I'm concerned that I'm not getting enough practice (Int'l Med student)

Hi,
I'm a British fourth year studying in Italy. The system isn't vastly different; the first three years are pre-clinical, and the final three are clinical, during which we intern in a number of departments. However, there seems to be a far heavier emphasis on theory than on practical experience, and I'm concerned that I'm not getting enough practice.
Could anyone could tell me what procedures a med student in the UK would be expected to perform, what degree of autonomy a clinical student should have, and what we're expected to know how to do before we start FY1?

Thanks in advance.

Reply 1

Ghotay

This is the full list from my clinical skills booklet:

ABG
Blood culture taking
BM
ECG monitoring
12 lead ECG
Ophthalmoscopy
O2 monitoring
Swab taking
Urinalysis
Venepuncture
Bag and mask ventilation
Intubation
Guedel airway
Observe blood transfusion
Central venous access
Fluid infusions
IM injections
IV bolus
Subcut injections
NG insertion
Nebs
O2 administration
Making up drugs for parenteral administration
Suturing
Catheterisation
Cannulation
Wound dressing

Bear in mind that there are quite a few things on there that you are unlikely to ever do in practice like swabs, nebs, dressing etc because the nurses generally do them. There are also a few things that medical school concedes we may not have the opportunity do such as NG insertion, ABGs etc. And there are also plenty of things that you would be expected to be able to do that aren't on there like blood pressure measuring, otoscopy etc

For my money, if you can take blood, cannulate, ventilate, manage an airway, and put in catheters you'll PROBABLY be okay.

Even though there's more of an emphasis on theory surely there's nothing stopping you from going on the wards to get experience for your own sake? There's really no substitute for actually being there when it comes to learning. Doesn't sound like your course is well designed

Reply 2

Helenia

Intubation and central venous access?! Not likely.

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Reply 3

AnonymousPenguin

Original post by Helenia

Intubation and central venous access?! Not likely.

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I agree.

Having said that, I am pretty sure most of our year had quite a bit of teaching about intubation and got to do it at least a couple of times. At least the anaesthetics tutor I had during my surgical block was very keen to teach me intubation and for me to try it at least once - and that was 4th year.

I completely agree about central venous access, but for some reason it comes up as an OSCE station in our finals - not actually doing it, but describing how you would do it.

Reply 4

Helenia

Original post by AnonymousPenguin

Oh, it's perfectly possible that students may have done a handful of intubations on anaesthetic placement, and maybe a CVC or two - I did both as a student. But there's a difference between having done it and being competent at it, and I don't think either are core competencies for foundation docs.

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Reply 5

Ghotay

Original post by Helenia

Intubation and central venous access?! Not likely.

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I agree about CVA, but we're required to do 6-8 intubations on our anaesthetics rotation and the majority of people do that number without difficulty. We're encouraged to be extremely hands-on during anaesthetics.

Reply 6

Helenia

Original post by Ghotay

As you should be. Still doesn't make you competent to do it on your own as a foundation doc though.

Edit: As an aside, it really hacks me off when medical schools reduce placements to a list of procedures to get "signed off."

(edited 8 years ago)

Reply 7

MonteCristo

Going out on a limb here... I qualified from a UK medical school and probably couldn't have done any of those things unsupervised on my first day as an FY1. I'm sorry to say this included venepuncture and cannulation, which I just had to pick up on the job. I may well have done some of these procedures at medical school (I probably did most of them once, perhaps on a mannequin...) but certainly wouldn't have felt happy doing them on patients from the beginning. This did make my first few on calls unnecessarily stressful but you learn quickly enough when you have to...

I'm not suggesting that this was ideal by any means but it should go some way towards convincing you that (a) there will be new NHS doctors whose practical experience is less than your own and (b) any deficits in your practical skills on qualification will be rectified pretty quickly once you start work.

I like your idea of creating your own syllabus of procedures to learn as a student. Although it's great to have done as many of the things on Ghotay's list as possible, I would focus on venepuncture, cannulation, ABGs, male catheterisation, and possibly NG tube insertion. Realistically the other tasks (e.g. ECG, IM injections) will either be performed by nursing staff or you will have time to learn them as you become more senior (suturing, central lines). Your life as an FY1 will however be much easier if you can feel confident about those five tasks.