Putting a Plan into Action

[jdemt]

I’m 125 hrs into my medic internship. In class I could easily write down a plan of action that was usually on the right track. Now that I’m in the field I find myself getting distracted. I can only think of a couple assessments on the spot. For example, putting a 12-lead on a patient with chest pain and getting stuck when it comes back normal. I also didn’t palpate his chest and totally forgot to get a BP. On the other hand when I know “for sure” (insert air quotes) what’s going on, I don’t end up looking for anything else that it could be. Does anyone have any ideas? I really need to fix this.

 

[mgr22]

What you describe sounds like a normal part of the learning process. Very few students come out of medic class ready to rock the field. That's why there are internships. Watch, listen, learn and apply as best you can, but expect it to take time.

The only thing you said that I'd question is "getting distracted." Do you mean you're not paying attention to what's going on, or you feel overwhelmed by the possibilities? The latter is ok for now, the former isn't.

 

[StCEMT]

Figure out what you need to do better and write it down as a goal for the day. Make an effort to fix it. Tell your preceptor what you want to fix so they know what your goals are.

 

[rujero]

Tunnel vision to a certain diagnosis based on signs and symptoms is normal when you're new because you're so excited to recognize a possible problem, then when things appear within normal limits your whole assumption is rebuked and you get stumped. Try to keep an open mind as to ALL the reasons something could be happening. For example: A person falls and hits their head. They claim it was mechanical in nature, but now they have AMS. Was it from a TBI or was their sugar 22 and they're also having a diabetic emergency?

Remember the basics, every pt should get a full set of vital signs as a baseline and that includes a blood sugar, and SPO2 check if applicable to your region. Were you BLS before you went to medic school? The distraction thing could definitely be a problem, but don't confuse distraction with being overwhelmed. Ask a lot of questions. Not just technical ones. Ask for advice, or an insight into your preceptor's line of thought for their actions. This will help you develop your own practice. Good luck!

-r

 

[jdemt]

What you describe sounds like a normal part of the learning process. Very few students come out of medic class ready to rock the field. That's why there are internships. Watch, listen, learn and apply as best you can, but expect it to take time.

The only thing you said that I'd question is "getting distracted." Do you mean you're not paying attention to what's going on, or you feel overwhelmed by the possibilities? The latter is ok for now, the former isn't.

It’s more that I get distracted by what I think is going on, and not looking for anything else. Thank you for your response!

 

[jdemt]

Figure out what you need to do better and write it down as a goal for the day. Make an effort to fix it. Tell your preceptor what you want to fix so they know what your goals are.

Thanks!

 

[jdemt]

Tunnel vision to a certain diagnosis based on signs and symptoms is normal when you're new because you're so excited to recognize a possible problem, then when things appear within normal limits your whole assumption is rebuked and you get stumped. Try to keep an open mind as to ALL the reasons something could be happening. For example: A person falls and hits their head. They claim it was mechanical in nature, but now they have AMS. Was it from a TBI or was their sugar 22 and they're also having a diabetic emergency?

Remember the basics, every pt should get a full set of vital signs as a baseline and that includes a blood sugar, and SPO2 check if applicable to your region. Were you BLS before you went to medic school? The distraction thing could definitely be a problem, but don't confuse distraction with being overwhelmed. Ask a lot of questions. Not just technical ones. Ask for advice, or an insight into your preceptor's line of thought for their actions. This will help you develop your own practice. Good luck!

-r

Makes sense. Thank you!