“I’ve only successfully intubated 50% of the time. I blow my peripheral IVs. I get blood flash on my arterial lines, but I can’t thread a wire. I bent the guidewire placing a central line. I feel like I’m so far behind my classmates!”

Dear colleague, I hear you… and I’ve been there! I remember being barraged very early in my training:

“Go a little more lateral. Flatten your angle. What do you see? Show me the needle tip on ultrasound. Feel the lung with your finger. Palpate the pulse more medially. Don’t rock your hand! Take a deeper bite. Dilate like you mean it! Steeper… steeper… okay too steep! Not too fast! Now go faster!”

Every attending has a slightly different way of performing a procedure, and everyone thinks their technique is the “right way.” Working in highly acute environments like the operating room and intensive care unit flavors all procedures with the “hurry up” mentality. Yet as a trainee learning for the first time, attendings need to balance patience with efficiency while maintaining patient safety above all else. This can often times confer sentiments of inadequacy and failure.

Do not feel discouraged! Unlike the knowledge you obtained from didactics, procedural finesse comes with practice and preparation. As a trainee, I remember asking very skilled attendings to perform procedures while I observed. Additionally, I took advantage of every opportunity to watch more senior colleagues also perform procedures. One can learn a lot by watching how proceduralists set themselves up for success by preparing their equipment, positioning the patient, and eliminating unnecessary steps. No amount of textbook or simulation preparation beats real-life experience with patients.

At some point, everyone goes through an “a-ha” moment where they know exactly how hard to push, how aggressive to be, how fast to go, and, most importantly, when to stop and try something else. Give yourself time, learn from others, practice, and you too will be just as proficient in time! 🙂

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