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Tuesday, April 22, 2008

The real RT world -vs- the RT student world

I have an RT student who follows me every Thursday. She is in her first clinical rotation, but she's such a good worker that I'm actually able to allow her to do several procedures on her own. She even does EKGs.

While I do let her do some procedures by herself at this stage, most of the time I'm with her, and sharing with her my opinion on this and on that. This way it is more of an educational experience for her, as opposed to just sending her out to do my work.

Yes, I do have to slow way down when she is with me, but I actually enjoy it. To be able to share the knowledge I've obtained is something I like to do. I don't know if I ever wrote this before on this blog, but I actually had my choices limited once to either being an RT or a teacher.

And the only reason I chose to be an RT was because I could start working right away, as opposed to waiting four years before I could teach. The bottom line in me choosing to be an RT was that I needed money right now.

Thus, when I get the opportunity to teach, I really enjoy it. But I told her that she needs to be careful what we teach her, because what goes on in the real RT world is not the same as what occurs in the teaching world. And, while it is our job to teach our RT students how to be an RT in the real world, it is your RT teachers job to teach them how to pass the exam.

For example, I showed her ABG results from the weekend before where I had a patient with a pH of 7.10 and she said, "The patient was vented, Right?" I said, "No. The patient was placed on BiPAP for 24 hours and now he's fine."

In the real world, I told her, you don't treat the number, you treat the patient individually. However, in the RT student world, the one where you have to prepare for "The Test," you have to intubate any person with a pH less than 7.30. At least that's what I was taught when I was preparing for the test.

Likewise, the theories they teach in school are not the same as theories in real life. For example, I told my student that I'm not sure I really believe in the hypoxic drive theory. I told her I wouldn't tell her why because I didn't want to confuse her.

"But tell me," she insisted.

"After you take your test I'll fill you in," I said.

I almost felt guilty bringing it up. And, the next week she told me her teacher said, "What kind of junk are they filling your head with."

I said, "I didn't tell you why I thought it was a myth, only that it was my opinion that it was. And," I added, "You can even look in that book of yours right there, the one with Egan's name on it, and it's in there that some people believe that the hypoxic drive theory is a myth. I know it's in there because I read it just last night."



Again I felt guilty for having brought it up, except that it wasn't five minutes later, back in the RT cave, that we were having a hearty RT discussion with Jane Sage, and Jane coincidentally brought up the "hypoxic drive myth."

"If you follow it to a tee," she said, "like you would if you were taking the respiratory exam, you might kill some patients."

"Why is that?" the student asked.

"Well, let's give an example," Mrs. Sage said, "Say you have a patient who is a known COPD retainer, and that patient has an SpO2 of 40. What do you do?"

"You put him on a 40% venti mask or a nasal cannula at 3-4 LPM."

"According to your test, the answer would be yes," Jane said, "But in real life, you would want to give 100% oxygen. Think of it this way, your heart needs oxygen, and if it's oxygen deprived, it will poop out at some point. If you only give that person 100%, he might lose his drive to breath in 20 minutes. But, if you give him 40% FiO2, he might lose his drive to breath due to pure exhaustion and Oxygen depletion in ten minutes."

"Wow, you guys make some good points," the RT student said. "I never learned that in school."

"Well, it's just something to keep in mind that you can apply when you are doing clinicals, but when you are taking your tests you'll want to stick with what your teachers tell you. That's just the way it is in the medical field."

I'm sure we can think of many more examples of the differences between the real RT world and the RT student world.

1 comment:

Unknown said...

I was actually taught in school that you give 100%, but try to wean them off as soon as they are stable.