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Procedural skills

Procedures are an essential and unavoidable part of working as a junior doctor. There are 'simple' skills we are expected to be able to do straight out of medical school such as venepuncture and cannulation, and more complex procedures that we are expected to learn whilst in training such as lumbar puncture and ascitic drain insertion. However, the reality of it is, there is such a high volume of simple procedures you need to do that you will eventually run into challenging ones that you are unsuccessful at, regardless of how proficient you may be. Here are some tips that cover how to deal with challenging procedures:

  1. Understand the procedure- it was enlightening when I first sat down and played with the cannula, giving a good thought towards how it behaves whilst in a blood vessel and the importance of maintaining a low angle of insertion. It is often helpful to understand the anatomy of the tools you are using. Following that, it may be helpful to refresh the best practices of performing these simple procedures as we generally cut corners whilst on the job. Going back to the basics for a particularly difficult procedure often helps. Websites like Geeky Medics have a variety of resources for this purpose.

  2. Ensure YOU are comfortable- it is important that the patient is comfortable so they can cooperate with positioning, and many people do realise this. However, it is equally important to position yourself comfortably too. Get yourself a chair if it is going to take a while, raise the bed so you don't have to strain your back, ensure proper lighting so you don't squint your eyes.

  3. Take your time- It can be hard to ignore the 10 other cannulas on your jobs list, but if you keep failing, it will waste you more time overall. For example, when doing venepunctures, ensure you take time to survey all areas to look for the best vein. Your patient will (hopefully) appreciate not pricking them multiple times.

  4. Escalate for help- ask the next available senior to assist if you fail, offer to prepare the equipment and stay with them to observe if they try a different technique that you can learn from. You are there to care for the patient first and foremost so you should seek help rather than blindly re-attempting, but if you can learn and improve yourself at the same time, that would be ideal. There may be additional assets you will pick up this way simply by being present and observing. As an example, I picked up some basic skills with ultrasound-guided venepuncture which was very helpful when I stayed and observed a vascular access nurse attempt a difficult case.

  5. Just keep practicing!- More experience with procedures will make your life a lot easier, so keep at it. There will inevitably be failures, but learn from them and constantly reflect on how you could do it differently. Also consider then go on to supervise and teach others the procedures as that can add to the confidence in and mastery of the skill.


Let us know if you have any general tips on procedural skills!

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