Tuesday, June 16, 2015

It wasn't like this in my med school

When I was a medical student, we had to practice drawing blood on our lab partners. I remember the first day we did it. One guy fainted as he was having his blood drawn, and another fainted while he was drawing someone else's blood.

We've made a lot of progress in medical education since then. In 2015, teaching blood drawing, which is going to eventually be taken over by robots anyway, is passé.

Students are suing a Florida sonography school because they were forced to perform transvaginal ultrasounds on each other almost every week. Those who complained were allegedly told to “find another school if they did not wish to be probed” said an article in the Washington Post.

While that seems out of line, it pales in comparison to allegations lodged against a former US Army doctor who ran a company that taught battlefield medicine to soldiers and made more than $10.5 million in the process.

According to Reuters, he gave students alcohol and drugs, including ketamine, a powerful hypnotic used as an anesthetic. Sometimes alcohol and ketamine were given at the same time.

Trainees were told to insert urinary catheters into each other, and two students underwent penile nerve blocks. On another occasion, when students balked at receiving penile blocks, the doctor had the students perform a penile nerve block on him. It's not clear what a penile nerve block has to do with treating wartime casualties.

If that's not troubling enough, he supposedly ran what he called "shock labs," during which he drew blood from trainees, observed them, and gave their blood back to them.

But wait, there's more. The doctor is alleged to have had a few beers with a student and examined, manipulated, and photographed the student's uncircumcised penis.

The doctor's claim that his methods are standard in Virginia medical schools was refuted by experts quoted in the Reuters piece.

The Virginia Medical Board has suspended the doctor's license and will hold a hearing on June 19.

And we thought sticking each other with needles was traumatic.


Korhomme said...

A quite remarkable story—and we thought that the pretence of the ATLS moulages was grim.

GeronimoMD said...


I can't comment on Dr. Hagmann's conduct, and I did not participate in his training courses, but know many who did and spoke highly of him. After reading the complaints before the Virginia Board of Medicine resulting in suspension of his license, I believe the boards actions are justified. However, that comes with the caveat that realistic training saves lives on the battlefield. I can't begin to guess how beer and penile nerve blocks fit into that paradigm of realistic training, but I trust that the board will get to the bottom of it.

As for the shock labs, this training was also detailed in the memoir of an Army Ranger medic who described that he remained conscious, with intact mentation, and capable of performing moderate exercise, despite simulated volume loss induced with furosemide, vasodilator administration (presumably, nitroglycerin), and deflation of a pneumatic antishock garment applied to the lower extremities. These measures resulted in a nearly undectable blood pressure for the medic in training. The "shock lab" served to illustrate the capability of the young, athletic human body to compensate for volume loss. An important lesson that an otherwise well appearing patient may not indicate that you are out of the woods when managing trauma in a remote, austere environment. (Lest We Forget, Leo Jenkins, 2013)

This article speaks for my take on it, especially the live tissue training:

There's no upper limit to the number of goats I would sacrifice to save a human life. I have difficulty understanding those who argue differently.

Also, bear in mind, that during the course of the war, skills that were traditionally reserved for physicians at higher echelons of care were pushed down to combat medics working independently under very challenging conditions. As in many other instances, physicians have not been willing to place themselves in harms way or go without creature comforts. In their place, medics and physician assistants were sent to meet the need. Imparting the necessary capabilities to those medics and PA's requires intense and highly realistic training. Highly realistic training courses, including live tissue training and other "aggressive" methods met that need, and were likely responsible for the excellent outcomes in battlefield trauma care observed during OIF and OEF.

Anonymous said...

Yiiiiiiikes. Some things do stay the same in medical school, Skeptical Scalpel - I graduated in 2013 and my classmates and I still learned how to cannulate veins on each other... (definitely a more useful skill than blood draws, though I still find nurses or RTs do 99% of IV insertions)

JEN said...

I worked as a phlebotomist to pay my way through undergrad. I trained others and we practiced on each other. I still have the little scars from doing "bleeding times" complete with the filter paper to wick away the blood. Later, I worked on a research project where we gave other students and ourselves nitroglycerin pills and measured our brachial arteries via ultrasound.

I would look forward to robots drawing blood.

OldfoolRN said...

In nursing school, we practiced invasive and embarrassing procedures on a good natured lady named Mrs. Chase. She did have difficulty retaining enemas, but never complained. For the unpleasant details please see my blog post. Just google "A proxy patient for practicing procedures."

Skeptical Scalpel said...

Korhomme, I believe ATLS has not used live animals for quite a while. I agree that the moulages seem pretty tame in comparison.

Geronimo, thank you for the detailed comments. I must disagree about the shock labs. I wonder if the subjects were informed of the risks and if they signed consents. The link you provided is certainly a passionate defense of the use of live animals, but honestly, it seems more like a rant.

Anonymous, thank you for updating me on the continued use of lab partners as guinea pigs. Back in my day, we not only started most of the IVs in the hospital, we drew morning labs on all of our ward patients as interns.

JEN, too bad about the scars from bleeding times. No one does bleeding times anymore. Did anyone faint after they took nitroglycerin? I'm not sure what the point of giving nitroglycerin, a venous vasodilator, would be if you were looking at brachial arteries. I hope you read my post about robots drawing blood. They are not quite ready for prime time yet

Korhomme said...

Scalpel, I've been an instructor at ATLS courses in the UK and in Ireland. The use of animals for medical education is very restricted in the UK; AFAIK it's only possible to use rats to practice micro-vascular repairs on their aortas. In Ireland, we were able to use pigs as described in the ATLS manuals. But this was all some decades ago; I'm not sure what's done today.

Skeptical Scalpel said...

Old Fool RN, Mrs. Chase would appear to be one of the very first simulators ever used. It is interesting that she was discovered at Hartford Hospital, an institution that has been active in the use of simulators for many years. And when is the last time you saw a nurse wearing a cap?

The post is well-written, and I enjoyed reading it. Thank you.

Anonymous said...

Skep, if you'd like to do a story on the disaster of the Virginia State Medical Board let me know. There are conflicts of interest, FOIA refusals, refusal to do redactions, inability to justify a ton of things from FOIA fees, FOIA refusals, following the law, etc. They are known to be horrible. I can give you examples where people think that leaving an item in someone with pain and not fixing it, saying its all in the patients' head (it was elsewhere) is perfectly fine care. Doctors who lie, a govt. group that covers up information.

That's the state medical board. They don't do anything until it is so wild and crazy they don't have a choice. Check out what the Arizona board did. They had a guy on the board who was on probation from Ca.

Way past time to get the govt. and doctors out of ruling medical boards.

Skeptical Scalpel said...

Let's see how the decision turns out this Friday. I'm convinced that most medical boards are useless.

Anonymous said...

They are not just useless. I am going to turn into them a recording (the transcript) where the surgeon I complained about and they did nothing on states:

twice that he couldn't say anything
and proceeds to say things in my record & id's me

they've done squat before. Considering how the boards have been used to hoose patients and, from what I understand, kill opposition to those on the board, I'd say it would be worth your while.

I'm just disgusted enough on behalf of the many hard working in the trenches docs who get reputations because boards and others do nothing about bad docs. Disgusted enough to be public about what they do and don't do.

Sort of like when I told the main risk manager and a health care suit/board member that I aint filling out surveys because hard working docs deserve the time & respect of admin who make "ever rising salaries" off their hard work.

PS The risk manager hasn't responded to that comment yet. :)

Skeptical Scalpel said...

Yes, I have heard from others that so-called "confidential" reports have ID'd the person doing the reporting. That's not likely to encourage others to do so. At least the Virginia Board did revoke his license.

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