What are you allowed to do on rotations?

[Laker4Life]

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I have always wondered what kind of neat stuff they allow 3rd and 4th year students do on their clinical rotations. Do they let you draw blood, insert IV tubing, Foley bag, administer shots, or cut someone open 🙂? Just wondering...

 

[Dedikated2liftn]

I have always wondered what kind of neat stuff they allow 3rd and 4th year students do on their clinical rotations. Do they let you draw blood, insert IV tubing, Foley bag, administer shots, or cut someone open 🙂? Just wondering...

Clean up ****, retractor bitch, and paperwork 🙂.

 

[Dedikated2liftn]

Oh, I forgot professional kiss ass.

 

[UnderdogMD]

Oh, I forgot professional kiss ass.

Yep, and it continues into residency. By the time you are done and a fully licensed physician you've jumped through so many hoops and kissed so much ass that your whole face is covered in s***.

 

[Law2Doc]

I have always wondered what kind of neat stuff they allow 3rd and 4th year students do on their clinical rotations. Do they let you draw blood, insert IV tubing, Foley bag, administer shots, or cut someone open 🙂? Just wondering...

You generally get to do most of that, and actually are required to do most of that at least once. Not sure what you mean by "insert IV tubing", but you will generally get to place an IV line. You probably won't get to "cut someone open", but you might help sew them closed.
And as mentioned, you will also do things like clean stuff up, unbandage or dress wounds, remove staples, remove sutures, digital rectal exams and hemocult tests, lots of paperwork. And sure kissing A**.

 

[jdh71]

It's my understanding that med students can basically do just about anything under the supervision of an attending physician, two of the cooler things I did while a medical student was first assist on an open appy, and the surgeon let me do practically the whole case (he must have been bored, or very patient and I don't know which), and three intubations in the ED on crashing patients (I was just hanging out the action and got lucky those times) - everyone usually has ONE story like that where they got to do something they think is really cool as a student. Otherwise, even though you technically can do a lot, practically you don't get to unless you are super-aggressive, which can get on everyone's nerves and actually work against you, because you have to be so closely watched. I had friends who put in chest tubes while students, do paracentesis, thoracentesis . . . and even one guy who got to throw a few sutures in an atria (I guess the CT surgeon just loved the hell out of him) . . . but mostly, you won't do much of this. Most students will get to draw blood, start an IV, suture superficial wounds at least once or twice, especially on certain services.

 

[smq123]

I have always wondered what kind of neat stuff they allow 3rd and 4th year students do on their clinical rotations. Do they let you draw blood, insert IV tubing, Foley bag, administer shots, or cut someone open 🙂? Just wondering...

"Neat" stuff you get to do on rotations:
- Insert foleys (not all that exciting, but still better than learning about the TCA cycle)
- Sew people closed
- Cut people open (sometimes. More on that later)
- Staple off parts of the intestines (sometimes.)
- Deliver babies/pelvic exams (this is totally subjective though. Some people HATE delivering babies)
- ABGs
- Insert central lines
- Remove drains and catheters
- Use the Bovie

Not-so-"neat" stuff that you MUST do on rotations:
- Hold the bucket while the patient dry-heaves and then pukes
- DREs
- Get stool samples
- Coach pregnant women as they push...this usually also entails using a measly 4x4 to wipe away the stool that accidentally comes out as they push.

The more involved you are, the more you'll get to do. A lot of surgery and OB/gyn residents (although not all) will reward your hard work and enthusiasm with fun procedures.

Also, the more carefully you listen to instructions as you do "neat" things, the more they'll trust you and the more that they'll let you do. For instance, if you Bovie your way through an artery the first time you ever set foot in an OR, then you'll be lucky if they let you within 10 feet of the operating table. So listen carefully and be enthusiastic!

 

[sestamibi]

Not-so-"neat" stuff that you MUST do on rotations:
- Hold the bucket while the patient dry-heaves and then pukes
- DREs
- Get stool samples
- Coach pregnant women as they push...this usually also entails using a measly 4x4 to wipe away the stool that accidentally comes out as they push.

