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Why Nurses are the Best Teachers for Medical Students

Discussion in 'Medical Students Cafe' started by Dr.Scorpiowoman, May 24, 2017.

  1. Dr.Scorpiowoman

    Dr.Scorpiowoman Golden Member

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    It was 5:30 a.m., and I could barely contain my excitement. I was almost done with my clinical rotations.

    I had worked tirelessly to improve my medical knowledge and spent hours mastering my clinical skills. Now, as I was nearing the end of my third year of medical school, I felt more than ready for what lay ahead.
    I walked into my patient’s room. As she slept, I examined the lines and tubes hooked up to her body. But today, something was off.




    Her Foley bag, which was collecting urine from the catheter in her bladder, was empty. It wasn’t that way before. And when I checked to see if the bag had recently been changed, I found that it hadn’t.

    My heart leaped into my throat. At this stage in my training, I knew poor urine output was never a good sign.
    Not knowing what to do, I ran to my patient’s nurse. She smiled and assured me that the Foley catheter was simply kinked, blocking urine from emptying into the bag. All we had to do, she said, was to just re-insert the Foley. Problem solved.

    As we walked back to my patient’s room together, I replayed her instructions in my head. Sure, just re-insert the Foley. I can totally do that!

    But the truth was that I had only done this once before.My heart raced, and my palms grew sweaty. I was about to be a fourth-year medical student, and this was such a fundamental medical procedure.

    How could I be so inexperienced?

    In 1998, the American Association of Medical Colleges (AAMC) targeted eight procedures that each medical student is expected to know upon graduation, including drawing blood, placing IVs and managing urinary catheters. Unfortunately, many medical students are falling short of this goal.



    Multiple studies have shown that medical students feel uncomfortable performing these core procedures, like this one, this one or this one. For example, one medical school found that 61 percent of its senior students did not feel confident managing urinary catheters.

    These clinical gaps in soon-to-be-doctors are concerning. Proficiency in these skills is linked to better clinical outcomes and cost-savings in the hospital setting.

    Becoming adept at procedures requires practice. As it stands, medical students don’t get enough opportunities to hone their skills. In fact, only one-fourth of senior medical students has ever placed an IV.

    The competing demands of physician instructors often prevent them from providing the hands-on procedural training that medical students need. Fortunately, there is a solution to this problem.

    Nurses are underutilized in the clinical education of medical students. Among their many skills, they are experts in clinical assessment, patient communication and providing holistic care.

    Nurses are also experienced at both performing and teaching many fundamental procedures. They could be a valuable resource for medical students who need training in these areas.

    Additionally, nurses can help medical students handle challenging situations. They can provide useful information that can make delivering bad news or working with complex patients more manageable. After all, they often spend the most time with patients and their families.

    Medical schools would be wise to recognize what nurses can bring to the table when it comes to medical education. Students would benefit from more formal instruction by nurses. A nursing clinical rotation, in fact, could be the very solution that medical students need.

    I approached my patient’s bedside and stared blankly at her urinary catheter. I simply had no idea what to do.

    Sensing my uneasiness, my patient’s nurse offered to walk me through the procedure, step-by-step. Along the way, she answered my many questions.

    As we untangled and re-inserted the catheter, a flash of urine emptied into the Foley bag. Feeling accomplished, I pumped my fist into the air in triumph.

    Realizing that there were other people in the room, I embarrassingly looked over at my teacher. She was beaming. “You did it,” she smiled.

    I imagine that there is a lot more I could have learned from her.

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  2. WeirdmaskmanNG

    WeirdmaskmanNG Young Member

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    That's very true. They often make time to put students through more than most residents. And they do so whole-heartedly (when they're willing), however some medical doctors put their students off by ridiculing the nurses & engaging the students in the superfluous disparity between them & the nurses.
     

  3. Scarce01

    Scarce01 Active member

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    You are a Nurse you know that every day you will touch a life or a life will touch yours.
     

  4. Ruth Braga

    Ruth Braga Young Member

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    I am the Chair of the Nurses in Surgical Education Committee (NiSE) which is a part of the Association for Surgical Education, the education division for the ACS. The ASE has recognized nurses as an integral part of medical education for years, so I am very appreciative of this post. There are about 25 institutions across the US and Canada who are using nurses in undergraduate and graduate medical education and our numbers are growing.

    Nurses in these roles teach med students and residents anything within our scope, including communication and technical skills. We run simulations, set up learning experiences, run wellness activities, provide a shoulder to cry on and cheer on residents, students and attendings. We see formerly awkward medical students open their envelopes on Match Day and eagerly follow their successes and failures in residency on their social media accounts and through email. We refer our friends to them when they are attendings.

    Some of us have seen our students turn into Program Directors, Clerkship Directors and other leaders in science and medicine. Some of us have lost physicians to illness or suicide and wonder constantly if we could have done more. Because of them, we are acutely aware of when a resident has been persistently having "a bad day".

    In nursing school, no one tells you about the life of a resident or medical student. So we teach nurses too. We explain that residents aren't always onsite, tell them to use their resources such as their charge nurse or fellow nurses before paging about small things, and to cluster their pages just as they cluster their care. We also explain what it is like to cross cover for 60 patients and encourage them to be patient when an intern has to ask twice for information when they are returning a page. We help them understand that sometimes, when they page, a resident may be in the trauma bay, answering their attendings' questions, helping their senior resident, and preparing to go to the OR, so your patient who needs a stool softener may have to wait a moment.

    We also teach students and residents to trust their nurse. If they say come, they mean come. Or get someone else to come. Now. Don't pull out the feathers and strut around like a peacock during a rapid response, upset that someone else pulled the alarm about YOUR patient. Just get in there and help. Don't be afraid to ask your nurse for help, or for their suggestion. The good ones will take advantage of the opportunity to help you. Oh, and clean up after yourselves.

    We are the biggest non-physician, physician advocates you will ever meet. We work as liasions for our docs. We influence policy change to benefit both our docs and the nursing staff. We teach those tiny details that everyone assumes you learned from someone else and watch students walk into an OR confidently because of it.

    Some nurses have told me I'm a traitor because I "left nursing education" and joined the "other side" to teach doctors, but I don't care. I absolutely love my doctors and find great joy and satisfaction in what I do.

    To the author and other physicians and trainees, thank you for your kind words of support. We are here for YOU!

    Ruth Braga MSN, RN
    Surgery Education
    Dept. of Surgery
    University of Utah
     

    WeirdmaskmanNG likes this.

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