Written by: Lauryn Feil
Reviewed by: Kimberly Brown, MD
Hands-on learning is the foundation of training the next generation of doctors. If you’re a veteran doctor, nurse or other medical professional reading this, think back to the first time you ever practiced suturing or starting an IV. What were your thoughts and emotions? A little bit of fear, excitement, eagerness to learn and perfect? And if you’re usually on the other end as a patient, you definitely know the sense the relief you have when you can trust your provider’s knowledge and skills. But everyone has to start somewhere, right?
The Dell Medical School’s rising second-year class of medical students was just as wide-eyed and eager to apply what they learned throughout their first year and just as enthusiastic were their teachers. From across different hospitals and clinics, including UT Health Austin, and specializing in a variety of areas of medicine, these medical students are learning, even the basics, from some of the very best doctors in Texas.
Let’s talk about the fundamentals
Starting infusions, administering IV medications and managing IV therapy in children and adults are among the most basic and important skills to master in the healthcare field. Whether these future doctors will be administering IVs regularly or not, this skill can help restore a patient’s health and even save lives. Working with Todd Berger, MD, Associate Professor in the Department of Surgery and Perioperative Care at the Dell Medical School, students started with learning the proper way to tie a tourniquet, including the appropriate placement, tightness, the tie itself and the right time to release it after administering the IV. Then after receiving a lesson in how to manage the catheter and saline lock, they moved over to the anatomical model to practice it all together. While starting an IV on a dummy arm is less scary than a real patient, it’s essential to get a good feel for the movements and visualizations before moving to a real human.
Now, our medical students aren’t at the point where they are doing three-hour robotic surgeries on a grape yet, but soon they might be! Suturing is a skill in medicine that takes practice, practice and more practice. It is based as much on muscle memory and feeling as it is skill. You can’t put too much tension into the sutures, you have to grab the skin ever so softly with the forceps, even the placement of your elbows and hands for steadiness can affect your ability to close a wound perfectly that will lead to minimal scarring for the patient. Medical students here practiced with leading surgeons including, UT Health Austin’s Ziv Beckerman, MD, pediatric and congenital heart surgeon, who gave sound advice on technique and hand steadiness. Because who better to learn from than someone who operates on the smallest and most delicate human hearts?
If you’re going to suture, you’re going to need to know how to tie a knot and not just any knot. There are a variety of knots (square knot, split knot, surgeon’s knot) and a variety of ways to tie a knot (two-handed, one-handed, instrument) but no matter which method is chosen, it’s critically important that the knot stays securely in place. For this exercise, students practiced the two-handed square knot with large teaching tools to emphasize the movements. Instructors including, Alison Brooks, MD, Assistant Professor in the Department of Women’s Health and Barbara Bergin, MD, Department of Surgery and Perioperative Care. The point here was to lay down multiple throws as squarely as possible. When efficiency is critical in the operating room, these medical students will need to have deliberate and intentional movements when it comes to suturing and knot tying. Starting here will help them get there.
Inserting a Foley catheter, also called a urinary catheter, is not an easy procedure and it involves a great deal of precision and practice to perform it correctly. It’s an essential skill in medicine and if performed improperly patients can experience tissue trauma and infection. One instructor, Stuart Wolf, MD, Associate Chair of Clinical Integration and Operations and Professor in the Department of Surgery and Perioperative Care, teaches students about maintaining sterilization while cleaning and preparing the patient for catheter insertion. Then students were shown how to insert a catheter for a male and then for a female. Two critical points these instructors made, one, you can never have too much lube, and two, the urethra is longer than you think, as several students struggled with inflating the balloon at just the right time. Practice makes perfect though and these anatomical models and skills labs are great for just that.
Ultrasound imaging is the most commonly performed diagnostic imaging modality practiced in medicine. It is a frequently used tool in patient care that allows physicians to perform rapid bedside evaluation and interventional management. Learning to use an ultrasound machine involves not only understanding how to use the device itself but also an understanding of what you’re actually looking at. Taught by Marissa Mery, MD, assistant professor in the Department of Surgery and Perioperative Care, students here were first taught how to read the screen and imaging including, the difference between soft tissue, bone, veins, vessels and more. Then they were taught how to use the machine, the buttons, the probe and how to capture and store an image. After observing their teachers, they were finally able to test it out on themselves and each other!
In medicine no amount of practice is too much practice. Skills labs are woven into medical school curriculum early-on and continue through to residencies and fellowships until the students someday even become the teachers. Skills labs are about getting our future doctors comfortable not only performing a task or procedure but also comfortable with receiving feedback, working together, communicating with patients and building confidence. And as a patient, knowing a little more about how an ultrasound is performed or the art of suturing can also help everyone better understand how medical professionals learn, work, and teach.