See one, do one, teach one

How do you train a student in all the skills required to be a fantastic doctor?
18 October 2016

Interview with 

Calum Worsley, The University of Cambridge, Professor Annie Cushing, Queen Mary University of London


Hospitals have become a place of training and they're where all our future doctors take their first steps into medicine. But how on earth do you train a doctor in the many varied and technical skills required to be able to treat everyone that comes through the doors? Well, in medicine the best way to learn is to do, so Connie Orbach popped down to Cambridge University's clinical skills lab to get some training of her own...

Calum - So, a couple of needles; tubes for blood; a couple of wipes to clean the skin; some swabs for afterwards...

Connie - Taking blood - one of the many skills that all medics learn before they graduate. But how do you teach such a thing? Well instead of sending a first timer to stick a needle in a patient's arm, students are sent to the clinical skills lab - a practice room fully kitted out with plastic arms and bags of blood. I persuaded fifth year student, Calum Worsley, to take me along and give me a taste of being a medical student. First up - choose your arm...

Calum - The choice is yours - they've all got these little name bands on them. Who've we got here -  Moe Szyslak.

Connie - Isn't he the bartender in The Simpsons?

Calum - Yes, yes, yes.

Connie - He's' not yellow at all.

Calum - Well... not yet.

Connie - Not until I've got hold of him. Okay so what's next?

Calum - Wash your hands; gloves on. Part of the realism of this is to talk to this arm as if you would to a patient.

Connie - Next, add a tourniquet around the upper arm to increase the blood pressure and it's time to pick your vein.

Calum - If you just run your finger, you can feel a little bump where the vein is, and if you press on it feels a bit sort of spongy.

Connie - Then, give the arm a wash, grab your needle and...

Calum - Mr Szyslak - sharp scratch coming up, okay? Here we are, so we're in the right place, so we pull this back, point at the tube and we've got nice red stuff in the tube.

Connie - Success! It's easy right?

Calum - Now we'll just as Mr Szyslak to press on there for a couple of minutes to make sure you're not bleeding any more. And we'll label these to make sure they go to the right place ... perfect!

Connie - Well, I mean you did that one.

Calum - Seen one. Do you want to do one?

Connie - Yes, I guess so. You're going to have to hold the microphone.

Calum - That's fine.

Connie - Calum took me back through the steps one by one and it didn't go too badly,  or at least Mr Szyslak didn't complain. But a plastic arm is a far cry from a real one and that's why, in medical school, students will practice on each other for a more realistic experience. So Calum, how about it - would I be able to practice it on you?

Calum - I hate it but we'll find you someone.

Connie - Okay, I'll see if we can persuade someone around this building to let me... Not so keen then. Well luckily for the unsuspecting staff of the Deacon Centre, I managed to persuade Calum to do his bit for radio. You're going to let me take your blood after having said it's something that really freaks you out?

Calum - Well you get a bit used to it. We all try doing it on each other.

Connie - Okay, the pressure is definitely on me. This is not the right thing to say but now I know I'm going to do it I've actually got butterflies in my stomach. Not very reassuring.  Luckily Calum didn't change his mind and successfully coached me to taking his blood but I don't think I'll be hanging up the microphone just yet.

Now I'm just going to... just prod it in.

Calum - Yes, done.

Connie - Oh and it's filling.

Calum - Perfect.

Connie - And this one doesn't look like ribena, it looks like real blood.

Calum - That's it now and just relax.

Connie - You're the one who's having your blood taken and I'm the one who's hands are shaking. Clearly I have a lot to learn and, even if I did manage to hit the vein first time, my shaky hands and anxiety would not have put the patient at ease. And that's a lot of what is taught at medical school - how to act with patients. But how much of a difference can a good bedside manner really make? Well, according to Annie Cushing from Queen Mary University in London... quite a lot!

Annie - Physical health like blood pressure and blood sugar control in diabetics are shown to be improved as well as emotional health. Women with breast cancer are better able to adapt to their diagnosis, and less likely to have depression, when they feel their communication with their doctors is good. Communication is, obviously, important in helping patients manage their condition, such as lifestyle changes and we do know that a high proportion of  drugs (between a half and two thirds) are not taken properly or as recommended by patients. So it has been suggested that improving medicines taking by patients may have a far greater impact on clinical outcome than any improvements in new treatment methods.

Connie - So the way a doctor communicates is important. But, how do you teach this sort of thing - send them off with a list of the right and wrong things to say?

Annie - We have particular sessions where we use actors who can play the part of a patient with a particular condition or problem and the students get to practice. We sometimes video record them so that they can see themselves, and they get feedback from the patient on what was working for the patient or what they found difficult in terms of understanding the student or in terms of aspects of the kind of non-verbal side. Whether they felt the student was interested in them and how they detected that. We also encourage our students to actually ask patients for feedback when they're out there in clinic, to ask for any comments on how they found it talking to the student. And in these ways we deliberately approach the learning of communication skills as part of good medical practice.


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