Hmm…during my training, we had several practice sessions with dummies, but then a required anesthesia rotation where we had to fill out a card, showing we’ve done a sufficient number of intubations. I forget what the number was, but it was in the double digits. These were controlled intubations though - I’ve never been allowed near an unstable airway. And, honestly, I wouldn’t want to be. In all seriousness, you could really hurt someone if you screw up the intubation.
We’ll see what happens in residency - I’m going into pediatrics, and I’m not expecting to get a lot of intubations unless I do a critical care fellowship. Pediatric airways are significantly different than adults and no one wants to risk hurting a child. Consequently, at least at my institution, only fellows or higher handle the intubations.
Doesn’t the AMA require somebody to say something, in a deeply anguished tone, about “You can’t save every one, dammit!” while the rest of the room bursts into tears?
(Incarcerated hernia means the bowel is just stuck in the scrotum, strangulated means it is stuck, its blood supply is cut off, and the bowel tissue is dying)
No to Boston Legal, yes to Law & Order. They definitely favor entertainment over accuracy, but compared to Perry Mason, Law & Order is nearly a friggin’ documentary.
We were watching NCIS a while back, and my wife (a retired cop) snorted about the laughably bad police procedures, my sister (an ER doc) complained about the bad medical procedures, and I griped about the bad technology.
Funny thing is, we all enjoyed the other parts of the show aside from our own specialty.
I think you are confused. William Felt was not in the movie by that name. William Felt was the Nixon leak.
**askeptic **'s point was that by the grammar of the sentence, you were referring to the Nixon leak, not the person performing fellatio in the movie from which the nickname derived.
wolfman said:
But that’s the way Latin works.
You imprison the prisoner in a prison.
The judge adjudicates a judicial matter.
A strangler strangles using strangulation.
You intubate a tube into the intubant. Only we call him a patient.
Yeah, but it’s the big things they get wrong that are funny. Things that I, not even yet in nursing school, know are ridiculous.
The details of a head angle on an intubation? That’s more subtle, and I bet it’s only picked up by people who already know how to do it - people that aren’t students. I don’t think it’s that these kids are studying ER for tips, I think it’s more likely that ER does 5 intubations in an average episode, and watching that for 15 years gives you the unconscious idea for how to do it - wrongly, as it turns out. You don’t even know what you don’t know, in other words. First you’ve got to learn what you unconsciously know in order to unlearn it.
Like those oxygen bags that inflate with every exhalation - in reality, they don’t do that, but the poor actor needs to breathe! Didn’t stop me from being nervous when my baby’s oxygen bag wasn’t inflating “correctly”, because unconsciously, I knew what it was supposed to look like. Only I was wrong.
Gods, people are stupid. How many of those dummies are moist, slippery and twitch on you at just the wrong moment despite being sedated? How many of them have “atypical” tracheas which didn’t read the anatomy textbook? People who want medical professionals to learn on dummies make me stabby.
Well…see, what you are referring to is experience…people don’t learn how to deal with atypical anatomy until they’ve had years and years of experience and have had enough patients to actually see one with some weird variant. No amount of practice on real people in med school will prepare someone for that. Those are skills that come with years of practice. And we do check to make sure people are good and sedated before jamming a tube down their trachea. It’s kind of bad form otherwise.
The best argument for the teaching dummies I’ve ever heard, has been the set up. I think there’s a human tendency when faced with an emergency and adrenaline is pumping to forget the obvious. When I was doing simulation sessions, a lot of it was focused on the general procedure, so that it becomes second nature.
Patient is in distress - do A, B, C and then D. When you intubate, do this, then that, then that. Don’t rush around and skip a step because you are panicked and scared. Do it the same way every time so you don’t forget something obvious and screw it up. I guess what I’m trying to say is that the sim sessions were trying to create an instinct, so that these motions become reflexive.
