Training institutions face an interesting dilemma in allowing relatively inexperienced trainees to practice their skills while trying to provide safe and effective patient care. Attending physicians have mentioned feedback from trainees along the lines of “Dr. X took the procedure away from me!” This conveniently leaves out any unsuccessful attempts made by the trainee (attempts which were graciously allowed by the attending in the first place) and the circumstances surrounding the situation (trauma, decompensating patients, etc.)
More seasoned residents have an intuitive idea when things are critical… when it’s important to forego multiple attempts at endotracheal intubation, central or arterial line placement, neuraxial techniques, and the like in favor of promoting safe patient care. Sometimes our trauma patients can’t wait for a brand new resident or SRNA to practice placing an arterial line 5+ times.
We should be more willing to step aside and ask for help when things are getting out of hand. There are plenty of opportunities in the non-acute setting to garner procedural finesse. Till then, we need to be more cognizant of acute situations, accept our inexperience, swallow our pride and defer to someone more proficient when things are spiraling downward. We owe at least that much to our patients’ well-being and safety.
