My name is Cassidy Lilienthal. I am a second-year cardiovascular student at Spokane Community College (SCC) in Washington state. The invasive cardiovascular program at SCC started in Spokane around the late 1970’s. The program is the only Commission on Accreditation of Allied Health Education Programs (CAAHEP)-approved invasive technology program in the northwestern United States. Our program is unique because we involve a class in Tacoma, Washington via a video-conferencing system. Although they attend class with the Spokane students by means of microphones and television screens, they have their own lab instructor to assist them with the hands-on aspect of our field. In this rare and technologically advanced manner, our program incorporates the east and west sides of Washington. There are a combined total of 24 second-year students in both Spokane and Tacoma.
We spend the first 9 months in didactic training, learning basic sciences and cardiology, combined with the noninvasive cardiovascular program. In the summer, we attend three weeks (120 hours) at clinical. The invasive students return the second year for 6 months, concentrating on the technical aspects of cardiac catheterization and spend 10 hours a week in the local hospital cardiac laboratories. Thereafter, we return to clinical for another 2 1/2 months (400 hours) and graduate in June with an Associate of Applied Science as Invasive Cardiovascular Technologists. We then have the ability to sit for the Cardiovascular Credentialing International (CCI) national registry exam. Due to the saturation at the labs in Spokane, many students, regardless of situation, must leave town to attend clinical. Following is an account of my first hands-on experience in the cath lab.
As a first-year student, I had a lot of questions circulating in my mind: Was I going to pass? Where would I go to clinical? Could I afford it? What would they think of me? Would I get along with the staff? Could I perform all the duties asked of me?
These are the overwhelming thoughts and feelings of most students as they begin to think about their first clinical experience. I knew my grades weren’t the best, but I was hoping that my technical skills could carry me through. I felt confident and willing to work hard on any task that my preceptors would put before me. But I also knew that my strong personality, if left unchecked, could get the best of me. My stomach worked itself into knots just thinking about the first day stepping into the hospital, not knowing where I was supposed to go, hoping my car could make the drive. I was over-thinking and overanalyzing everything, including where I would park, if I would be allowed a locker to put my things, if like a fellow student’s first day, my first patient would die, etc. Not only did I have a new place to go, I also had new people to meet.
During the first week of the program, instructors tell students to venture out of their comfort zone and try going to new places for clinical. Only 4 of the 14 students in Spokane can stay in town to attend clinical. When contemplating site opportunities, months prior I sent out an email to everyone I knew, asking if anyone had contacts in the Denver area. I had a few respond, but a friend stationed in Iraq finally mentioned family that lived in the Denver-metro area. After several emails to the family I would be living with for 3 weeks, I decided to make it official. Through this experience, I am now a part of a family I never knew.
My 1990 Volkswagen Jetta and I headed east with a full tank of gas, a trusty map, tunes, and a suitcase packed. Twelve hundred miles, 2 days, 5 sodas, 3 packages of candy and one emergency oil change later, I arrived in Denver, Colorado. I had never traveled to Denver before, but driving through the most boring part of Wyoming to get there was worth my time and money. I learned a vast amount of information in the first 9 months of the program. However, it did not seem to stack up as much as the invaluable experience I gained from being a part of the staff at Providence St. Anthony Hospital– Central (SAC) in Denver.
I was optimistic about my stay and the 120 hours I would complete in the 3-week period. The staff was very welcoming and warm, despite their efforts to be “tough” on me as the new student. I was able to scrub approximately 42 cases during my stay and observed more than 65. I met some amazing nurses, physicians and technologists. Staff allowed me to participate in any cases I wished, including cardioversions, known interventions, patent foramen ovale (PFO) closures, standard right and left heart caths, implants, electrophysiology studies and ST-elevation myocardial infarctions (STEMIs) and it wasn’t just prepping the groin — an important, but thankless, task. The months of preparation, exams and often confusing concepts and lectures made sense as soon as I was able to put the information I learned to use and lay my hands on the equipment. All the technical jargon I had to remember and regurgitate on tests did not seem to sink in until I heard it used in the lab. Now along with English and Spanish, I am fluent in the “CathLabbian” language.
While in Denver, a SimSuite training unit came to SAC. I administered medications, ran the catheters, cannulated, rotoblated and stented. I was put into the driver’s seat as the “doctor” (minus the extra years of education). Cannulating was much more difficult than I expected and made me appreciate the previous case I assisted when the physician seemingly took forever to cannulate the right coronary artery. I remember my inner monologue calling out, “What is taking so long?! It’s right there!” This training opened my eyes to the woes and joys of physicians’ tasks, giving me more appreciation for the skill and technique they employ every day. I even received a souvenir Taxus stent bouffant out of the experience, which I proudly donned the remainder of my time there.
For my first hands-on experience in the cath lab, panning, manipulating movable core wires, keeping up with the experienced physician and calling out to the monitor was a little too much for me. My assigned preceptor helped by always keeping one hand on the table, whispering tips and tricks into my ear, and stepping in for the in-depth, beyond-my-scope moments. Every staff member at SAC shares duties, including circulating, scrubbing, and monitoring. Therefore, physicians and staff tend to be more forgiving and patient, taking on the “everyone has to start somewhere” mentality that every hospital encountering students should have.
In the short time I have been in the field, I have met some outstanding people and some bullies. After my awesome educational and upbeat experience at Denver, I have since gone elsewhere, thinking my experience would be the same; unfortunately, that has mostly not been the case.
As a student, I am required to learn other technologists’ methods, but staff should be willing to let students know where there is needed improvement without belittling and sticking the student behind the trash can when they do not want to “deal” with you. Even Dr. Jarvik had to be a student before he developed the artificial heart.
In all honesty, I have had dozens of great experiences for every bad one, but unfortunately it is the bad experiences that students tend to remember. Being a student should not be like boot camp. You do not need to tear us down to build us up. I try to learn from all the experience I have undergone and plan on being the type of technologist who is not suffocating with my students, but still there to give a helping hand when they are feeling alone and out of place, as we all have felt sometime in our careers. There is a happy medium between being the “mother” in the lab who holds your hand while putting a nasal cannula on and being an insensitive dictator who questions your competency. I urge staff to find that spot and remember what it is like to be a student when one shows up to learn from you. Being a student is tough, no question, but a good experience, a friendly smile and two willing parties can make a student blossom into a fellow tech. My 3 weeks at St. Anthony’s went by quickly and I wished I had more time. Not only did I have an eye-opening and educational experience, I made new friends and became a small part of one of Solucient’s Top 100 Cardiovascular Hospitals. I would be fortunate to have the opportunity to train at St. Anthony Hospital again and complete my degree.
Cassidy Lilienthal can be contacted at firstname.lastname@example.org