1) I've gotten those small, yellowish trays for patients to hold while they heave. I'm not actually holding it for them.

2) I went 6 months thru 3rd year without having to do one. The last week of IM, my intern busted me.

3) Uhh...really? I've never done it.

4) Ditto. Although I'd probably leave if that happened.

 

[smq123]

1) I've gotten those small, yellowish trays for patients to hold while they heave. I'm not actually holding it for them.

Elderly woman in the ICU. Barely strong enough to hold her own head up - couldn't hold the yellow plastic tray near her mouth, so I had to do it.

2) I went 6 months thru 3rd year without having to do one. The last week of IM, my intern busted me.

Heh.

3) Uhh...really? I've never done it.

Long story.

4) Ditto. Although I'd probably leave if that happened.

You've never had that happen to you? Consider yourself lucky.

At least it was FORMED stool. My friend got stuck with the pregnant woman who also had really bad diarrhea.

 

[LadyWolverine]

At least it was FORMED stool. My friend got stuck with the pregnant woman who also had really bad diarrhea.

Oh MAN.

 

[Ashers]

On surgery I was allowed to eat sometimes and use the restroom occasionally.

One of the cooler things I got to do was one of a serial washout in the OR when the resident scrubbed, took the bandage off to have a look, then let me wash out the wound with 9L of NS. Also got to put screws into a tibia, a nail into a femur. On medicine got to do a thoracentesis.

Not-so-"neat" stuff that you MUST do on rotations:
- DREs
- Deliver babies/pelvic exams (this is totally subjective though. Some people HATE delivering babies)- Get stool samples
- Coach pregnant women as they push...this usually also entails using a measly 4x4 to wipe away the stool that accidentally comes out as they push.

The more involved you are, the more you'll get to do. A lot of surgery and OB/gyn residents (although not all) will reward your hard work and enthusiasm with fun procedures.

Also, the more carefully you listen to instructions as you do "neat" things, the more they'll trust you and the more that they'll let you do. For instance, if you Bovie your way through an artery the first time you ever set foot in an OR, then you'll be lucky if they let you within 10 feet of the operating table. So listen carefully and be enthusiastic!

Usually the OB attending wiped up the stool usually as I stood in the back of the room and watched because at the private hospital, the patients were their patients and they didn't want a student doing much. Yay for never doing a complete delivery by myself. Those deliveries in which I was scrubbed in, I had the honor of delivering the placenta.

Also got through M3 year without having to do a DRE on an awake person (only on patients on gen surg). We weren't allowed to do them on OB/gyn, and I never had to on medicine (ED usually did them).

The bolded part is so true. I had ortho residents tell me that they reward students by letting them put in traction pins, nails, screws, and suture (since we're generally a lot slower than they are).

 

[bcat85]

Boy I'm excited to get started.😱

 

[BigRedBeta]

For the most part the best things I got to do as a medical student were actually while I was in the summer between my first and second years...my school requires a 3-week rural preceptorship during that summer. I followed a surgeon around in a town of about 3500. Over the course of 3 weeks I did the following:

Closed on most of the cases.
After proving myself driving the scope with his help, I did about 20 colonoscopies and 15 EGD's by myself. There were several times when my preceptor left the room and said "call me if you find anything" and he'd go get coffee (there was a great staff of nurses and CRNA's there who were a massive help). A PA student joined our team the last week, and I taught her how to do scopes.
Nearly removed a lipoma of the scalp on my own. He didn't even scrub in to the case until it started bleeding like crazy.

I'm sure that I violated something by doing all of this after only one year of med school...but it was pretty awesome. Considering going back there for a month of M4.

 

[noentiendo]

For the most part the best things I got to do as a medical student were actually while I was in the summer between my first and second years...my school requires a 3-week rural preceptorship during that summer. I followed a surgeon around in a town of about 3500. Over the course of 3 weeks I did the following:

Closed on most of the cases.
After proving myself driving the scope with his help, I did about 20 colonoscopies and 15 EGD's by myself. There were several times when my preceptor left the room and said "call me if you find anything" and he'd go get coffee (there was a great staff of nurses and CRNA's there who were a massive help). A PA student joined our team the last week, and I taught her how to do scopes.
Nearly removed a lipoma of the scalp on my own. He didn't even scrub in to the case until it started bleeding like crazy.

