospital. Patients can't say to you "Have you done this before?" or "Can't the attending do this procedure?" if they're unable to speak English.

OP, you have to establish whether or not the patient is fluent in the language you intend to use. If not, then you have to arrange for an interpreter to be present.

 

[MilkmanAl]

Unintentional humor is always the best kind.

 

[CultureDoc]

Wow. This thread simultaneously cracked me up and reminded me why I haven't been on SDN in a year!

I wasn't going to comment because my comment necessitates mentioning how annoying it is when people get on their high horses in threads that are intended to be inquisitive and light-hearted in spirit . . . and so, in commenting, I am also getting on my high horse. Oh, the irony! I'll just keep right on going, though, as I do have a few more things to say.

1) cartoondoc - you are a freaking comic genius (I'm a big fan of your blog!), and I think njbmd is secretly jealous.

2) when I first started reading njbmd's comment, I hadn't paid attention to what she quoted, and I assumed she was going to deservedly lambaste MilkmanAl's comment that "being a med student is pretty much your ticket to whatever." I wholeheartedly disagree, and I'm pretty sure it's that sense of entitlement that makes people hate med students.

3) the one-upsmanship displayed on this thread is, well, (excuse me!) another great reason to hate typical gunner med students and also SUCH classic SDN!

But also, some thanks are in order: Thanks to ArcGurren for having the cajones to say what I (and I'm sure many) were thinking; thanks to the OP, Lacheln, KeyzerSoze, nlax30, auburn05, and Fromss (unintentional though it was) for the lolz, and thanks to all for reminding me not to check in here again unless I need to work out my oculomotor muscles or when I need a good laugh.

Oh, and I learned something here! I think it'll make a great mantra! *must not be med student wallflower. must not be med student wallflower.* Got it!

 

[MilkmanAl]

MilkmanAl's comment that "being a med student is pretty much your ticket to whatever." I wholeheartedly disagree, and I'm pretty sure it's that sense of entitlement that makes people hate med students.

Wow, nice reading comprehension. I was agreeing with Jolie's staement that if you're a med student, all you have to do is talk to an attending or resident to get involved in a case you're interested in. Let's add complete inability to interpret verbal cues to the reasons people hate med students.

 

[nlax30]

Though.... if asked if you want in on a human centipede project.... Just. Say. No.

 

[MilkmanAl]

But you could get in on it if you wanted to.

 

[45408]

Oh, and I learned something here! I think it'll make a great mantra! *must not be med student wallflower. must not be med student wallflower.* Got it!

Funny, that's exactly what MilkManAl was trying to say...