Procedures

[stefanlukic]

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Hi everyone
First I'd like to apologize if i posted a topic that was discussed previously (on some other thread).
I am a med student from Serbia, MS4.
We have a terrible med school system here and I am trying (and failing) to change something.
That is why I need your input...
Our clinical rotations are as follows:
Pray that the "professor" even shows up.
He shows up and gives you an already diagnosed patient, tells you the dg and tells you to take a history.
You take a history and do a pseudo-physical.
Digression: Pseudo-physical - my personal name for that abomination of a physical exam where 5 students try to touch a single patient even though there are enough patients to go around and the students aren't even allowed to do a rectal.
Then you read the history to the "professor" and go home.
Max 7 hours of clinical rotations a week.
If you try to do a procedure like start an IV, administer and IM you are in big trouble. Don't even think about central lines or intubation or even suturing.
Well, I spend every waking minute running to the hospital and begging for procedures and begging to be on call which is actually not allowed but I manage somehow. So I got to do all of the procedures and have become quite skilled.
Yeah and the students always try to avoid those couple of hours of clinical rotations.
So my questions are:
Is it completely different in the USA?
Do you actually learn to be MDs or are you "playing" pseudoMDs like us here?
Do you do any procedures?
I'd really appreciate any input and I am sorry if all this sounds too incredible but this is Serbia so nothing's too strange...
Every time I tell people that med schools in other countries actually teach their students I end up being ridiculed.

 

[Droopy Snoopy]

Hi everyone
First I'd like to apologize if i posted a topic that was discussed previously (on some other thread).
I am a med student from Serbia, MS4.
We have a terrible med school system here and I am trying (and failing) to change something.
That is why I need your input...
Our clinical rotations are as follows:
Pray that the "professor" even shows up.
He shows up and gives you an already diagnosed patient, tells you the dg and tells you to take a history.
You take a history and do a pseudo-physical.
Digression: Pseudo-physical - my personal name for that abomination of a physical exam where 5 students try to touch a single patient even though there are enough patients to go around and the students aren't even allowed to do a rectal.
Then you read the history to the "professor" and go home.
Max 7 hours of clinical rotations a week.
If you try to do a procedure like start an IV, administer and IM you are in big trouble. Don't even think about central lines or intubation or even suturing.
Well, I spend every waking minute running to the hospital and begging for procedures and begging to be on call which is actually not allowed but I manage somehow. So I got to do all of the procedures and have become quite skilled.
Yeah and the students always try to avoid those couple of hours of clinical rotations.
So my questions are:
Is it completely different in the USA?
Do you actually learn to be MDs or are you "playing" pseudoMDs like us here?
Do you do any procedures?
I'd really appreciate any input and I am sorry if all this sounds too incredible but this is Serbia so nothing's too strange...
Every time I tell people that med schools in other countries actually teach their students I end up being ridiculed.

Keeping in mind that not every American medical school is the same, your experiences are unfortunately quite different from ours. Although there are times when we 'play' MD - many schools have mannikins or actors portraying patients - during the pre-clinical years, most of our clinical learning is done on real patients in the hospital/clinic for real problems. I've did all of the procedures you mentioned and more as an M3, except intubation and central line both of which I did as an M4 in the intensive care unit last month. We have lectures and conferences that take up time to be sure, but your 7 hour week of clinical medicine sounds like a fairly short day of clinical medicine at my school.

 

[stefanlukic]

Well, I am the only one in my medical school (over 1000 students) who knows how to do any procedures and I had to sell a limb for that. I am also the only one who goes on-call, I had to sell my firstborn for that and I had to sell my soul for some patients....
No really, I endured all kinds of crap to get that:
I've been forcefully removed from the premises by doctors who are non-teaching....
I've been sworn at...
I've been thrown out of the OR...
....
And when we get a good professor who wants to show us something everyone tries to evade him and their excuse is that they don't have time for that...
The big problem is corruption, 80% of students are children of doctors or professors and have a guaranteed A on all exams and have a job waiting for them.
While the rest of us have to work our asses off and even then have no chance of getting a job....
The worst part is when you hear a med student thinking that a pseudo H&P taken from one patient is too much for a week of clinical rotations....

