Concerned about a lack of proficiency in skills/procedures as I approach clinicals

[Cgrizzle]

Hey guys. So I'm finishing up didactic year and I'm getting a little concerned as I approach clinicals due to what I feel is a lack of preparation, specifically in skills and procedures. Like many of you, I was online for half of didactic due to Covid. The skills training we were able to get in was very brief, and I feel like I had very little time to practice. One day for IVs, one day for chest tubes, intubation, suturing, injections etc. I honestly wouldn't say I feel proficient in any skills or procedures at this point. I feel like I'm gonna be completely lost during clinicals. Is this normal? Is there anything you would recommend really spending some extra time going over? I purchased a suture kit and have been working on that. 

[DiggySRNA]

I'm going to chime in here not as a PA but rather a practicing RN who asks PA students if they would like to practice IVs on my patients during their ER rotation.

IVs/injections are nursing skills and not necessarily something you need to "master" before rotation (especially your first one). You'll be busy with being a medical provider-in-training  so don't fret on that one. You'll get plenty of chances to practice if you seek out the opportunities. Knowing why/how to safely do them is more important than the actual dexterity of performing them.

Also, as witnessed, students are not expected to be proficient at these skills (suturing, chest tubes, LPs, cardioversion etc) but knowing the tools needed, indications, contraindications, benefits, and risks are expected of said student.

The goal is to practice in a safe environment rather than being expected to perform at the level of an experienced PA. Good luck and remember to breathe

Edited May 3, 2021 by Diggy

[ohiovolffemtp]

What Diggy said.  Clinical rotations are when you actually develop proficiency in procedures.  Realistically, you'll only get enough opportunities to become even slightly proficient with suturing, I&D's, injections, and some basic foreign body removals.  IV's are primarily done by nursing.  You can do them, but they really won't be part of your practice as a PA.  It's extremely unlikely that you'll get more than a very few opportunities to intubate - unless you make friends with anesthesia during your surgery rotation and your surgeon gives you a chance.  Central lines and chest tubes may never come.  You may get a chance to do some reductions of fractures and dislocations.

Don't worry about actually having the skills - just be familiar with the steps.

[TheFatMan]

To add, there are many procedures that even experienced PAs/NPs/physicians rarely get a chance to do and rarely get any opportunity to practice. This is where mental practice comes in. Find a procedures book or watch a video on a procedure. Repeat the steps over and over in your head until you can't get it wrong. Visualize the anatomy and get every step down. Think about complications. All of this should be available to you for little or no charge. Yes, there are certain things that require physical proficiency, but the more common things you can easily practice at home (i.e. suturing and knot tying - I practice knot tying with an old shoe string and fishing line...it works.)

Here, Scott Weingart talks about expertise and gaining proficiency. I think he discusses procedures towards the end.

[Cgrizzle]

Thanks everyone I really appreciate your input! You've all been very helpful.