Procedures

[Moogash]

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All,

Current PGY1 here. I know we did not enter this field knowing that we would be doing a high volume of procedures, but I am quite disappointed with my numbers at this point in the year. I've done 2 central lines, 2 art lines, 1 LP, and 3 paras. I am interested in general cards, so the main procedures I really care about are lines. However, I've managed to complete my MICU and CCU rotations with only 2 of each. In a few short months, I will be an upper level and most likely will not be "signed off" on these procedures (my institution requires 5 centrals and 3 arts to perform unsupervised). I have some co-interns that are already signed off, but there are several upper levels who have never even done 5 by the time they graduate. It seems like an element of luck is involved.

I am concerned that I will be an upper level next year who constantly needs to call someone else to supervise; even worse, I will be forced to take lines from the new interns who need them as well just so I can meet my numbers. Also, as a new cards fellow in just a couple of years (assuming I match), I will be expected to be able to perform these procedures regularly and independently. Do any folks out there have similar experiences? Are there ways you have found to get more lines? It almost makes me feel impotent .

 

[wamcp]

Be aggressive be assertive. Simple as that. At end of residency I had over two dozen of each: central lines, LP, para. Less than ten radial art lines. Never got enough thora and not confident in those.

 

[wjs010]

Wow you only need 5 central as an intern to sign off? In mine you can’t sign off as an intern. And btw, most of my co interns didn’t do more than 2-3 centrals. Granted we don’t do icu as interns. But still, you’ll get plenty in 2nd-3rd yr


Sent from my iPhone using SDN

 

[Gastrapathy]

Make friends with the EP fellow (if one exists). Lines galore

 

[Lexdiamondz]

If your institution offers it, I would consider an IR or anaesthesia rotation - plenty of lines

The reality is that IM doesn't require procedures for the most part and many of them have gotten farmed out to subspecialists - you'll learn what you need in fellowship but during residency you'll need to be more agressive and vocal to get stuff.

 

[redpanda]

As a resident, other than being in the right place at the right time, you need to show interest in getting procedures. As a fellow, I'm generally swimming in junior trainees in the ICU, so what dictates who is going to done whatever line is governed by urgency, skill needed, availability of the residents/interns, and their interest. I'll try to give procedures on suitable patients with decent anatomy (no doing your first line ever as an HD line on some bleedy patient). In my particular institution, I have gotten feedback from the residents that they'd like more procedures, but there are a lot of times where the procedure can't wait for rounds to be over and when the residents are having problems knowing/understanding all the patients which are collectively "theirs" on the team, there's little chance I'm going to pull one off rounds to teach a line.