 

[stefanlukic]

Anyone else?

 

[Tiger26]

I sewed on a skin graft yesterday and assisted with a laparoscopic liver lobe resection. Also been able to intubate, deliver babies, do IV's, put in guidewires . . . as a third year

 

[lord_jeebus]

As a medical student I was allowed to do IVs, A-lines, intubations, central lines, epidurals, suturing, paracentesis, vaginal deliveries... and one spinal cord stimulator implant.

I'm sorry that your system does not permit you more autonomy. When are you expected to pick up these skills?

 

[MSKalltheway]

I apologize that I am not familiar with Serbia's system, but when you say MS4, do you mean you are doing your last year before you get your degree?

Where I'm at if you are aggressive enough you can do loads of stuff as an MS3, central lines, a-lines, intubation, IVs, catching babies, joint injections, urinary cathing...we are largely also expected to do everything for our patients too, H&P's, A/P's, ordering/prescribing meds, and consults, of course with appropriate supervision. I'm sorry that youre being admonished for motivation.

 

[stefanlukic]

As a medical student I was allowed to do IVs, A-lines, intubations, central lines, epidurals, suturing, paracentesis, vaginal deliveries... and one spinal cord stimulator implant.

I'm sorry that your system does not permit you more autonomy. When are you expected to pick up these skills?

They say that we are supposed to pick up those skills in residency.
But the truth is that:
Only surgeons know how to suture...
Almost no doc knows how to place IVs or give IMs....
Only EM and anesthesiology know how to intubate...
Only anesthesia can place central lines....
Only URO and some nurses can place foleys...
Only anesthesia can draw ABGs....
So the system is specialty oriented....
For example FP can't do almost anything except sore throats, anything more complex (Hep A, mono, arrythmias, HTN) has to go to a specialist...
It's common to get referrals in the middle of the night from some city like 50-70miles away to suture a head laceration.
I mean, 48y/o from a city 70miles away sent by ambulance by a surgeon b/c of a supraorbital 2cm head laceration and neurosurgery (ME) had to suture it....

 

[stefanlukic]

I apologize that I am not familiar with Serbia's system, but when you say MS4, do you mean you are doing your last year before you get your degree?

Where I'm at if you are aggressive enough you can do loads of stuff as an MS3, central lines, a-lines, intubation, IVs, catching babies, joint injections, urinary cathing...we are largely also expected to do everything for our patients too, H&P's, A/P's, ordering/prescribing meds, and consults, of course with appropriate supervision. I'm sorry that youre being admonished for motivation.

The med school is 6 years but we start "Clinical practice" in 1st year. IM professors teach it and it's H&Ps. We've got clinical practice 2 in the 2nd year, same stuff. Then "Medical First Aid" in 2nd year, which is supposed to be procedure oriented (at least that's what it says), it's supposed to teach you all the procedures but nobody showed up(I mean the professors) and we didn't learn any procedures.
But even though I am 4th year I know a lot more procedures than any of the 6th years or even residents.
Last time on call (neurosurg) I was teaching a couple of Interns (intership here is rotational, no specific service) how to suture a head laceration. Time before that I taught an intern how debride decubitus.
And the time before that I had to show them how to debride osteomyelitic bone from a post-op head wound(wife shot by husband, 2x 12gauge to the back of the head, post op osteomyelitis)...
And I really don't think that this system should be allowed but no one seems to care.
Only a couple of them let me be on their service after our regular clinical time(neurosurgery chief, peds surgery chief, IM chiefs and ID chief).....