I'm sure that I violated something by doing all of this after only one year of med school...but it was pretty awesome. Considering going back there for a month of M4.

If that is true, which I have trouble believing, that preceptor is just begging for a lawsuit.

 

[anon-y-mouse]

A few centeses, IJ line with u/s and subclavian line with fluoro. I think I just showed a lot of enthusiasm and have ridiculously steady hands, and my residents and interns also have a "see one, do one, teach one" attitude. Plus, you can't beat the NEJM procedure videos!! I don't see what problem people have with DRE's though... "Sir, I'm going to have to examine your bottom to make sure there's no bleeding that could interfere with the medication we'll be giving you"... Double glove, lube, slight pressure, get sample, deglove, blah blah... I mean it's invasive but necessary, and I have always been excited for the opportunity to do it...

 

[sestamibi]

After proving myself driving the scope with his help, I did about 20 colonoscopies and 15 EGD's by myself.

Lies will get you nowhere.

 

[DragonWell]

I have always wondered what kind of neat stuff they allow 3rd and 4th year students do on their clinical rotations. Do they let you draw blood, insert IV tubing, Foley bag, administer shots, or cut someone open 🙂? Just wondering...

I've gotten to do all this stuff in the past month, if you count an I&D as cutting someone open. 😉 Also gotten to suture up several small lacs.

When learning to start lines, foleys, etc. intoxicated patients are good since they tend to be pretty "tolerant" if you're a bit unsure.

Be nice to the nurses: if you get free sodas or something, always offer to pick them up something when you go to the cafeteria. If a patient or room needs to get cleaned up, hang out for a minute and help. Then, when a procedure comes up, ask if they mind if you watch them do it. Like as not they'll just go ahead and let you do it.

 

[BigRedBeta]

Lies will get you nowhere.

If it hadn't happened to me, I'd agree and be very skeptical. But it did, and I wasn't the only student he allowed to do this. He had 3 other students out there for periods over the summer and not all of them got such freedom but one other guy did and another was by himself for some of the procedures, but not as many as myself and the other guy...I've also confirmed this with students who went out to follow him last summer and this summer and have gotten similar reports.

 

[ginger60]

What you get to do depends highly upon the rotation, what is available to do, and most importantly what your supervising resident/attending is like. If you luck out you can do some pretty neat things, especially in 4th year. If you have access to rotations at a VA, I'd recommend doing them there because the residents/attendings tend to be pretty laidback, the patients are very tolerant, and the nurses don't really do anything so you often have to do it yourself. So far I've done tons of intubations and IV/art lines on anesthesia at the VA, and on medicine there I did blood draws, art sticks, foleys, and I&Ds while another student got to do 2 thoracenteses and a paracentesis.

 

[Ypo.]

- Insert foleys
Done that.

- Sew people closed
Yep

- Cut people open
Once I was allowed to make a cut (and it was a panniculectomy). At my school they never let students do first cut.


- Staple off parts of the intestines (sometimes.)
Nope. Have used the stapler to close skin plenty of time, though.

- Deliver babies/pelvic exams
2 babies. Tons of pelvics.

- ABGs
One attempt (one fail)

- Insert central lines
Never.

- Remove drains and catheters
Not much skill to it.

- Use the Bovie
A couple of times.

Got to suture a ton (close wounds in the ER and in the OR).

 

[Law2Doc]

If that is true, which I have trouble believing, that preceptor is just begging for a lawsuit.

Agreed. That is medical malpractice no matter how you slice it. If something got perf'ed, or the patient coded and died, it would be indefensible. If the hospital found out about such, the dude would be out on his ***** quicker than you can imagine. It is far from the standard of care, no matter how you portray it. you could do this kind of stuff under his close supervision, but if he actually left the room, he's not long for this career.

 

[BigRedBeta]

Agreed. That is medical malpractice no matter how you slice it. If something got perf'ed, or the patient coded and died, it would be indefensible. If the hospital found out about such, the dude would be out on his ***** quicker than you can imagine. It is far from the standard of care, no matter how you portray it. you could do this kind of stuff under his close supervision, but if he actually left the room, he's not long for this career.

