So, I think that I just failed the IV portion of my clinical final.
I did everything perfectly and in the correct order, and yes, I got the vein, flushed it with saline, and compressed sufficiently, so that I didn't spurt blood everywhere. When I was done, I sealed the IV tubing down with Tegrederm, but I couldn't get the tape roll to open. I took off a glove to pry at it with my bare hands and still, no success.
Since our exams are timed, and the standardized patient gave me a funny look, I had the moment of "Oh crap, now I failed because I took off a glove and I'm going to run out of time." So, I wrapped up with a, "OK, well, I won't worry about the tape this time," and finished.
And, then?
I got lectured for five minutes by the standardized patient about the proper application of tape. Which probably means that I failed.
At my medical school, you have to do all the items of the checklist completely and in the correct order. While I think that the checklist says to "secure" the IV placement (without specifying if you need to put five strips of tape on top of the Tegrederm), I've had this SP in the past and he's particularly mean. So, if he says that I skipped the last step by "not properly securing the IV," then I have to do a four hour remediation during my final exams.
To learn how to properly apply tape.
What I find most ironic is that when the SP grabbed the tape roll to show me how to do this, he had to try four different rolls before he got one that worked. He said to me, "Oh, I see why you had trouble." Then, he proceeded to show me how I should use two pieces of tape, and space the loop of the IV tube his way, not my way, and then, I should put one of piece of tape on the hand, but not on top of the Tegrederm, and put the other piece of tape this far away...
If this didn't just happen to me, I'd be incredulous of someone else telling this story. Call me crazy, but if I was a patient, I'd care more about a medical student finding my vein quickly, keeping the site sterile, and you know, not causing a hematoma.
So...
You know all of those annoying things that I allude to, but can't talk about here, that make me hate medical school?
Having a paid actor who knows nothing about IVs or medicine lecture me about the proper application of mother effing tape and then fail me, so that I have to waste four hours of my finals week learning about how much tape I should use, and where, and how the tape should be placed in relation to the Tegrederm--all when I'm not even going to be the one placing the IV on the wards?
That would be one of them.
9 comments:
RS, this is not worth stressing over. I know if I were in your position I'd be flipping out too, but in the grand scheme of things (from the point of view of someone who got a full night's sleep last night -- huzzah!!) this is NOT going to matter at all. We both know SPs don't know anything about clinical medicine. We both know they can come across as patronizing dickheads when they give their (generally not terribly helpful) feedback. So who cares what they think. If he fails you he fails you and worrying about it won't solve anything. And I'm sure you're NOT the only one who had this problem.
Point is, you're going to be a dr no matter what so F that SP and that stupid IV exam.
Sending you happy and relaxed thoughts. You will get through this, just wait and see.
i am an sp in the area, and stumbled upon your blog accidentally when googling something else a couple years ago. i really enjoy your blog and and am so happy you found the lawyer!
im usually on your side, and in general, agree with what you had to say in this entry.
until the last paragraph.
we are paid actors. yes. but we also are trained in whatever case we are hired to do. and we are hired to do a job. if the preceptor wants us to cover A, B, and C in feedback then we have to, or we dont get hired again.
ive done the IV case, and i TOTALLY agree with you about order. i feel terrible when i have to mark down, or give feedback based on order, when everything else is correct. its not fun for us to give you a bad grade. we are on your side. but we are required to learn how to place an IV before we do this case. obviously we do not have the medical knowledge that you have, but we are extensively familiar with the cases we are given.
im sorry to go on so long. i feel very passionate about what i do, and like to think we are appreciated, especially by people who are as nice as you.
OMDG- Thank you for that encouragement & glad you got some rest! I am calmer now, and yes, other people probably failed. 1/4 of last year's class had to remediate apparently.
Petite- I didn't mean that to be a diatribe against you personally. I've had some very helpful SPs, but this particular one is just mean & my response is reflecting many other interactions that I haven't blogged about. I have no problem with people trying to teach me things, but a lot of SPs are very entitled, rude, and generally, mean. Perhaps I do deserve to remediate this, but my attitude right now is reflecting al lot of other stresses, which I now have even less time to deal with. You left a very nice & respectful comment, so again, I don't mean this to be personal against you.
My sister is a surgeon, and I'm a scientist (the math type -- Red, you know me :) ), and one of the striking differences between our grad school experiences, and current jobs, is how hers has a lot of manual labor. I mean you have to be smart and analytical, but you also have to do this IV thing in under X minutes! It reminds me of all those reports on Foxconn in China (the true, NYtimes ones, not the TAL one) where the workers have to assemble a certain amount of items an hour.
Good luck!! I don't envy you -- except for the fact that you are following your dreams!!!
PS- Hi lady! Haha...yes, we have to be nimble and swift! (Is that from a fairy tale?) Apparently, we're not though, as my earlier statistic about 1/4 failing last year was wrong. It was actually 40%. I wonder how many failures were tape-related (ahem).
From someone who has started 100's of IV's. Always cut the tape before you start.
OldSquid- Noted! I'm sure I will have plenty of time in my 4 hour remediation to think about this.
We didn't have a clinical with I.V.'s, I actually only started one during my entire med school career. Probably best that they added that in, considering. Although, now that I think about it, I haven't started one in the four years since the end of residency....hmm...
Things Patients Say- I know. It is for the better, especially since we always remember things that we fail, so I'll never ever ever EVER forget how to place a STUPID IV! But, the taking 4 hours out of my day during finals week part? THAT is seriously upsetting.
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