Monday, December 23, 2013

Anesthesia Teaching in Kigali - Life as a local medical student on rotation

I walked into an operating room two hours after inducing the patient with a resident. The patient was covered from head to toe in a green sheet and no one was in the room. My first thought was, “oh no, what happened, how did this patient die?” This was not an unreasonable question given the number of codes that occur in the ORs. But then I heard the steady chirping of the pulse ox and realized that my patient was still alive and seems to doing well under the sheets despite being alone and unmonitored in the room. I went to find the surgery resident to see what the situation was. His response was “we were hungry and it was lunch time so we covered him up and went for food.” This patient was having a craniotomy for a meningioma removal so his brain was exposed where the skull defect was. I don’t remember what my response was because of being so shell shocked. It turned out, after prying information out of the resident, that one of their surgical instruments were not sterilized yet despite the request being made a few days ago so they decided to break scrub until the equipment could be used 2 hours later. A typical example of the going-ons at CHUK operating rooms.

The past two days have been much more satisfying. I gave the medical students a lecture in anaphylaxis yesterday and have really taken on the role of being the medical student instructor in the OR. Having never had the opportunity to teach in the past, I have found it to be a very satisfying and rewarding job. These students are extremely easy to teach. They seem so starved for information and were so enthusiastic about any information that is taught to them. There is currently no real medical student curriculum and no one to teach them or guide them. I remember how terrible it was when I was a medical student feeling neglected during my rotations. It felt like no one really care about what you were doing. This is 500x worst. The reality here is that no one does care about them. They make their own schedules, they show up to the OR and to the ICU when they feel like it and leave when they feel like it. There is no accountability. At first I was shocked by their seemingly lack of motivation but then seeing what their rotation is like, I wouldn’t waste my time at the hospital either if I wasn’t learning anything standing around.

It wasn’t until now that I realized why there was such an emphasis on the painful 10 page H+P and presentations in med school. It pounded in the organizational skills that we needed to have in order to systematically think about problems, formulate plans and perform tasks. We had a set curriculum during our non-clinical years that provided us with our basic science framework and all the rotations that we had had a set curriculum that allowed to learn about the basics of each specialty. It seems though that no one has really provided them with a strong foundation in which to build their medical knowledge on. Things like intracranial pressure is not understood by the students, the idea of ventilation vs. oxygenation is foreign to them. It was with this in mind that along with my attendings, I decided to write a medical student curriculum. The challenging part was to decide how to do this in a way that would be sustainable. We decided to write four modules on topics that I felt like are the most vital for each medical student to know: airway management, fluid and blood management, pain management, basic life support and communication. Each module consisted of a transcript with a PowerPoint, simulator sessions, and discussion points that precisely provided all the information that is needed. The hope is that any anesthesiologist can pick up this transcript and be able to run this module without any difficulty. By providing this framework, we hope that it will create an easy transition to the local physicians who plan continue to this curriculum when both I and my attending are gone.

 Me with our residents and med students after our OB postpartum hemorrhage simulator case. The patient survived.

 My med students. Celebrating after surviving one of our anesthesia modules!

 This was a part of our airway management module with an airway simulator session at the sim center at the hospital.


1 comment:

  1. Finally, even though the entire process demands endless commitment and energy. When the opportunity to take the role in curing diseases, easing pains and saving one's life comes, all the hardship will absolutely be eliminate. In a medical student's life, one can say the end justifies the means. Www.SecureWaste.Net