Trainees I

Imagine you are a hospital inpatient. The person who walks into the room, young and apprehensive, identifies herself as a student. You let her take a history and do a physical exam, and then she asks if it's alright for her to put in the IV or perform a lumbar puncture or deliver a baby. What do you do?

Trainees are an essential part of the culture and backbone of academic medicine. Of course, I'm biased, being one myself. Most patients I've encountered accept the fact that students "come with the territory." Some will welcome students, especially VA patients who understand an environment of learning and hierarchy. Almost all patients I know will allow a student to do a basic history and physical exam, including asking about "sensitive" information like drug use or sexual activity.

But sometimes a problem arises when it comes to invasive procedures. "How many times have you done this?" you ask. The student, without making eye contact, replies, "Well, umm..." None, she thinks to herself.

No one wants to be the first person that a student attempts a procedure on. Yet every practitioner has a first for every procedure. For some procedures like phlebotomy (blood draws) and IV placement, the problem is ameliorated by having students learn on each other. For others like suturing or gynecologic exams, there may be suitable substitutes like tying knots on pig skin or hiring patient educators who are willing to have a speculum exam done. But for some "bigger" procedures - paracentesis, thoracentesis, lumbar puncture, chest tubes, incisions and drainage - the first time someone learns to do it, they're doing it on a patient. There's really no way around it.

This is a scary topic to broach in a blog read by the general public. But there are several things I'd like to say. First, you always have the right to decline care. However, I would encourage you not to do that. It's not that bad. While we are medical students who may be doing something for the first time, we will be adequately supervised. We will be adequately trained for what we're doing. No one is going to let a medical student do something they can't do completely successfully, and no medical student should allow themselves to do something they don't feel comfortable doing.