 

[mules05]

They say that we are supposed to pick up those skills in residency.
But the truth is that:
Only surgeons know how to suture...
Almost no doc knows how to place IVs or give IMs....
Only EM and anesthesiology know how to intubate...
Only anesthesia can place central lines....
Only URO and some nurses can place foleys...
Only anesthesia can draw ABGs....
So the system is specialty oriented....
For example FP can't do almost anything except sore throats, anything more complex (Hep A, mono, arrythmias, HTN) has to go to a specialist...
It's common to get referrals in the middle of the night from some city like 50-70miles away to suture a head laceration.
I mean, 48y/o from a city 70miles away sent by ambulance by a surgeon b/c of a supraorbital 2cm head laceration and neurosurgery (ME) had to suture it....

What hospital are you at that anesthesia is doing all the central lines and ABGs? Everywhere I've rotated surgery does all the lines other than perioperative ones, and everyone does their own abgs.

 

[stefanlukic]

What hospital are you at that anesthesia is doing all the central lines and ABGs? Everywhere I've rotated surgery does all the lines other than perioperative ones, and everyone does their own abgs.

Serbia - weird I know...
Surgeons wouldn't even know where to place them....
I know only one neurosurgeon and one trauma surgeon that insist on doing their own central lines and intubations (that's out of more than a hundred).
Central lines are considered a last resort here and they are very rare. Usually all the nurses practice placing multiple IV's, then the anesthesiologist comes and does the same and only after quite some time does he consider putting a central....
The last time I was in ped's surgery I asked about intraosseus lines and they were confused, they didn't know what that was. It took some time to find a anesthesiologist who's done one.
Anesthesiologists don't even give epidurals for deliveries here (300'000 people city with a massive clinical center covering more than 2 milion people). They claim that it's very hard to perform them and that the complication rate is high 😕

 

[dilated]

The med school is 6 years but we start "Clinical practice" in 1st year.

This is mostly why. I've spoken to a lot of residents from other countries (South American especially but also the EU) where they're amazed at what we're allowed to do compared to countries with six year programs. The difference is largely age, I think. The average third year in my class is like 26 or 27 years old. The average third year in six-year post HS programs is probably like 21 or 22. It's not shocking that people are more hesitant about letting someone barely post-puberty put in central lines. 😛

Although the residents here also seem to have more autonomy, too.

 

[stefanlukic]

This is mostly why. I've spoken to a lot of residents from other countries (South American especially but also the EU) where they're amazed at what we're allowed to do compared to countries with six year programs. The difference is largely age, I think. The average third year in my class is like 26 or 27 years old. The average third year in six-year post HS programs is probably like 21 or 22. It's not shocking that people are more hesitant about letting someone barely post-puberty put in central lines. 😛

Although the residents here also seem to have more autonomy, too.

It's not just central lines...
It's also about extremely low risk procesdures.
You can't do foleys, you can't suture, no IMs, no IVs....
Almost nothing is allowed...
And nursing students (nursing is not college-level here, it's a high school) can do IVs and IMs and foleys in their first year, about 15 years of age....
So I don't think it's age related....
I think it's just stupidity that a 15 y/o half-wit can do more procedures than a 20-something med student....

 

[stefanlukic]

After much begging I just got to do a bronchoscopy....
😀😀😀😀

 

[Anka]

Congrads! Bronchs are fun.

I (as a US med student) got to do a lot of suturing (even on the heart), intubate, place foleys, bronch, place chest tubes, do tracheostomies, j tubes, g tubes, got to do the gastrojejunostomy on a Whipple several times, and lots more -- not that these are experiences typical of medical school here (in fact, some of them were very atypical), but I developed personal relationships with the people who were able to allow me to do these procedures, and over a period of years did more and more.

My advice is to keep doing what you're doing -- aggressively seek out opportunities to do things, develop personal relationships. And perhaps consider doing away rotations in the US and/or coming here for residency. Just keep in mind that the standard if you do a rotation here is quite different (the rotators we have from European countries are often not prepared to take on the service role that we expect). I've found the European students probably have more of the theoretical knowledge than US students (e.g., knowing some obscure physical finding by the correct eponym, as well as what it means), while we tend to have more practical skills (H&Ps in the 10-15 minutes you have to do one, presenting patients, ordering the correct things on admission [cosigned by a resident], drawing blood, ABGs, IV placement).

Best,
Anka