Anyone ever been denied an intubation during clinicals?

[281mustang]

I was in an ER clinical a couple days ago when an ETOH female came into the ER for an MVC after she was driving on the wrong side of the road and ran head-on into a car sitting at a stop light.

Her vitals were fine but she was extremely combative so the ER doc decided to just RSI her. While the Nurses were getting the meds I went up to the doc and asked if "she would mind if I intubated the pt" to which she responded "yes, I actually do mind" with an extremely condescending tone and immediately walked away. It's difficult to express verbal emotion via text but lets just say it was obvious by her tone that she resented the fact I even bothered to ask her.

Maybe I'm just spoiled by the fact that the CRNA's I worked with in the OR were extremely helpful and went out of their way to teach as much as possible but I think denying a Medic student a shot at a tube is a load of crap, especially when I'm at the tail end of my clinicals and have another 4 left before I'm eligable to graduate.

This is the first time I've ever spoken with this specific doc but the Nurses all like me and I believe I've proven myself to be a quality student at this clinical site.

Does anyone has similar stories or opinions/conflicting views?

 

[usafmedic45]

Yeah...happens all the time. It's not a big deal so if you have a problem with it the real issue here is your ability to attribute properly and to deal with things like a professional.

 

[JPINFV]

Were you working with that physician during the shift or had you worked with her prior to that shift?

 

[281mustang]

Yeah...happens all the time. It's not a big deal so if you have a problem with it the real issue here is your ability to attribute properly and to deal with things like a professional.

Eh, hearing that it's common practice makes me feel a little better about the situation. Although I wouldn't say I've been 'unprofessional', I haven't been rude or treated her differently since it all transpired. I'm not enthusiastic about it but my motivation for creating this thread was to hear how prevalent this is.

 

[281mustang]

Were you working with that physician during the shift or had you worked with her prior to that shift?

No and no, in all fairness she was clueless to my skill level or lack thereof.

 

[bstone]

From time to time various docs and nurses in the ER where I did my Intermediate internship would try to exclude the Intermediate students from various cases. They claimed something like "this is a bad one" or "we need to handle this seriously". When I calmly and gently replied (after they had handled it) that I would be seeing these same situations in the field and needed to have this training and experience they would actually agree. A few of them even apologized and said something like "you're right, sorry".

 

[JPINFV]

No and no, in all fairness she was clueless to my skill level or lack thereof.

...and this is why I don't see a problem with this during this procedure. Some random person comes up and asks to intubate? Err, the answer is most likely going to be "no."

 

[Smash]

...and this is why I don't see a problem with this during this procedure. Some random person comes up and asks to intubate? Err, the answer is most likely going to be "no."

Exactly. Without knowing you, your background, your training etc, it is a pretty big risk to let you crack on with the tube.

 

[bstone]

Exactly. Without knowing you, your background, your training etc, it is a pretty big risk to let you crack on with the tube.

In theory they have been informed that there are students in the ER and part of their duties is to teach. In practice they are often not told, or forget, or don't care.

 

[Sodapop]

During my clinical time I never asked a doctor to do a procedure but I asked if I coukd observe a few times. Luckily our docs would ask me if I wanted to do procedures. I found being there asking them questions when it was appropriate and interacting with them that they became comfirtable and would include me in everything possible including tubes, meds pushes, cardiac and cva and codes. I had docs take me to ct scan with them on cva alerts and traumas and another that mafe sure I was included and taken to cath lab on a stemi. I did see the same docs deny others procedures and told them flat out they were not comfortable with them attempting. In one case the doc had never seen the student and another a dic asked a question the student could not answer that was pertinent to the procefure so he asked him to step back. Both were professional and completely understood. In two cases I had docs ask me if I wanted to intubate amd I said I would but that the ither student had not had an attempt yet and both times the doc let the othet student do the tube. Maybe I should have taken the added experience but I felt that others who had no experience might benefit more since I had one on nearly every shift.

Sent from my mobile on tap talk please excuse the typos

 

[JPINFV]

In theory they have been informed that there are students in the ER and part of their duties is to teach. In practice they are often not told, or forget, or don't care.

So, at your service if one unit gets a student then all units are told about that specific student and the student's level just in case they encounter the student on a call? Furthermore, how many students are we talking about? If it's an academic center, the attending is already going to have the residents and medical students to look after, plus now any students from other health care programs? Now consider that many EMS programs attach their students to nurses and not physicians.