Even when I was in the ICU, I would just watch central line placements. No one was going to let me do one solo - but just watching to see what the set up is like was valuable. Check the pulses on both sides, check your line, check the guidewire, prep the area like this, the sterile sheets fold out funny, grab it in such and such a way so everything stays sterile…etc. etc.
The point of dummies isn’t to completely teach you how to do something - it’s to adjust the learning curve a bit so that it’s not quite so steep. And it does work, I think.
That works. They also accept “It NEVER! GETS! ANY! EASIER!”
They’re very firm about the rule that if there are instruments set up on a Mayo stand, you have to knock them all to the floor on your way out the door.
FUCK the sweetheart nurse! Except, on these shows, everybody already has, but at Very Special, one-year intervals, to show what jags the recent (male) doctor hires are, OR what jags the higher up (female) nurses are.
And yeah, that is with NO experience watching modern medical dramas. Hell, my wife turned off the very first episode of “St Elsewhere” because, “they’re doing the CPR wrong,” followed by a ten-minute rant on how people would watch it and think it was the correct procedure to save Grandpa. I never expected nor assumed that REAL MDs would take TV seriously. I mean, that’s just STOOPID!
Ah yes, there’s also the TV rule that you must shock any and all heart conditions, especially flatlines. To Hollywood writers, defibrillator = Frankenstein’s thunder rod. CLEAR !
Anecdote time ! I recently got a pair of wisdom teeth extracted at a teaching hospital, so the procedure was done by a supervised student (as a side note, she was much, much more gentle than most dentists I’ve been to. Probably not jaded enough to just jam those needles in there).
After the ordeal was over, she asked me if I wanted to see them, which I did, and I commented that they looked weird : the roots were somehow fused together instead of the clear W shape you see on medical diagrams. I couldn’t find the words for that at the time so I just said “They’re…they’re… they’re not like in the books.”
She gave me this knowing look and said “Yeah, no kidding.”
My sister in law is a doctor. Bro and her met in their last year of high school; I know that she would treat ER and Hospital Central (Spanish docs series) as gospel during all 6 years of med school and the 3 years it took her to get accepted into Medical Internship (with a med school degree you can practice, but only in limited jobs, you need the “MIR” in a given specialty to be able to practice the specialty, even for “family doctor”). It wasn’t until she was in her 2nd year of MIR that she realized those TV doctors are actors
But at least she did realize it… eventually.
OTOH, one of Spain’s two Vice Presidents has been known to quote the law straight from TV shows; specifically, Constitutional Rights. The American Constitution… :smack: (she quoted it as if it applied to Spain, not as an example of how it’s done in Places Abroad)
Hijayck: I read/heard somewhere that airplane companies changed their oxygen bags - the ones that drop from the ceiling when the air pressure drops - to inflate, because people used to tear them off thinking “they don’t inflate, so they aren’t working!” although the tubes did supply oxygen nicely. (They apparently now route some part of your breath into the bag so you can see it swell up and feel safe).
You would prefer students to practice on real patients?? Or wait for an atypical patient to die, instead of using dummys? Isn’t it much better that we have dummies people can train on instead of real live patients?
And theoretically, can’T a dummy be modified for several different abnormalities easier than a real patient where you have to wait until a real “weird” angle comes into the door? (I remember they recently showed on TV a new dummy that simulates a real patient much better, that’s used to simulate a coding patient in the middle of the night, so the nurses and doctors keep their training up to date and can train with the stress of a more life-like crisis, instead of the normal simulations.)
Quite a few of the very fresh ones, I expect. Possibly more than actual sedated patients. There are random nerve firings as the brain dies that cause muscle twitching. Threw us for a loop when Grandpa died in hospice, lemmetellya! “He stopped breathing 10 minutes ago.” “Um…did he just move his head?” “No, really, his last breath was…wait a sec…nope, still dead.”
I’d prefer they practice on real recently dead John Does, at least some of the time. Isn’t that what internship and residency is for, so you practice on actual people?
I’m not saying dummies have no place in medical education, just that they shouldn’t be the only thing a baby doc practices on before a live patient.
