Perrotfish

Has an MD in Horribleness
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So 6 months into 3rd year an I'm still pretty much completely incompetent when it comes to the actual physical skills of medicine. I can barely suture (I'm pretty sure every patient I've closed is quite literally scarred for life), can't intubate (tried twice, couldn't visualize the airway), can't place an NG tube, an IV, or any kind of catheter, and of course I have absolutely no clue how to do real surgical/medical procedures like needle decompressions/chest tubes. I'm trying my very best to improve (I'm putting myself through that 'learn to tie up wounds' course that advertises on SDN this weekend) and I'm working in the sim center whenever I can find time but I'm worried this is going to be a continuing problem. So, I guess my question is, other than a General Surgery rotation, do y'all know of any procedures or courses that really help you develp your procedural skills? I don't want to show up to my residency without knowing anything.
 

BigRedBeta

Why am I in a handbasket?
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1) It takes practice. Everything requires practice. How many times have you actually done all of these procedures? If it's less than 10, don't worry about it. And how many times have you done them on real patients - mannequins and simulations are all well and good, but it's the rare plastic doll that really simulates what working on a real patient feels like. For example suturing: skin is both significantly stronger, yet at the same time more pliable than any rubber, plastic or fabric I've ever seen used. Even pigs' feet, while better than plastic, aren't great representations of real live tissue.

2) What field are you actually going into? Obviously very few fields will require you to do all of these things.

3) Most people start residency sucking at the common procedures in their field. Peds residents suck at LP's on infants, Orthopods suck at splinting/casting, surgery interns when they do actually get in the OR suck at whatever they're allowed to do. ER folks suck at handling a trauma. OB/GYN's suck at delivering a baby. It's natural and expected, and everyone gets better.
 
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Perrotfish

Perrotfish

Has an MD in Horribleness
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2) What field are you actually going into? Obviously very few fields will require you to do all of these things.
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I'm not really sure yet (considering psych and ER as my top choices) but I'm in the military so I want to be less than a complete schmuck when it comes to basic trauma (including the procedures involved), if only so that I can train my Corpsmen.
 

turkeyjerky

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an anesthesia rotation is prolly your best bet for IVs and intubating. Depending on the attendings, you might also get a couple A-lines and central-lines.
 

OveractiveBrain

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You want to learn how to start IVs? Find a paramedic, or Anesthesiologist
You want to learn how to intubate? Find a paramedic, or Anesthesiologist

You want to learn how to suture? Surgery
You want to learn how to paracentese? Interventional Radiology
You want to learn how to thoracentese? Interventional Radiology
You want to learn how to Pericardiacentese? Interventional Radiology

Here's the thing. Most residents barely get their numbers for procedures. You are expected to come into intern not knowing how to do any procedure. Its ok. You learn on sim centers, dolls, or easy patients under the supervision of people whose job it is to teach you. As a Med Student no one has any fiduciary responsibility to teach you any procedures. You are there to learn history and physicals, to develop ideas for diagnosis and management. Like algorythims, disease severity, decision making. Procedures come in residency.

Here's another thing. What do you need to train your Corsman? What skills and abilities do you think you have that they dont? If you want to train a medic to be a medic, give him a medic instructor. If you want to train a medic the knowledge of medicine, give him a doctor instructor. Medics are going to have real-life experience, a shi-t ton of practice, and more connection with other medics than you could possibly develop as a doctor (especially psych).

Sit back, relax. Learn the knowledge. Fill the procedural gaps when you hit residency. They expect you to be a n00b and its ok.
 
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Perrotfish

Perrotfish

Has an MD in Horribleness
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Sit back, relax. Learn the knowledge. Fill the procedural gaps when you hit residency. They expect you to be a n00b and its ok.
Like I said, my issue is that I fully expect the military to kick me out into practice after just an Intern year, rather than allowing me to complete residency and learn the procedures like civilian doctors do (as they do with 70% of residency matriculants). I'm not worried about falling behind the class, I think I'll do just fine compared to my peers and I don't think the expectations are unreasonable, however I am worried that as a batallion surgeon I will suddenly be responsible for managing a pediatric airway in an acute trauma without so much as a PALS course to my name and will therefore kill a kid.

The idea of doing a one month intervetional radiology elective is interesting, though. Sounds like a good idea, actually. I'd already pretty much figured out that I'm going to want to do at least a couple of weeks of anesthesia and some extra EM time.
 

Rendar5

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Nov 12, 2003
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practice practice practice. I'm EM so I have plenty of procedures and I started out sucking at all of them except a few. Those that I practice and do repeatedly I've mastered. You're 2 and a half years away from being past intern year anyway, and by that time when the **** hits the fan and you need to do it, you just do it. If the army sends you out into the field and you suddenly have to cric a guy in Afghanistan, you'll be fine if you just do it within 20 seconds and stop thinking about it.
 

km11

R1
Sep 22, 2010
74
1
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Medical Student
I'm not sure how your rotations are set up but during my EM rotation we had ample opportunity to suture up lacs and place a bajillion IVs. You can get intubation experience with a solid anesthesia rotations. If you still have a large inpatient rotation left, you can go bother the phlebotomists and nurses and have them grab you for IV inserts if you wanna learn more about that stuff.

My surgery clerkship was not very helpful when it came to suturing skills that you might need outside the OR. No one ever does simple interrupted when doing the final close on a belly (at least through my experience).
 
Nov 8, 2010
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Don't stress not knowing the hands on stuff to your Corpsmen, most of the simpler stuff is simply just practice makes better. The senior Corpsmen (or IDCs) likely have multiple tours with plenty of practice and know their jobs, and how to train the juniors, pat. You are who they consent for the advanced stuff, not sexy, but very important.
 

Knicks

10+ Year Member
7+ Year Member
Aug 28, 2007
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You want to learn how to start IVs? Find a paramedic, or Anesthesiologist
You want to learn how to intubate? Find a paramedic, or Anesthesiologist

You want to learn how to suture? Surgery
You want to learn how to paracentese? Interventional Radiology
You want to learn how to thoracentese? Interventional Radiology
You want to learn how to Pericardiacentese? Interventional Radiology

Here's the thing. Most residents barely get their numbers for procedures. You are expected to come into intern not knowing how to do any procedure. Its ok. You learn on sim centers, dolls, or easy patients under the supervision of people whose job it is to teach you. As a Med Student no one has any fiduciary responsibility to teach you any procedures. You are there to learn history and physicals, to develop ideas for diagnosis and management. Like algorythims, disease severity, decision making. Procedures come in residency.

Here's another thing. What do you need to train your Corsman? What skills and abilities do you think you have that they dont? If you want to train a medic to be a medic, give him a medic instructor. If you want to train a medic the knowledge of medicine, give him a doctor instructor. Medics are going to have real-life experience, a shi-t ton of practice, and more connection with other medics than you could possibly develop as a doctor (especially psych).

Sit back, relax. Learn the knowledge. Fill the procedural gaps when you hit residency. They expect you to be a n00b and its ok.
The parts that I bolded, if true, make me feel better (also). :oops: