Student placements in ICU

[shane246]

Does ICU constitute an appropriate learning environment to achieve core cardiorespiratory requirements of an entry level physiotherapy program?
If an entry level physio student was to have a placement in ICU and this was deemed as their only cardiorespiratory placement over their 4 year course, would you feel that core cardiorespiratory experiences and expectations for graduation could/should be met in this environment?
Alternatively should ICU be an elective entry level placement, part of a combined cardio placement that ensures learning opportunities on general medical/surgical wards as well, or the realm of post-graduate learning only?

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[Fiona Schreuder]

I strongly believe that all students, no matter what level, should be allowed to take part in all ITU treatments. The principles of assessment are the same as for non- ventilated patients. The manual skills are not difficult- obviously they need to know the indications and contra-indications. I would never leave them to treat a ventilated patient unsupervised. As you say this may be their only respiratory placement before graduation and then we expect them to take part in the on call rota. We should be giving them every opportunity to learn in a supportive environment as under- graduates. Let's not turn ITU into some elitist speciality!!

[liz buckman]

While, in an ideal world a student placement would include ICU with some surgical/medical experience, it should not become a specialist entity. Students can learn so much if the ICU experience is handled in a supportive manner. It also starts the preparation for them participating in the on call rota in a positive non threatening manner.

[Martin345]

going back to the original question... you used the word "core".
i don't think it is necessarily the most appropriate environment for students to learn their core or basic respiratory undergraduate requirements. even for some new graduates, i feel the same way.

when students come to do a "respiratory" placement at my hospital, we tell them in advance that they will spend some time on med/surg wards, in pulmonary rehab, with the community respiratory service, in cf and in critical care (itu/hdu). that said, we deliberately leave things open, making decisions on where they will spend time based upon the placements they have done previously (some arrive with previous resp experience, others no wards experience whatsoever) and how they perform in their first week. we warn them that we may change things around and most are quite accepting of this because they feel it is done with their best interests in mind. i find the majority of students want to get up to scratch on the basics and anything else that is done is a bonus.


fiona i am also wary of making itu seem elitist. it should not have that attachment at all for it will not rub off on colleagues in other areas and will unnecessarily instill fear into the minds of students and new graduates. i find even with this attitude, several new grads find it intimidating, especially when preparing them for on-call. they are thrust back into student mode because you have to test them in some way to know they are capable and safe.

i agree also that supervised student time is the way to go. even for those students whom i think are not quite ready to really push forward into learning in the critical care environment, i nevertheless expose them as much as time allows and get them participating to make them feel more comfortable, even though i won't necessarily assess them in this area as i do with others.

[shane246]

Thanks for comments to date. I agree that ICU should not be seen as elitist or made to conjur fear into students or new-grads alike.
However, back to my original concern: presently I have students coming to ICU alone for their 4 or 5 week cardio prac and never having any other time in their undergraduate placements on basic surgical or medical wards, covering PR or CR, seeing CFs, respiratory community PT, etc. Therefore the students coming to me never get to see the 'bread & butter' of cardio work, they only see whatever casemix happens to be in ICU during their placement. Useful learning opportunity - yes! But in the absence of time on other wards doing 'cardio' learning and practice, does ICU sufficiently provide the skills, knowledge and core experiences for them to then have to manage a medical/surgical ward or a PR program etc on graduation?

[Physiobase]

When I was an undergraduate we were never allowed onto the ICU before the elective rotations. This meant that everyone had already done 4-6 weeks on each of the cardiothoracic, respiratory, general medicine and rehabilitation wards. I do not think it appropriate to place students in the ICU before they have spent suitable time on the wards.

[Fiona Schreuder]

If you have the luxury of enabling students to complete one or more other respiratory placements then I feel that that is OK to delay their experience on ITU at under grad level. Unfortunately in the UK we do not have that luxury. Most students will only complete one respiratory placement prior to graduation. I understand the comment regarding only giving students ITU experience. Our students did a mix of ITU and surgical ward work. They often got to follow their ITU patients back to the ward as well as doing the basics. If the students were on a medical respiratory placement then they just worked on the medical wards (occasionally seeing some NIV).
It is very difficult to give students "ideal" experience prior to graduation. It is dependent on so many factors which are often beyond our control! In my experience the students all enjoyed ITU. We gave them sufficient support technically and emotionally and I never had a negative experience. Even the self confessed non lovers of respiratory enjoyed the placement!
The new grads often did need a lot of support on ITU but those who had experience at undergrad level were a lot more confident and needed less support to build up their competence.

[Physiobase]

Perhaps some countries need to assess the length of their undergraduate courses. With fast track courses like the 2 years post grad. ones we are seeing in the UK, it is becoming near impossible for an undergraduate to experience all the necessary clinical areas in order to gain basic compedency prior to graduation. Any comments?.. 8o

[gpywwp]

the skill mix for icu and general-ward (med/surg) patients are very different.

in a sedated icu patient, there is less "interaction" with the patient; the techniques are mostly passive.

the situation is so very different in a general-ward copd patient with acute exacerbation for whom we may need to be tactful in communication (and even to a certain extent "charm" for the irascibly breathless patient) in order to elicit cooperation.

and for the new graduates who enter the work force, they are always the ones getting rostered for weekend and night duties, so they need to be able to work with icu patients.

[Fiona Schreuder]

I agree that the students on the fast track courses will be unable to get clinical experience in a broad variety of areas. I don't know what the answer is. I think it is just another government initiative of trying to get "qualified" staff into hospitals quickly!
I disagree with the statement that students do not learn to interact with ITU patients. Nowadays patients are rarely sedated for long periods. Rehab usually begins while the patients are still ventilated so students are able to learn skills of negotiation and dealing with quite anxious patients in a sensitive manner. These are skills which should easily be transferrable to ward patients.