 

[bstone]

So, at your service if one unit gets a student then all units are told about that specific student and the student's level just in case they encounter the student on a call? Furthermore, how many students are we talking about? If it's an academic center, the attending is already going to have the residents and medical students to look after, plus now any students from other health care programs? Now consider that many EMS programs attach their students to nurses and not physicians.

I am not certain I understand any of your questions.

 

[JPINFV]

Question 1:

Why should every physician be notified that a student is present in the emergency room?

Corollary 1:

Does every ambulance crew at your service know about every student regardless of if the student is on that specific ambulance?

Question 2:

Is it reasonable to expect physicians to track every student in the ED, even if the student's preceptor is someone else?

Question 3:

How many students is it reasonable to have the attending track, given that in some centers, there's a relative high number of students when simply considering the residents and medical students.

 

[bstone]

Question 1:

Why should every physician be notified that a student is present in the emergency room?

I was told that ER docs are informed that the ER is used for training nurses and EMTs during the orientation of the ER docs. This is what I meant by they may not remember.

Corollary 1:

Does every ambulance crew at your service know about every student regardless of if the student is on that specific ambulance?

Nope. I only know of students when they are on my bus.

Question 2:

Is it reasonable to expect physicians to track every student in the ED, even if the student's preceptor is someone else?

Nope. The student needs to be present, ready, willing and able to participate in their training. If they are absent then they have no one to blame but themselves.

Question 3:

How many students is it reasonable to have the attending track, given that in some centers, there's a relative high number of students when simply considering the residents and medical students.

I don't think anyone is asking the attending to track a student. That would be ridiculous. They have been informed that the ER is used for formal training of EMTs and nurses and part of their duties is to teach.

 

[RocketMedic]

Is it reasonable for a doctor at a teaching instiution to flatly deny a student relevent learning on the basis of an ego trip or a bad mood?

 

[JPINFV]

Is it reasonable for a doctor at a teaching instiution to flatly deny a student relevent learning on the basis of an ego trip or a bad mood?

No.

Is it reasonable for a physician to deny a student the chance to perform a dangerous procedure when the physician has no clue about the capabilities and competency of the individual student?

Yes.

 

[JPINFV]

I don't think anyone is asking the attending to track a student. That would be ridiculous. They have been informed that the ER is used for formal training of EMTs and nurses and part of their duties is to teach.

...but that's the problem. If a student from another ambulance walked up to you and identified them as a paramedic student and asked to have access to your drug box, would you just hand over the drug box? If a student's first interaction with an individual physician is, "Hi, I'm a student, can I intubate?" then I find it reasonable to decline the student to intubate that specific patient.


Of course this is also why I think EMS student need to be shadowing physicians in the ED and not nurses.

 

[exodus]

The doctor may have wanted to exclude you from a procedure that may have not actually been indicated as well. Unless there was something else going on with the patient.

 

[systemet]

Of course this is also why I think EMS student need to be shadowing physicians in the ED and not nurses.

This ^

About 1000X.

RNs are fantastic, they are a wealth of knowledge, and see a volume of patients in the ER / ICU that most paramedics never approach in the street. There is tons we can learn from them, and in an ideal world they'd be our healthcare brothers and sisters.

But, there's so much more an MD can give a paramedic in terms of education about clinical decision making, and various technical procedures that aren't commonly performed by RNs in the hospital.

 

[281mustang]

Of course this is also why I think EMS student need to be shadowing physicians in the ED and not nurses.

That would be amazing and would make for better Medics across the board, but the extreme backlash that would ensue if that ever happend would terminate it immediately.

I've met some great docs that were more than willing to help with anything, but most believe their time is too valuable to spend an extended period of time with an EMS student that has a miniscule amount of knowledge in comparison to them. Not to mention the fact that there are EMS students in ER's more often than not meaning they would spend most of their time on the clock with EMS students. I can only imagine their reaction to that scenario.

The doctor may have wanted to exclude you from a procedure that may have not actually been indicated as well. Unless there was something else going on with the patient.

Good point. The decision to RSI her was definitely in the patient's disinterest.

While the Charge Nurse was drawing up the Succs I leaned over and asked "Are you all seriously going to RSI this lady?" to which he replied "Yep! This is why you never throw a fit in an ER!"