This I realize.

That said, you guys also seem to have no idea what small town hospitals are like. Not saying that what you've written isn't absolutely true and if there was a major accident it'd be an issue, just that in an area where the nearest town with more than 7,500 people is about an hour away, things are different.

 

[0T6]

Here's what I've gotten to do on my own or with minimal supervision by rotation (in the order I did my rotaitons in)

Fam Med
- PAPs and pelvics
- Immunizations
- Phlebotomy

Psych
- ECT (literally see one, do one, not so exciting really)

Internal
- ABG (it got to the point the RTs were buying me coffee cause I dropped their workload in half on nights we were on call together)
- IV
- NG tube
- Chest compressions during a code
- Paracentesis
- LP
- I&D, sutures
- Carried around a spinal needle incase one of our patients went into cardiac tamponade. LOL funny story, another day.

Emerg
- Ran a code (we do ACLS as MS3's and my emerg doc during that shift happened to be the ACLS tutor a week before)
- IVs, foleys, phlebotomy, NG tube
- Paracentesis
- Sutures
- Casting
- LP
- Reduction of digit fracture
- Reduction of dislocated shoulder

Anesthesia
- IVs and intubations

Pediatrics - probably the stingiest when it came to procedures
- LPs
- Bone marrow aspirate
- neonatal intubation

Ambulatory Care
- ophtho - removing eye foreign objects
- derm - skin biopsies, sutures, cryotherapy

Ob/Gyn
- 1st/2nd assist in sections, gyne OR, gyne-onc OR
- pelvics, specs, and PAPs
- vag deliveries
- D&C
- I&D for Bartholin's cysts. End up getting at least 1 from emerg every night on call

Surgery
- Start next week!

 

[Law2Doc]

This I realize.

That said, you guys also seem to have no idea what small town hospitals are like. Not saying that what you've written isn't absolutely true and if there was a major accident it'd be an issue, just that in an area where the nearest town with more than 7,500 people is about an hour away, things are different.

Apparently your attending has no idea what a small town jury is like either. The biggest dollar awards are often from such locales.

 

[TheMightyAngus]

First assist on a craniotomy during neurosurg. Chief let me open. Incision--->bone flap.

 

[DD214_DOC]

I just started rotations last month, almost finished with surgery. Here's the stuff I've done


OB/Gyn
- tons of pelvic exams, including PAPs, cultures, bimanual
- ultrasounds
- cervical checks (I didn't really care for them; nurses do this in the real world anyway)
- Lots of outpatient clinic interviews/exams for pre and post natal chickies
- First assist in a couple C-sections
- Checking up on the inpatient post-partum/post-op ladies
- Delivered lots of placentae. The lower-level residents usually stole the actual baby deliveries since my hospital was low volume for OB and they had a quota
- Couple colpos
- All I remember off hand

Surgery
- Retraction (duh)
- Writing post-op notes
- Subcuticular suturing to close
- injecting the local after I closed
- Holding various organs out of the way during procedures
- Typical first-assist stuff like following and what not
- They know I'm more interested in medicine so I get to see all of their ER consults and report back to them. They used to check behind me but stopped after they realized I wasn't that bad at it, plus if I forgot to ask something I would say so instead of making it up. Scut to them but I like it

I haven't really asked about getting more involved, such as using the bovie and what not. I'm not really all that interested in surgery any longer so it doesn't matter to me. The CRNAs/MDAs will let you intubate if you annoy them enough. I plan to get a bit more obnoxious my last few days to get some of that type of stuff in.

 

[RussianJoo]

I have only done surgery so far. I have 3 weeks left... Here's what I have done:

inseted iv's, inserted foley's, inserted NG tubes, closed incisions i.e. sutured, intubated, inserted OG tubes, pushed iv narcotics, DRE's, changed dressings, wrote post op notes, done consults by myself (then had to page the resident and report to him), wrote progress notes, used the camera and cut sutures for laproscopic surgeries, cut off casts, used bovie, did a guillatine amputation of LLE with assistance from the attending, got to be first assistant on a Fem-Pop arterectomy (got to hold the vessel with vessel loops and open and close them to let the fogerty balloon in and out of the vessel), got to do first incisions on a few cases. I probably did other stuff but i forget..

