Procedures

[Dr.Acula99]

I'm doing an IM prelim year, and having quite a hard time trying to do procedures. I'm wondering if other people at IM programs have the same problem. On the medical wards, if a patient needs an LP, paracentesis, thora, etc, everyone gets sent to IR. I always try and stop this from happening and push to do it, but there is never anyone available to supervise the procedure. Nearly all the hospitalists are not certified in these procedures and will not supervise. Any advice on how to get around this.

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[gutonc]

ICU and EM rotations.

 

[AdmiralChz]

What are you going into? You are just doing a prelim - your main residency may get you all the experience you need. Does your program have an IM procedures rotation?

 

[Dr.Acula99]

I'm going into anesthesiology, so I know I'll do plenty of lines. I'll probably never get another chance to do a paracentesis, thoracentesis, etc again though. I already did an ED rotation, and nothing. I have ICU coming up, maybe it'll be better.

 

[gutonc]

I'm going into anesthesiology, so I know I'll do plenty of lines. I'll probably never get another chance to do a paracentesis, thoracentesis, etc again though. I already did an ED rotation, and nothing. I have ICU coming up, maybe it'll be better.

You'll do plenty of ICU during anesthesia and have lots of opportunities to do paras and thoras. Why you would want to do them though, unless you're planning to follow on into a CC fellowship, is beyond me.

 

[AdmiralChz]

Yeah, agreed. Those procedures are nice to have, but you won't be doing them hardly ever. Just focus on your medical knowledge base as it's the core of anesthesiology - you'll be taught procedures later, that's part of the goal of your clinical anesthesia years,

 

[sluggs]

I feel for you. I trained in IM just before all of this stuff started going to IR. First off, note that IR does most LPs blind/by landmarks unless there is difficult anatomy or obesity in which case they use fluro if needed. Paras and thorax are just done with US. In my opinion, IM should know how to use US and should be doing para, thora and lp. Waiting for rads can delay diagnostics and treatment. Suspected meningitis admitted at 10 pm? antibios should be started, but wouldn't it help to get CSF immediately and not wait till the sample is collected the next morning after antibios are on board?
Your best bet is to go down to IR with your patient. You may get home later but you will learn this valuable skill. Even may make you better at anesthesia!

 

[Crayola227]

I didn't say it in another thread, but procedures is like the last reason anyone should ever do IM (I'm not talking about procedure heavy fellowships after the fact)

 

[rokshana]

Suspected meningitis admitted at 10 pm? antibios should be started, but wouldn't it help to get CSF immediately and not wait till the sample is collected the next morning after antibios are on board?

well this example really isn't the best of example since the ED really should do this LP and not just send them up to the floor at 10pm.

 

[Dr.Acula99]

I like the idea of going to IR, unfortunately I already did an elective in IR, and got to do no procedures. There is always a radiology resident doing IR, and they get all the procedures. If there was a way for me to go down to IR and actually get to do something I would.

 

[DrYoda]

Well hopefully your ICU rotation is better at getting your procedures. and also see if the IR attendings are willing to let you do procedures under their supervision, doesn't hurt to ask when you're sending someone down. If the resident are seniors or if fellows are on they may not be that interested in taking a procedure from you. otherwise if you want my honest opinion paras and thoras are not very difficult or exciting procedures, so your not missing much... I do my fare share of them and don't really care for them but to each their own.

 

[AdmiralChz]

I like the idea of going to IR, unfortunately I already did an elective in IR, and got to do no procedures.

... then what were you doing during this elective?? Clinic (does IR even have such a thing)? Watching? Sounds like a vacation month to me.

These sorts of things do happen. When I was in medical school we sometimes rotate at a distant community hospital that used to have a TY program. One of the interns on wards had just come off a Pathology elective where he was told the first day if he wasn't interested he didn't have to show up just do some reading on the subject. He hit the beach for 3 weeks. Sadly this TY has been gone for a few years now.