Anaesthesia for the medical student.
A guide to the student standing terrified in the corner on how to get the most of your short time in the anaesthetic department even if you never plan to do anaesthesia or anything acute as a career.
In my institution the medical student attachment for anaesthesia lasts two weeks, and is part of the junior surgical firm. Other medical schools have one week, and some none at all. This is a great shame in my (biased) opinion:
anaesthetists form the largest in-hospital specialty and an appreciable proportion of the students will eventually become anaesthetists (often via other specialties, maybe a direct result of the lack of anaesthetic presence in undergraduate curriculums)
Every student can learn stacks during their anaesthetic attachment – even if they want to do the most community-based non-acute specialty imaginable.
I’ve put together a few words on how to get the most of your time with us anaesthetists.
Before you start
Do a little bit of reading. Not much, just a bit. Revise your physiology and pharmacology a little. Particularly analgesics and fluid therapy. Think about the relationship between heart rate, blood pressure and blood flow. Know a little about how we deliver oxygen to the tissues. It should all be there somewhere in the first and second year notes, it just didn’t mean much then, but now you’re going to see all this physiology and pharmacology in action.
Do a bit of background work: find out where you’re supposed to turn up, ask the students who’ve just finished the attachment for some tips. Particularly find out which anaesthetists are interested in teaching and go for those lists.
Learning objectives
Your objectives during your time with us is not to learn how to give an anaesthetic. If you want to do anaesthesia as a career there’s plenty of time for this later, and if you don’t it’s an entirely useless skill. Your objectives are threefold: practical skills, acute care, and safety/teamwork/non-technical skills.
Practical skills
Cannulation is probably the most useful of these. Anaesthetists cannulate all the time and we’re generally quite good at it. Did you know that for every successful cannulation by a junior doctor on the wards 2.4 cannulas get used? This translates to a first time hit rate of about 40%. I realise I may offend some people here, but the technique most junior doctors employ isn’t very good and sets them up to fail. Learning cannulation on plastic arms with veins that don’t move about and thick skin that you don’t need to tether doesn’t help with real people.
Other really useful practical skills include setting up monitoring, drawing up drugs, opening glass ampoules without shredding your thumb to pieces and running through IV fluids. All of these skills make you useful in emergencies. You don’t want to be the junior doctor who stands back barking orders at the overloaded nurse because the doctor doesn’t know how to draw up antibiotics.
Acute care
We render our patients unconscious and hypotensive with the drugs we give them. The way we support their physiology isn’t very different to how you would deal with an acutely unwell patients, and seeing it in a controlled elective environment allows you to gain great insight into how a patient’s physiology responds to insult and the treatment we initiate. The anaesthetic attachment is a fantastic opportunity to revise (learn) your physiology and pharmacology.
Safety and communication
Anaesthesia has become so safe through advances both in technology and safety behaviour that most people take it for granted. Observe how we communicate as a team, how we can gain a patient’s trust when they’re terrified of being anaesthetised, how the WHO time out is done and how surgeon and anaesthetist and theatre staff communicate during the operation.
Before the operating list starts
Introduce yourself to the patient. You’re part of the team and it can be immensely comforting for the patient to have someone else around when they’re being anaesthetised. However, don’t delay the admission staff from getting the patient ready, as this may delay the theatre list. Remember running an operating theatre costs more than £500 per hour, so even a small delay has large financial consequences.
Have a look at the other operating lists running. The patients may have some great surgical signs, and they will often be bored waiting around a bit for their turn, so happy to assist students.
In theatre
Become part of the team. By all means help out, particularly transferring patients on and off the operating table. If you hang back and cower in the corner everyone will forget you’re there.
Don’t touch or have your nose in the sterile field.
Engage with the theatre nurses and the anaesthetic assistant/ODP. They will teach you a lot. Learn from them especially how to scrub, draw up drugs, and how to run a bag of fluid through a giving set. Basic stuff that many doctors seem utterly incapable of doing.
Get your balance of questions vs silence right. The silent student will get forgotten about, the one that fires constant questions becomes irritating and can actually impair safety by distracting me at crucial moments.
Give me time to write my anaesthetic documentation.
There are probably a lot of things I’ve forgotten about – I’m sure some of my anaesthetic twitter colleagues will add to this and I’ll post it underneath. Please enjoy your anaesthetic attachment, don’t be intimidated by the operating theatre environment and take part in the team working. We enjoy teaching you, particularly when we get interested and keen students.