It really depends on the hospital you're in and if you show the resident that you can do stuff and that they can trust you. At my hospital we get a lot of charity cases so during those cases the resident and student or resident and intern do all the work and the attending just sits in the corner and playes games on his phone. I am sure if I was in a hospital with more private patients I would do a lot less.

 

[Law2Doc]

It really depends on the hospital you're in and if you show the resident that you can do stuff and that they can trust you. At my hospital we get a lot of charity cases so during those cases the resident and student or resident and intern do all the work and the attending just sits in the corner and playes games on his phone. I am sure if I was in a hospital with more private patients I would do a lot less.

Are you at a US hospital (I see you are attending SGU)? That may also account for some of the lack of attentiveness of your attendings. Many other countries don't have as severe liability risks.

 

[RussianJoo]

Are you at a US hospital (I see you are attending SGU)? That may also account for some of the lack of attentiveness of your attendings. Many other countries don't have as severe liability risks.

yep we all attend US hospitals for clinicals.

 

[krikkrak]

I am only on the first rotation which is OB. We are three weeks in and I have done a couple of pelvic exams, a few pap smears, a colposcopy and delivered a placenta ( lol)..making sure to collect cord blood before pulling the rest out. The dept has several new residents so they do most of the procedures but there is opportunity to "do" something even if it is minor

 

[RussianJoo]

just to add to the list i was on call last night and the peds surgeon had a new born with Gastroschisis that he had to close. the intern and senior resident on call with me were busy in the ER so they sent me to the OR to let that attending know that they'll be on their way shortly. Well somehow the attending confused me for another senior resident and so we started the case without them. I got to tie off bleeding vessels and did some suturing.. when the residents came in he was very surprised that I wasn't a resident and he was a little uncomofortable letting me do proceedures from that point on so i just retracted and cut sutures from that point on. This attending is an ass and anyother attending at the my hospital would have let me continue with my work since both of the residents were impressed at my speed of tieing knots.

 

[Old_Mil]

I have always wondered what kind of neat stuff they allow 3rd and 4th year students do on their clinical rotations. Do they let you draw blood, insert IV tubing, Foley bag, administer shots, or cut someone open 🙂? Just wondering...

It varied widely for me...

A couple of rotations were 100% Job shadowing. No H&Ps, no exams. Even rotated through an inpatient IM month where the hospital had decided not to give students any computer access, meaning no notes, no reading old notes, no looking up labs, no viewing studies or reading reports on the same. I could have been laying in a hammock in the Bahamas with a medicine text and would have been better off. Bugged me enough that I burned an elective on another month of IM (and loved it).

Then there's the other extreme: By week two, attending tells me to grab a couple of clipboards, see the patients, and come back and tell him what to do with them. By week four, he goes to sleep and tells me to get him if I need him. The thing is, for this sort of thing, all the stars have to align just perfectly. It has to be in subject that's a natural fit for you and that you're good at, the practice personalities of you and your attending have to mesh, and your decision making styles have to be similar.

Usually its somewhere in between these two extremes.

 

[ArcherM2]

- Insert foleys
Check.

- Sew people closed
Check.

- Cut people open
Check. Did a lipoma from incision to closure, not much to screw up.


- Staple off parts of the intestines (sometimes.)
Intestines, bronchi, blood vessels...check.

- Deliver babies/pelvic exams
Check on the babies. The only pelvics I did were during labor.
Pap smears: 0. <-------- I am really proud of this one. I have about 10 months left and I'm hoping to graduate without doing one.

- ABGs
Check. Do an ICU rotation, you'll do tons.

- Insert central lines
Check. 5 as a third-year (three groins and two subclavians), 1 as a fourth-year. Again, do an ICU rotation or more surgery rotations.

- Remove drains and catheters
Check, boring.

- Use the Bovie
Check. Nothing more glorious.