Tuesday, August 9, 2011

Me Med Student, Me Watch Things and Do Nothing

Today I went to Middle of Nowhere (MON) Ireland for a rural lumps and bumps clinic. I really enjoy the outings to the country, hanging around the little hospitals, and seeing the old farmers who drive in on their tractors (true story). I had the chance to see a nice variety of patients: from swallowing difficulties to sebaceous cysts, urinary retention to infected toe nails. For me the real fun is with the procedures so I had to sit on my hands all day. Naturally I jumped at doing dressings or applying pressure to the odd excised mole lesion. Hey, that is how I need to get my kicks these days. Sigh. MC actually told me last week to stop making the beds between patients. Old habits die hard, I guess.

My registrar (I.S) and the locum consultant are both Muslims so they are currently fasting for Ramadan. This means that I.S gets up at 0315h to eat and cannot have any food or water until after 2100h. So today when he offered to buy me lunch I had to decline--I was definitely not about to scarf down a giant lunch in front of him after hearing his rumbling stomach all morning. I guiltily ate an orange in the hour long ride back to the hospital instead. It was 1430h after all, and despite the fact that most days it feels like I am fasting at the hospital...I am not obliged to.

Today's clinic reinforced that being a medical student in Ireland is way different than being a medical student in Canada. I suppose the main reason is over here, when one graduates one is allowed to test the waters for a bit longer, in Canada one is thrown into the pool at the deep end.

For example, I was chatting to the surgical intern yesterday at lunch and I asked him what clinical skills he can perform here at the hospital: IV cannulation (though mostly Senior House Officers [SHO's] do that), catheterization, and blood draws. He has never scrubbed in for a single surgery and likely will not have the chance to this year as he is on call for the wards and spends his days doing scut (writing discharge orders, medication charts, ultrasound requisitions, etc.). After an intern year, one becomes an SHO and does a little more, like admit patients, start IV's, mix and administer meds, maybe hold the odd retractor in surgery.

When I told him that medical students do all those things, plus skills like intubation, arterial lines, and suturing he almost choked on his egg roll.

Needless to say medical students here are to be seen and not...well...heard, unless they are being pimped, in which case the responses should be quick and confident sounding.

I know that I chose to sign up for this training but frankly I am a little worried I'll lose the skills I learned as a nurse such as cannulation, catheterization, blood draws, arterial blood gases, and suturing. Never mind the fact that I'll be hopeless at case management, creating care plans, admitting and discharging patients. Hopefully I can cram as much of that type of learning into my Canadian electives over the next two years...

Tomorrow brings a couple of long theater (O.R) cases so I must hit the books and Acland videos. Here's to hoping for light pimping, kind scrub nurses, and no lead aprons.


dolce vita said...

I'm applying to med school (Me! Earnest! Hopeful! Accept me! Please?) right now and was speaking to a friend of mine, who was an ER nurse turned premed turned med student (4th year). She said that a lot of things that her fellow students on the wards took a while to pick up, she felt she was able to pick up a lot faster. She didn't mean the IVs and such, (although it helps), but more the intangibles, like how to talk to a patient, how to deal with the hierarchy, and the thing she classified as the 'gut feeling of something just isn't right'.

What do you think?

Beach Bum said...

Having done my third year in the UK, where the culture of medical education is similar (although I did a LOT of blood draws, IV starts, and ABGs), I was worried about having spent a year mostly observing. I have to say, I was very well prepared for my rotations in the US. I think that an intelligent person can absorb a lot while just watching, especially if one is not panicked about getting paperwork done correctly, or being abused by a senior.

Red Stethoscope said...

I don't think you're going to forget your skills. You have all of that experience behind you already...it has to be like riding a bicycle, right? In the meantime, it must be very hard to just watch and not do. Hang in there!

Sharp Incisions said...

Echoing others, I don't think it'd take long for you to pick all your skills back up again. I'm really surprised at the differences in task division/ skill development between health systems though: I'd done an ABG and a venepuncture 6 weeks into medical school, and by the end of the year had assisted on two surgeries and scrubbed in on many more. Granted, much of this was due to my own initiative, but Australian med students seem to have similar experience and training to the Canadians by the end of their degree. We'd get reamed by the SRMO if, as an intern, we called them to do a cannula without having a couple of tries ourself first!

Absentbabinski said...

I can totally relate, so many of my clinical skills have gone soft in the past 12 months.

working full-time(ish) over the summer seems to have been a good refresher, though. And has given me chance to get on the good side of some ward sisters in the hospital I start my clinical year in!

jaotte said...

wow that sounds crazy

especially when you were working probably at the level of a nurse practitioner in the north. must be frustrating.

hopefully there are more diagnostic puzzles and other challenges to keep you on your toes in the meantime!

Anonymous said...

What really shocks me is how freakin' LONG the UK guys train for, as opposed to how comparatively short the training period for, say, a surgeon is. I don't know why anyone would go into surgery there.

Unknown said...

Ok, adding my (first, yay) comment a bit late. Love the blog so far (I started at the beginning, and am quickly moving through the "back issues". You might not realise it, but this is actually quite inspiring.

I wonder what the intern would think if he heard I assisted in several eye-surgeries (including an evisceration), as well as observing/assisting in neurosurg, gastro and ECT... as a nursing student. Then again; it might just be because I asked. Never got to intubate, though (only anesthesiologist and anesthesia nurses do that here).

But seriously? This seems like a local culture thing. I can´t imagine a hospital, not to speak of an education, actually being able to function like that.

Albinoblackbear said...

Thanks Marcus! Glad you are enjoying the blog. :) Always nice to hear.