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Getting Oriented

Ben_5Ben Bryner -- One of the hardest things about a new rotation is getting oriented. Often the actual work you are expected to do is not that complicated, but figuring out what's going on is more complicated. On any given rotation you have to figure out where your patients are, where the conference room is, who gets what done, what tasks take top priority, etc. It can be difficult piecing it all together.

I think it gets easier to get oriented each time you start a rotation. But it's still a significant challenge, and it can be a big help if someone can pass on their knowledge ahead of time. Right before starting the rotation I'm on now, one of the students from last month emailed me some rotation-specific tips that were helpful. One of my interns was nice enough to warn me ahead of time that the ICU had moved to another floor, so not only did I avoid being late the first day, but I also avoided thinking I was losing my mind for forgetting the way to the ICU. If you know people who are on your rotation after you, it's nice to send on tips because it will likely come around to benefit you later.

Of course, there's only so much somebody can tell you before a rotation. The number of decisions and instructions handled on any given day in an inpatient service is astounding. There's no way to predict what kind of patients will come in, what procedures will need to be done, or what exactly you'll be expected to do, so you'll virtually always spend the first few days getting settled in.

I guess I'd been doing that without really thinking about it, but it made sense the other day when one of the surgical critical care fellows was showing me how to perform a bronchoscopy. This procedure involves getting images through a fiber optic tube that is pushed down the trachea and into the lungs. The bronchoscope is kind of like an elephant's trunk because of the way it can curl up at the end when you raise or lower a lever. Like an elephant's trunk it can also suction fluids out of the trachea (hopefully suctioning as little as possible to let you see without drying out the lungs or removing too much surfactant). I don't know if it can pick up peanuts, and it doesn't make a trumpeting noise, so I guess the analogy is imperfect. Oh, right, and there's a camera in it too.

After performing all the necessary examinations of the bronchi and sampling fluid for laboratory analysis, the fellow let me try using it. He took a few seconds to show me the controls to move the tube end to one side or the other, as well as how to hold the scope and turn it to send the scope in a different direction, which was easy enough to understand. But it was a lot harder to actually use those controls; the images on the screen seemed completely disconnected from the movements of the controls. One of the nurses said "it's like driving backwards," and it was kind of true. When I tried to go right, the image on screen would move up, or some other direction.

For a minute or two I awkwardly twisted my arm around to various angles, looking between the screen and my hands, and asking which direction I was going. Then I thought I was starting to get the hang of it, sort of, but at that point it was time to remove the scope. (You can't leave the bronchoscope in for very long at a time since the scope is blocking much of the trachea; the patient is carefully monitored during the procedure to make sure that their oxygenation is adequate between glances down the scope). So I had a little basic information beforehand that was essential, but it was much harder to orient myself once I started the actual procedure.

In the same way, whatever formal instructions from the rotation director you may have or advice from another student, there will be a period at the beginning where you have to get yourself oriented. For that reason the first week of a rotation is never as enjoyable or educational as the last couple of weeks. I think it's important not to get discouraged during that orientation period, since it takes a while to really figure out what you're supposed to do.

August 21, 2008 in Ben Bryner | Permalink


hey thats good advice on not the quiting thing. well my case is well i've just started my clinical years , well the doctors on duty expect you to know everything and to make matters worse I'm studying in a foreign country language problems , the patients have there own dialect of the arabic i know. and well who cares you have to get the full history whether you like it or not. i would really like some tips on this matter anyone help!!!!!!!!!

Posted by: salma omar | Aug 31, 2008 7:12:06 AM

hi Ben
this is a good topic because every one of us is passing this situation, and every one of us will be aware of the situation if he\she got an information of how the thing will be handeld in this rotation, i think as you previously mentioned that it will be easy to adapt on the new rotation if you recive a background on "what is going on here" before starting any new rotation

Posted by: mona | Aug 31, 2008 7:39:07 PM

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