Today I went to Middle of Nowhere, Ireland for a rural lumps and bumps clinic. I really enjoy the outings to the country, hanging around the little hospitals, and seeing the old farmers who drive in on their tractors (true story).
I had the chance to see a nice variety of patients: from swallowing difficulties to sebaceous cysts, urinary retention to infected toe nails. For me the real fun is with the procedures so I had to sit on my hands all day. Naturally I jumped at doing dressings or applying pressure to the odd excised mole lesion. Hey, that is how I need to get my kicks these days.
My registrar and the locum consultant are both Muslims so they are currently fasting for Ramadan. This means that they get up at 0315h to eat and cannot have any food or water until after 2100h. So today when he offered to buy me lunch I had to decline — I was definitely not about to scarf down a giant lunch in front of him after hearing his rumbling stomach all morning. I guiltily ate an orange in the hour long ride back to the hospital instead. It was 1430h after all, and despite the fact that most days it feels like I am fasting at the hospital … I am not obliged to.
Today’s clinic reinforced that being a medical student in Ireland is way different than being a medical student in Canada. I suppose the main reason is over here, when one graduates one is allowed to test the waters for a bit longer, in Canada one is thrown into the pool at the deep end.
For example, I was chatting to the surgical intern yesterday at lunch and I asked him what clinical skills he can perform here at the hospital: IV cannulation (though mostly Senior House Officers [SHO’s] do that), catheterization, and blood draws. He has never scrubbed in for a single surgery and likely will not have the chance to this year as he is on call for the wards and spends his days doing scut (writing discharge orders, medication charts, ultrasound requisitions, etc.). After an intern year, one becomes an SHO and does a little more, like admit patients, start IV’s, mix and administer meds, maybe hold the odd retractor in surgery.
When I told him that medical students do all those things, plus skills like intubation, arterial lines, and suturing he almost choked on his egg roll.
Needless to say medical students here are to be seen and not heard, unless they are being pimped, in which case the responses should be quick and confident sounding.
I know that I chose to sign up for this training but frankly I am a little worried I’ll lose the skills I learned as a nurse such as cannulation, catheterization, blood draws, arterial blood gases, and suturing. Never mind the fact that I’ll be hopeless at case management, creating care plans, admitting and discharging patients. Hopefully I can cram as much of that type of learning into my Canadian electives over the next two years.
“Albinoblackbear” is a nurse turned medical student who blogs at Asystole is the Most Stable Rhythm.
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