Hey, how are you doing? Got a question. You said you junior doctors start all the pIVs in the hospital. What about central lines? Do they let you do those?
Certain skills like cannulas and putting up drips, im or sc medications are part of our core skillset that we are expected to be signed off in our first year of being a doctor.
In reality, you’ll be expected to do thousands of cannulas and bleed thousands of patients, but nobody generally asks you to put up a drip except in a resuscitation situation (and nobody trains you to use the 564 different pump machines or syringe drivers in every hospital). So despite these being core skills we use some more than others.
In practice, it’s usually still our nurse colleagues who’ll start an IV medication and who will know important things like how to make up every different drug and how long it should be given over; I’ve seen the reference books, there are just so many ways you can give medications! But of course there are times when we have to administer meds ourselves so it is essential to be comfortable with different modalities of doing this.
Central lines are considered a more advanced skill, so they are something we are expected to be trained to do on the job in our junior doctor years. If you go into hospital medicine, then it’s a skill which is considered important by around registrar level. However a GP trainee on the hospital part of their rota, or a surgeon would not necessarily be trained in doing them at all.
We don’t always get a huge amount of formal training on how to do things, either. Though I suspect there’s more training on these kinds of procedures if you specialise in medicine or acute medicine, because it becomes a skill you’re expected to know by a certain level of seniority.
At a more junior level, a lot can depend on which placements you have done and how much you’ve been taught and observed on the jobs you have done. My colleagues who had placements in ITU saw tonnes and have done them, however I’ve only ever done them or arterial lines on models because my patient population on my placements very rarely required them.
Even before we officially specialise, our wide range of jobs means we all end up with different skills and weaknesses.