January 15, 2019

Core Clinical Education begins…

Our first clinical block began bright and early on a Wednesday in early January with a block called Core Clinical Education 1 (CCE 1 for short). CCE 1 is our first proper block where the majority of our time is spent in hospital on placement. The basic structure of the block for me is that we have a community day/GP placement on most Tuesdays every week. Every other Friday we have "academic days”, where we have CBL (Cased Based Learning) and lectures at university, and every other day of the week, we are at hospital on placement, where we have a variety of different activities. These include “T-DOCs” (practical skill teaching), workshops (clinical teaching), and the rest of our time we are shadowing our consultants and their juniors on the wards and in outpatient clinics.

Thursday started with our first “T-DOC” of this block. A T-DOC is a name for a practical skill which we must learn before we graduate as doctors – named after the GMC document “Tomorrow’s Doctors”, which outlines the basic procedures doctors should be proficient in. Our first T-DOC of this block was our cannulation T-DOC. A cannula is a plastic tube which fluids and medications can be given into the venous system, and for ill patients, they are one of the main ways of giving medications to the patient. The session is structured so that we are shown the procedure and then given time to practice on plastic mannequins, who, surprisingly, have veins and blood and everything you would expect in a real patient!

We have already done our venepuncture/phlebotomy T-DOC, so I was vaguely familiar with finding a vein and applying the tourniquet. The main difference is that cannulation is done by an aseptic technique, which means that you have to be very careful with what parts of the sterile field and equipment you touch. Happily, I passed the assessment at the end, meaning that I have been marked as suitable to practice with real patients, under the supervision of someone who is qualified. No doubt my first actual time inserting a cannula in a real patient would be slightly terrifying, but at least we have the reassuring back up of someone supervising us who can make sure we are doing each stage of the procedure correctly.

Both of our named consultants for this block are still away on annual leave until next week, so my clinical partner and I were discussing the best way to use the couple of days we have in hospital this week. We decided that it was about time to get some real-life experience with one of our core practical skills – phlebotomy (i.e. taking blood!). We had our official training (our “T-DOC”), which was the theory and practice on rubber arms last term, but we hadn’t found time to actually practice supervised on our first real patients yet. Phlebotomy is one of the most fundamental practical skills that doctors need to be able to undertake, and also something which has the potential to appear in our practical exams – so no time like the present! It was very nerve-wracking doing my first couple, but the phlebotomists who were supervising us were very patient and good at explaining the correct technique to reinforce our previous training. As experts who undertake the procedure all day every day, they were definitely thebestpeople to teach us. It was only one morning of practice, and I wasn’t successful every time, but even so, I feel as though my confidence has massively increased. I would feel much less daunted when it comes to doing it again. All of the patients who agreed to let me try were very kind and patient – thank you!

I then had my first workshop in hospital – based around acute abdominal pain. The way that CCE works is that we get given a list of ‘presentations’ – i.e. the symptoms with which patients may come to us. We then have to come up with our differential diagnoses and management of each presentation. This core list forms the large part of the content for ourYear 2exams. We do however have taught workshops every week which aim to help us to cover the important aspects. The workshop was run by a surgeon who deals with acute abdominal issues every day and also one of our Clinical Education Fellows. I found the workshop really useful in knowing which aspects were the most important to cover, and ultimately, revise.

That brings us to the end of week 1 of this block! Next week, I am going to try and find our consultants and go on some ward rounds and maybe attend some outpatient clinics. So far, this block seems really interesting and I can’t wait for more next week

Jordan


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