When physicians at an Alberta hospital asked why so many medical students and residents were using a faulty technique for inserting life-saving breathing tubes in patients, they received an unexpected answer: It’s television’s fault.
Many of the doctors in training said they had learned the procedure from watching medical dramas. And a subsequent analysis of the show ER revealed its fictional MDs and nurses performed intubations incorrectly almost every time.
The findings, just published in the journal Resuscitation, revive an intriguing debate over whether entertainment TV has an obligation to portray medicine accurately, and underline what some see as chronic flaws in the system of training Canada’s physicians.
“We were a bit shocked,” said Dr. Peter Brindley, the critical-care specialist at the University of Alberta Hospital who discovered the students’ extra-curricular secret. “The important lesson here is that we can’t leave medical education to chance alone.”
Intubation is the insertion of a tube down the windpipe, usually so a patient can be hooked up to a mechanical ventilator when they are unable to breathe properly on their own.
The first step is to position the head properly so the tube can be quickly and easily installed.
Dr. Brindley said he and his colleague, Dr. Craig Needham, noticed that many students and residents – medical-school graduates training in specialities such as anesthesia, surgery and emergency care – positioned the head incorrectly.
Such a slip-up can make bad outcomes more likely when time is of the essence and “it’s a matter of life and death,” he said.
To find out where the faulty knowledge was coming from, the physicians surveyed 80 students and residents. Many said they learned through “trial and error,” but a large proportion indicated they had picked up tips from white-coated TV characters.
ER was the program most commonly cited by the students, so Drs. Brindley and Needham analyzed a season of the show. Some aspect of the head positioning was wrong in all 22 intubations that could be fully viewed on screen, their paper says.
Dr. Brindley said his findings are more evidence that the traditional approach to teaching doctors needs improving. Medical students typically learn about procedures such as intubation in a lecture hall, then find themselves practising on a real, perhaps critically ill patient, often with minimal supervision. Later, the same doctors sometimes train others.
Known as “see one, do one, teach one,” the concept does not work so well in an era when the population is ageing, hospitals see more patients with complex health problems and doctors are chronically over-worked, Dr. Brindley said.
He promotes the use of simulators, computer-assisted dummies that provide life-like practice for medical students before they start working on real people. In general, there needs to be a move to evidence-based medical education: testing teaching techniques the same way that drugs and other treatments are evaluated, Dr. Brindley said.
Producers with ER could not be reached for comment on Monday.
One resident in emergency-medicine, however, said he was surprised to hear that some of his colleagues might be learning from television.
Dr. Alim Pardham, a resident at McMaster University in Hamilton, Ont., said intubation in his experience is taught to students and residents under close supervision by experienced physicians.
Medical shows are popular with doctors in training, but most take the content with a grain of salt, he said.
“People just enjoy it as good TV,” Dr. Pardham said. “They’re not particularly accurate in terms of what the hospital is like in real life.”
There has been heated debate, though, about how the shows affect the non-medical public. A 1996 study in the New England Journal of Medicine found that 75% of the patients who went into cardiac arrest on three shows – ER, Chicago Hope and Rescue 911 – were revived, compared to the real rate of six to 15%.
Such small-screen successes “may encourage the public to disregard the advice of physicians and hope that such a miracle will occur for them as well,” the authors argued.
Neal Baer, a doctor and producer on ER, later argued in the same journal that the show takes pains to be accurate, with scripts vetted by multiple experts. The action, however, is deliberately made fast-paced and dramatic, Dr. Baer admitted.
“Real life in an emergency room is often quiet, even boring,” he wrote. “If we were to re-enact a minute-by-minute account of actual events … we would not have 35 million viewers each week.”
National Post
tblackwell@nationalpost.com
– haha nice
