Saturday, April 16, 2011

Procedure list

My last entry got me thinking about procedures I wanted to learn how to do real well in med school. And if I actually managed to be able to do any of them....

My list:

1) Phlebotomy -- Actually got halfway decent at it during 3rd year because one of our private hospitals didn't have great ancillary services, but since it's not something that you EVER do in most hospitals, I probably would have trouble doing it now.

2) Start an IV -- Tried this a few times during med school, never successfully. I finally learned how to do it when I was doing epidural steroid injections at a really ghetto hospital when we had to place our own IVs. But since I never actually ran anything through any of those IVs, I'm not entirely sure they were functional. Eh, I'm sure they were.

3) Put in a Foley catheter -- Got very good at this during surgery, but since (once again) the nurses do this, I discovered it was a useless skill.

4) Suture -- See yesterday's entry.

5) Pap smear -- I was terrible at these coming out of med school, having only done a handful. Finally I did a GYN rotation during intern year where I did like a million of them.

6) Lumbar puncture -- Well, this was more on my "wish list." I got to do around 4-5 in med school. I did more during internship, but not enough to really feel comfortable.

Looking back at this list... um, what the hell did I do during med school? I never even removed any staples until like May of my third year... and removing staples is half of what med students do.


  1. Accurate, except I never wanted to do Pap Smears, and never have, though will have to soon as next placement is OBGYN.

    Add intubation to the list and it's pretty accurate.

    Got quite good at phlebotomy and cannulation during anaesthetic/A&E placements. Never had to put in an orange though, which could be trickier.

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  3. You neglected to mention THE MOST IMPORTANT ONE

    - Deliver baby

    And I almost didn't even get to do that on my Ob rotation. I would have felt really gypped if that had happened.

    Intubation was AWESOME, but it never occurred to me to be a thing you learn in med school for some reason.

    We aren't allowed to do foleys, but for some reason I've done a bunch of ABGs, and I got really good at NGs tubes. I even got to do a diagnostic para a few months back on a quick stint in the ER.

  4. Mr. Mobius: Intubation wasn't on my list, which is a good thing since I never learned to do it in med school. I guess I figured there was no chance of ever being able to intubate independently, whereas the other things were possible.

    OMDG: All I remember from my OB rotation is the babies just kind of falling out. Maybe I had a lot of multips. One time I was with a FP who was delivering a baby and when she turned her head for a second, the baby popped out and was fortunately caught by the plastic guard underneath her.

    I never did any paras during med school either, but I interned at a county hospital, so that was our procedure du jour.

  5. I'm good at LP's.

    Avoiding pap smears was high on the reasons of why I wanted to be a neurologist. And, I must admit, I haven't had to do one in this field.

  6. I really need to practice suturing before my surgery rotation in july. I sucked at it when we did it in our procedures class.
    It's cool you got to do so many LPs in med school, I don't know if they let us do them.

  7. I'm a surgical intern and half the time they don't let me suture.

    Hmmm...we had to start 3 peripheral lines or something in MS3 but i was sleeping with my resident so I didn't have to do that. We were also supposed to do a ton of male and female foleys but I didn't have to do those either...that being said I more than made up for it when I did a joint replacement rotation because it was always the job of the med student to put in the foley. I haven't had to do that since i graduated.

    I intubated a couple of times but I have about a 50% success rate. I waited until residency to do LPs and i've done a whopping total of 2. I learned how to do art lines in med school but I didn't really get good at it until residency.

    Really, the only skills i got good at during med school were:
    -removing staples/sutures
    -wet-to-dry dressing changes
    -staying out of everyone's way

  8. JessJess: Glad you said that because I was beginning to wonder if I went to the lamest med school of all time :) Actually, I remember when I started my Family Med rotation in March, the med student I was working with told me he'd never taken a blood pressure before (or at least, hadn't done enough of them to feel comfortable at it).

  9. Phlebotomy, IV and foley all kind of fall in my "I sorta know how to do it, and I'm sure if I mucked around enough I could get it" list.

    Delivering babies...meh. Pap's....meh (though I still remember my evaluation telling me I could "find the urethra with ease" at a uro-gyne clinic.

    I'm still 0-for-intubation, though.

  10. That's a pretty good list of medical student duties. IV starts, phlebotomy, foley's, suture/removal, paps, delivering babies.

    More advanced things would be LP, intubation, art lines, central lines, chest tubes. I guess I've been pretty lucky and have gotten to do a bit more than my peers as a MS3.

  11. I graduate from nursing school in four weeks and have only attempted to start three IVs, none of which were successful.

    I did successfully put in a foley in a 850+ lb woman. The second time.

  12. The IV thing is true. I've done many times more central lines than I have IV's. Thank god for good nurses or all of my patients would look like pin cushions.

    I got most of my wish list as a 4th year med student (NICU and adult ICU rotation). Still haven't done a chest tube yet.

  13. I think what needed was not to go to med school but to spend a summer getting certified as an EMT.

  14. I finally managed to get the chance of putting a foley's in a patient. My first try was a success! I wish I delivered more babies on my own instead of just assisting the nurse or delivering the placenta

  15. I'm almost done with my first year of nursing school and I've learned how to do catheters, NG tubes (large bore, no guide wire) and enteric feeds, and wound care in skills lab. I've actually have got to do a couple of straight caths on the floor as a PCT. That was cool.

    My skills wish list: IVs and phlebotomy and ACLS skills. I really want to learn how to intubate!