Wednesday, 27 January 2010

A Little Dilemma

At my medical school, we learn clinical skills from year one. This year, I have so far been taught to take blood from patients and to cannulate them. However, I was taught to do these on a plastic arm. Those of you who are familiar with these "practice arms" will know that they just don't feel like a real vein on a real arm on a real person. 

My dilemma is this: However much you practice on a fake arm, it doesn't feel anything like the real thing. Cannulating your first patient, or performing your first venepuncture is absolutely terrifying and if you've never done it on a real person before, the chances are you might not manage it. If a patient asks you whether you've done it before, what do you say? "Yes, but not on a real person"? We're not allowed to practise on each other, and so we get no practice on real arms before we do it on real patients. I want to pose two questions to you.

  1. If a patient asks you "Have you done this before?" and you've only done it on a plastic arm, what would you say?
  2. Do you think medical students should be allowed to practise on each other, and what is your reasoning behind your answer?

I'd love to know what you think!! Leave me your comments and I'll try to answer them all.


  1. We get to practice on each other. It's firmly encouraged, in fact, but then our clinical skills tutors take the view that if you give consent for someone to do anything to you, then it's fine with them.

    Personally, I feel you shouldn't be prepared to do something to a patient you're not prepared to do, or have done, to yourself (within limits - I'm not cardioverting myself for shits and giggles), so letting other students practice on me is all well and good.

  2. I personally wouldn't let other students practice on me, but that's more that I'm loath to let anyone near me with a needle.

    My first venflon (and so far, only venflon) was on an anaesthetised patient, so she didn't have much say in it...

  3. im not a medstudent (yet, maybe one day) but several friends of mine at my university ARE and they have all said they practice on each other during clinical skills sessions. no one has even mentioned a plastic arm.

    when i worked briefly as an admin in a training dept one of the phlebotomy trainers heard about this and couldn't believe it, he thought training on the plastic arm was a much better way forward - how, i don't know, unless all of your casualties have complex plastic prostheses i can't see the value of NOT training something as basic and not particularly dangerous skill on another person.

  4. Hell yes practice on one another. We were encouraged at out Med school to practice taking blood on one another but it has moved a little beyond that with some people appropriating things such as cannulas, suturing kits and other medical equipment from A&E to practice on one another with. Haven't seen anyone practising catheterisation on each other yet though!

    Once you get to clinical years you can be walked through procedures on patients, and as you are being walked through they will be more than aware this is your first time. Or you will end up practising on drunks in A&E, ethical dilemmas be damned!

  5. I'm on an integrated course so clinical skills from Day One. I'm quite used to things now so am far better when a patient says "Have you done this before?" If it's no, I'll say no but explain I'm supervised the entire time and that they can ask for somebody else if they feel that's what they want. No qualms about anything any more but i do also know my limits!!


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