Urology intern concerns

[housefish26]

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I'm a urology resident in my intern year and I'm nervous about the lack of procedures I've done up to this point. I realize we're only a little over half-way through the year but the rest of my rotations are actually pretty easy. I ended up being quite the white cloud during my first few rotations (which should have been procedure-heavy) so I still have never put in a central line or a chest tube.

I realize that urologists these days probably are not putting in any lines or chest tubes but it still makes me a little nervous. What do you guys think, is this a big deal? Should I try to seek out these procedures so I can learn how to do them or just let it slide?

 

[Smurfette]

While we usually exposed our GU interns to these procedures, they did not do many. Once they were done with intern year/GS rotations, they never had reason to do these again (no one would call GU for a chest tube, and GU patients in the ICU would be managed/lined up by the ICU team; GU patients in the OR would have their lines placed by anesthesia). While it's possible GU may be responsible for doing lines on their own patients at your institution, I personally have never seen it happen. I wouldn't stress about it unless your seniors have different expectations; this would mean that they would need to feel comfortable enough doing a central line themselves to back you up doing one. Ask one of the seniors when you see them, to get an idea of what type of procedures/volume you are expected to have this year. Odds are, they will reassure you that you will be fine.

Honestly, trying to get in the OR to do other intern-level procedures (lumps/bumps, maybe a chemoport, hernias, breast biopsy, etc.) or double scrubbing more advanced cases would probably be better for you, in order to get comfortable handling (and naming) instruments and closing skin.

 

[Winged Scapula]

Its always good to want to do more, to increase your skills and fund of knowledge. As my esteemed colleagues have noted, lines and chest tubes, etc aren't really in the wheelhouse of urologists, so unless your seniors feel that these are basic skills I would concentrate on simple procedures which would be useful regardless of your specialty.

 

[armybound]

As a urology resident I've placed an A-line when anesthesia was busy messing with other things. I'd place a central line if they'd let me.

I did no other procedures as an intern. I started doing a chest tube once but the GS resident took over. Never wanted to intubate anyone, do a thoracentesis/paracentesis, etc.

I wouldn't worry about it. If somebody is relying on a urologist to do any of those interventions the patient's in a pretty bad situation to start with.

 

[cpants]

I wouldn't worry too much about getting lines. Lines are pretty useless for GU residents in my institution unless you plan on moonlighting for the ICU or trauma. Our attendings don't want us putting lines in their patients on the floor because they haven't done it since their intern year and can't back us up appropriately. If one of our guys needs a line they are usually in the ER, OR, or ICU anyway and there is someone more qualified to take care of it. I would advise learning how to do a chest tube. It's a pretty useful skill for a urologist, especially if you work anywhere where they do a decent amount of open nephrectomies. I've actually put in more chest tubes on GU than I did in GS.