Friday, September 18, 2009

my sign is vital

Every year, my course holds a joint workshop with the Stanford student-run health clinics (Cardinal Free Clinics) and the Primary Care Associate Program (physicians' assistants) to train the entering medical and PA students on a variety of basic procedure skills. These are: blood pressure measurement, PPD placement (for TB testing), glucometry, IM injections (for vaccinations), and blood draws. Every year, something different manages to go wrong, despite my best efforts to tightly control the activity.

The most common planning error is in the way of equipment and supplies - namely, ordering and receiving the right ones for each skills workshop. We do get closer every year, but it's never the same issue year to year. For instance, this year I had ordered saline for the PPD placements, but unknowingly received sterile water instead. This means that when the solution was injected subcutaneously, it burns like crazy. One of the trainers used it as a teaching moment for cell biology; as the water (which is hypotonic) diffuses into your cells, they undergo lysis. Or, as one of the students declared, "your cells be poppin'."

Nate teaching PPD placement
Nate is saying, "well, this should be saline, but it's not..."

Nate teaching PPD placement
"...which means you don't really need to inject all of it into my arm. Pretty please."

One of the problems with this workshop is that we struggle with balancing the amount of time to require the students to be there with giving them enough time to practice. This year, we did three hours, which I felt was enough for each of the students to at least do each procedure once. In addition, I was pretty sure some of the procedures (blood draw, and the Burning PPD Placement of Hades) were ones that the students would NOT want to repeat.

One of the first-year students, who blogged about the experience here (and whose experience with the blood draw room cracked my heart), puts it this way:
The funny thing about medical school, I'm realizing, is that we're never allowed enough time or practice to master something before moving on. My classmates and I are in a perpetual state of minor confusion, and we have had our confidences bruised just slightly, like the poor arm of my partner. I'm worried for the next person who has to be a victim of my ruthless blood drawing.

What I want to say to her is that we don't expect mastery of these skills after one workshop, or even five workshops. While it is fundamentally unfair to "get better" with real patients, there's really no other way to actually get better. And I want to reassure her that just the fact that she seems so worried about her next patient, makes me rather get my blood drawn from someone with this kind of empathy and less experience than someone who has done hundreds of blood draws but couldn't give two farts about my comfort or discomfort. You will eventually be a great physician, medical student; please see this as a initial step on a long and exciting journey.

(Or, we could try to get another grant and start using this baby to find veins).

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