Why can't young doctors intubate patients correctly? Blame television

It seems that residents and medical students are having trouble intubating patients these days.

Apparently, one of the biggest mistakes is positioning the head incorrectly, and the problem is traced back to the television drama ER. When surveyed, most young doctors and medical students cited television as the main source of tips on how to intubate correctly, specifically, ER.

But when researchers actually watched the show, “some aspect of the head positioning was wrong in all 22 intubations that could be fully viewed on screen.”

Oops.

So, the moral of the story is don’t believe everything you see on television. I shudder to think how House, M.D. is influencing the current generation of doctors-in-training.

Comments

HBowman, MD
Easy enough to blame TV….
Especially when the problem is the lack of adequate training of medical students and residents. If the seniors and attendings won’t take the time to train correctly (ideally first with anatomic mannequins, then the recently deceased) the students will develop all sorts of bad habits.
Why this is a surprise, or article worthy is a mystery. We wouldn’t allow someone to spend a couple of hours playing Grand Theft Auto to then get a drivers license – without real training and experience.
Suzanne Dewey
Your post nips at the reality/fiction line that is so prevalent in pop culture. Is it necessary to be entertained in order to be educated? Am I likely to encounter surgeons who pattern themselves after the too involved and time-available examples on Grey’s Anatomy?
Can we extend this concept by having a modern day Marcus Welby serve as a model to induce more medical students to select primary care as a vocation?
Peter
House-effect. It just means that Wegener’s Granulomatosis will always be in the differential… and nobody will ever suspect Lupus.
Buckeye Surgeon
As per BowmanMD. Don’t blame TV. If medical students nowadays are honestly attributing poor techniques to tips they learned on fictional television shows then we’re in a heap of trouble. Does anyone actually watch ER anymore? Is Nurse Hathaway still on that show?
shadowfax
Funny, but I call bullshit. The view from the side of the bed and the head of the bed are so different that you couldn’t possibly think to mimic technique. Plus, when you do it for real, there’s an attending there teaching you, and if he/she doesn’t teach you about the sniffing position, then they have failed as a teacher.
No, more likely someone saw an idea for a funny article that would get play in the press — and it worked. But it’s still BS.
Peter
The way the media portray medicine does significantly affect the attitudes of some entering the medical profession. Though procedural technique can be slightly influenced by media, it can be fixed relatively quickly. The problem is in the portrayal of professional ideals and ethical conflicts, which can be significantly influencing and serve as a role-model and test-case for young physicians. These effects are probably much more difficult to undo.
I did a series on of the ways that TV shows and movies incorporate components of medical practice on my blog here.
Anonymous
Buckeye, I’ve been watching (again) this season – the very last.
And Nurse Hathaway was on last week, she’s a transplant coordinator in Seattle, married (presumably) to Dr. Ross.
Next week is the very last show. It’s been a pretty good run, all things considered.
And if students are going to learn from TV, it’s a darned bit better they learn from ER than Gray’s Anatomy.
Anonymous
Maybe we could have some manequins with huge necks. I practiced on a manequin, yet everyone I need to intubate for real is 20x heavier. I am a small woman and sometimes just don’t have the upper body strength. That being said, my success rate on first try is over 95%. I feel like I should fail more. Also, I don’t watch ER so I didn’t learn poor technique from them.
I did notice that in my residency, procedures get passed on to the most experienced, so young people have a hard time learning them. I was a medicine resident and the anesthesiologists NEVER let us intubate if they were there. So, how are we supposed to learn and keep our skills up? Now that I am a hospitalist, I make a point to do the procedures myself despite the fact that it isn’t cost-effective just so I don’t “forget” some day. It is tempting to call IR though…
Anonymous
Plus as a med student you have to constantly fight with PAs and NPs to do anything. After fighting with them, you still have to luck into an attending who will teach you. It took me 2 weeks to deliver ONE baby and 4 days to TRY an intubation from start to finish. ABGs, PA would do them before we even knew about them.
So when the old fogey docs complain about new ones being incompetent, it’s because YOU wouldn’t let us do anything.
Joseph Sucher, MD FACS
First… Is this a joke? Really? You think that intelligent people actually are taking their teaching from TV?
Second… Anonymi (whatever the plural is for Anonymous).
You’re correct. It is getting harder for the less experience to gain experience. This is a function of societal demands, and less an individual trainer issue. As our society has increased its demand for safer care this has been translated into our training programs as not allowing students to essentially learn (practice) on real live patients. Everyone knows the phrase “See one, do one, teach one”. However, few of you will every actually see this in practice.
Ethically, this seems to make sound sense. Practically, it is clear that we are not fully achieving the goals of graduating independant practitioners ready to go take care of patients straight out of residency. This is a well known concern at the highest levels of education, and there is a considerable amount of effort directed at making changes in the educational system that meets with societies demands, but achieves the goal of training people to become the best physicians in the world.
JFS
Carey
Interesting discussion and perspectives. Do residents really have that much time to watch tv? Aside from blaming television, how are things being done in terms of medical education/medical training to instill a sense of confidence, composure and skill when having to intubate? What sorts of barriers get in the way from allowing young doctors to learn differently and master such an important part of their practice? Seems like a discussion we should be having with multiple voices present…Thanks for the post!
Anonymous
JFS -
I’m glad this is noted at a higher level in the educational system because I found that I was very nervous coming out of residency with my competency during procedures. I was very aggressive at doing them (I didn’t hand them off even if I was over my 80 hours – but that is a secret, right?) and I didn’t have complications. But, if you don’t do that many, then you won’t have many complications. And that is what separates the doctor from a kid playing a video game – how to recognize and manage the complications. I agree, it is an overall cultural attitude, not that of any single individual (although I could single a few of my attendings out who were clearly scared to have the residents do any procedures.)
Also, did you know that it is no longer a requirement for internal medicine residents to perform a certain number of procedures to graduate? You won’t get credentialed to do them, but you are still board eligible. This surprised me…but I guess you would just be limiting your own practice abilities.
One more thing – I love the Glidescope.
Anon #1
Mike
What about the fact that in residency they don’t LET you intubate anyone. I tried during my anesthesia rotation, to no avail.
Anyway, what’s the big deal with TV? They show that when ER was big, applications for ER spots went up. It’s the nature of the beast.

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