It is a funny nightmare to teach some of them laparoscopy. It is a nightmare because it is scary finding out that they don't know basic clinical skills of percussion. It is funny because some of their answers are hilarious.
I was teaching that second year resident doctor the technique of performing a laparoscopy. It was her first hands-on case. I expect them to know the theory before they do it, but they do not often expect it of themselves.
"Now check if the liver dullness is gone on percussion" I said, when a liter and half of carbon dioxide had gone into the peritoneal cavity. "here will you percuss?"
"In the fifth right intercostal space" she said, and proceeded to place her finger below the costal margin. So here was one who knew in theory where, but did not actually know where that 'where' was.
"You will get a dull note there only if there is hepatomegaly" I said. "How do you find the 5th intercostal space?"
"How?" she asked, sounding like 'what do you mean by how?'
"How do you locate the fifth intercostal space? What is the landmark?" I asked. I meant the lower edge of manubrium sterni, which is at the second intercostal space.
"Landmark?" she asked. So she did not know about the manubrium sterni business.
"Where is the fifth intercostal space?" I reframed the question.
"Between ribs" she said.
"There are 12 ribs" I said. "Which ones are you referring to? How will you find the correct space?"
"The fifth intercostal space is between the fourth and sixth intercostal spaces" she said. She had perseverance and guts to keep answering despite knowing full well she did not know the right answer. I could have kept on and got some more funny answers. But the patient was under anesthesia, and I could not prolong it without reason. I percussed for liver dullness, found that it had gone, and advised her to proceed with the next steps. I wonder if she realized where I had percussed, or if she went to her clinical medicine book from her undergraduate days and found out where the liver dullness is found.
I was teaching that second year resident doctor the technique of performing a laparoscopy. It was her first hands-on case. I expect them to know the theory before they do it, but they do not often expect it of themselves.
"Now check if the liver dullness is gone on percussion" I said, when a liter and half of carbon dioxide had gone into the peritoneal cavity. "here will you percuss?"
"In the fifth right intercostal space" she said, and proceeded to place her finger below the costal margin. So here was one who knew in theory where, but did not actually know where that 'where' was.
"You will get a dull note there only if there is hepatomegaly" I said. "How do you find the 5th intercostal space?"
"How?" she asked, sounding like 'what do you mean by how?'
"How do you locate the fifth intercostal space? What is the landmark?" I asked. I meant the lower edge of manubrium sterni, which is at the second intercostal space.
"Landmark?" she asked. So she did not know about the manubrium sterni business.
"Where is the fifth intercostal space?" I reframed the question.
"Between ribs" she said.
"There are 12 ribs" I said. "Which ones are you referring to? How will you find the correct space?"
"The fifth intercostal space is between the fourth and sixth intercostal spaces" she said. She had perseverance and guts to keep answering despite knowing full well she did not know the right answer. I could have kept on and got some more funny answers. But the patient was under anesthesia, and I could not prolong it without reason. I percussed for liver dullness, found that it had gone, and advised her to proceed with the next steps. I wonder if she realized where I had percussed, or if she went to her clinical medicine book from her undergraduate days and found out where the liver dullness is found.
