QUOTED: Scared of invasive procedures

[NotAProgDirector]

I'm finishing up my 4th rotation and am running into a major problem which makes me consider quitting medical school altogether. I'm hoping someone can give me some advice. I wish I could talk to my clinical coordinator, but she's involved with the residency that I will most likely apply to next year and I don't want to expose my weaknesses. I've completed 8 weeks of IM and 4 weeks of surgery without any trouble, but now I'm on a rotation which has my anxiety at an all-time high. This particular rotation encourages actually doing central lines, arterial lines, etc. I know that these are things that I should learn, but I'm absolutely frozen every time I think about attempting one of these procedures. I feel that I'm clumsy and worry that I'm going to do something terribly wrong. Right now this anxiety goes far beyond nervousness, to the point where I'm reconsidering my choice of professions. Everyday I consider quitting school altogether and because I just don't feel like this anxiety is going to pass. Does anyone have any advice for me?

Fear of invasive procedures is not uncommon. Especially for central lines, which seem blind and involve high risks -- arterial punctures, pneumothorax, etc.

The good news is this:

It gets easier with practice, and most programs have all PGY-1 procedures supervised.
Many programs are starting simulation labs, and use bedside U/S for guidance which seems to decrease risk (and your anxiety).
The ABIM has recently dropped the requirement for IM residents to become proficient in the most invasive procedures -- lines, thoracentesis and paracentesis. These will likely become optional for PGY-3 residents headed towards inpatient medicine.

So, you'll need to figure out whether this fear is simply a "newbie" effect or if this is really something you'd rather avoid. If the latter, then anesthesia and surgery seem like less optimal fields for you, but you can get through much of many residencies with a minimum of procedure exposure, and will additional resources to manage your anxiety.

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[XoQo]

A couple of thoughts:



are there any other faculty member who are assigned to you as an advisor? (apart from this clinical coordinator). I'm not familiar with your school's structure, but you may be able to find a clinician (or even non clinician) to speak with about this development who won't be involved with the residency program that you are planning to apply to.

I do empathize with aProgDirector in that there are definitely ways to minimize your exposure to invasive procedures, both during medical school and during residency. However, from how you have described the effect these procedures have had on you (i cannot from your post determine how much you may or may not be exaggerating), I am honestly a bit worried.

I do urge you to seek some help regarding this, whether it be speaking with someone unofficially (a resident/staff member/attending) or officially (someone who is bound by confidentiality rules like a psychiatrist or a therapist on campus). The benefit to seeking some face time to the latter would be that you would have an open forum to discuss this concern without worries about things appearing in evaluations or getting to people involved in the residency that you are interested in -- and it would give you a chance to tease out what is going on before each procedure.



best of luck