Practicing clinical skills

[Guest sn0w0wl]

I was wondering if any current students could enlighten me as to how clinical skills practiced in the first couple of years at UBC. Specifically, how much you use your classmates as guinea pigs (and for what kinds of procedures), and whether non-students volunteers or actors are used.

 

On the same note, how else do you learn practical procedures? Do you practice on cadavers, on model replicas, on pigskin?

 

Thanks for the info.

[Guest Danish]

Hew sn0w0wl,

 

We have a "Clinical Skills" longitudinal course that runs all year round in first year. From September to December, we focus mainly on interview skills. We practice interviewing eachother, volunteer patients, and standardized patients (basically actors). In December we do an interview that is observed by an instructor, who grades us on our performance. In January we start with the hands on clinical skills stuff. We learn how to do a head and neck exam, chest exam, cardio exam, pulmonary exam, sexual medicine, and genito-urinary exam (I think, we're not quite there yet) . Most of the patients we get are volunteer patients with real medical conditions. We even get to go on the wards and see patients there. At the end of this year we will have our "OSCE" or observed structured clinical exam. Basically we rotate from station to station and have to perform some sort of physical examination on a standardized patient. So as you can see, the clin skills is a big part of first year. Hope this answered your question.

 

Cheers,

 

Danish

[Guest not rex morgan]

Clinical skills continues in your second year, as well, minus the interviewing. As for practicing on each other, we are told that we don't have to do anything we don't feel comfortable with. We did eye exams on each other. Obviously we are not volunteering for pelvics...actually, they pay the pelvic tutors quite well. As for procedures, you don't really get any formal training in the first two years. I learned to suture on people with actual cuts, in the emergency room during my rural practice rotation. I learned to intubate on people who had already been induced and paralzyed...thus needing intubation. Of course the docs are usually right there if you need them, and you often do. I did a couple of deliveries without a doc, as they didn't make it in time, but I was lucky enough to have a fabulous nurse there telling me what to do. For the people going through clinical skills right now, I must say that it feels irrelevant at the time, and I know I blew it off. I am really feeling it now, though. You are expected to know it in third year, and nobody is teaching you the way they taught you before. Make the most of those sessions.

[Guest sn0w0wl]

Thanks for your feedback, guys. After first year, do students practice taking blood, IV lines, etc. on each other (like at some other schools) or does that teaching take place on clerkship? In some cases (minor things) it seems surprising to perform your maiden procedure on a real patient!

 

When my boyfriend and I were first going out and living in residence at university, I offered to sew back on the button on his shirt cuff that had fallen off. Trying to impress him, I was so intent on doing such a nice job (and though it was my first time, it really looked pretty good) that I accidentally sewed it on the wrong side! He's kept it that way ever since... c'est l'amour.

 

If they ever let me in, hopefully I'll never do something like that on a real person.

[Guest Ian Wong]

Most procedures are done for the first time on real patients, although I did get to stick a needle into the radial artery of one of my classmates (and she in turn did to me). UBC used to have a surgical skills laboratory where you could learn many procedures on anesthetized pigs (ie. IV's, chest tubes, venous cut-downs, cricothyrotomies or tracheostomies, suturing up complex lacerations, etc), but that has been discontinued as of a couple years ago.

 

There should always be someone senior to supervise you as you are learning these procedures, but there will undoubtedly come a time when you are deemed competant enough to do many of these procedures solo.

 

Ian

[Guest Misty]

I can't really speak for UBC but @ U of A during first year we practiced taking blood from each other during III (Infection, Immunity & Inflammation), I think basically to understand the sterile technique. Totally optional of course, though most people did poke and got poked. Also we have practiced thyroid exams, B.P. etc. on each other, nothing too exciting. Most of the stuff we have done so far has been on actor patients and mostly communication skills (histories of all sorts, reassuring, breaking bad news, smoking cessation etc.) as well as basic thyroid, pulmonary and cardio exams. We also had the option of signing up for suturing seminars in which we used our cadavers. I'm not really sure what second year has in store for us. Before we hit the wards in our third year we get a three week link block in which they teach us some procedures we will need to know including drawing blood, inserting nasogastric tubes, IVs etc. most of which is performed on fellow students. Again only what each person is comfortable with. I suppose if you want practice you will probably have to be the guinea pig your fair share of the time. Anyways that's my take on it so far, it's probably fairly similar @ UBC. It would also be helpful to have a willing "patient" at home ie. boyfriend/girlfriend/sibling, to practice the less invasive exams on.

 

M

[Guest Misty]

Sorry Ian, didn't see your reply till after. I guess some things are a bit different @ UBC.

 

M