Core skills

TWO months into my FY1 haematology placement and I had taken blood and inserted cannulas into patients many times. Yet my core procedures form was empty. I knew I had these skills, but to prove I was competent I needed someone to assess me.

One of the benefits of being on a haematology placement meant I could prepare and administer IV fluids for patients undergoing venesection. But I had never been formally assessed for this either. Trying to find someone to assess me was the difficult part. with my consultants and registrars busy in clinic, I was usually the first port of call for ward patients. Leaving the task for my next placements, a busy surgical rotation and a hectic respiratory firm, was not ideal either. Eventually, I plucked up the courage to ask someone to help me complete these first three core procedures: venepuncture, IV cannulation, and the preparation and administration of IV medications, injections and fluids.

I soon realised things do not always go right the first time round.

The haematology registrar agreed to assess me for venepuncture for a patient admitted with haemolytic anaemia. The patient had excellent veins, bulging and obvious. I introduced myself, confirmed the patient’s identity and confirmed that he needed a full blood count. I explained the procedure and gained consent. I prepared the equipment using aseptic non-touch technique and took a sharps bin with me. Things were going very smoothly. The problem was, I could not bleed the patient. The patient was kind and allowed me to try again. Unfortunately, it failed again. This was embarrassing and I asked my registrar to take over. I disposed of my equipment appropriately and documented the procedure in the notes. I also checked the patient was okay afterwards.

Afterwards, I sat down with my registrar who gave me feedback and encouragement. Although I didn’t get my core procedures signed off first time, this opportunity taught me the importance of seeking advice and help where appropriate and to learn from my failures. By keeping this in mind and using the same structured approach as I previously did, I was able to complete all three core procedures within my haematology placement, despite the rocky start.

What are core procedures?

F1 doctors must demonstrate competence in 15 procedures mandated by the General Medical Council (GMC). In order to become eligible for full GMC registration, all 15 procedures need to be completed within the year along with supporting evidence of competence. Once we can competently perform these, we will likely then be able to teach undergraduates the same skills to that standard.

Assessors can be anyone who is qualified to do the core procedure. This can involve GPs, consultants, specialist registrars, staff grade and associate doctors, trainee doctors more senior than F1, fully qualified nurses and allied healthcare professionals. It is best to use a different assessor for each encounter. The GMC also understands that it may not always be possible to actually do the core procedure itself, so it provides two other options for F1s to choose from – simulated and shadowed. Simulation involves talking through and demonstrating the procedure, but not on a real patient. Shadowing someone who is trained in the core procedure allows you to discuss the procedure first and then to reconsolidate your knowledge by watching someone else demonstrate. This provides a learning opportunity to competently perform on a patient in the near future (with adequate supervision).

My main pointers for core procedures:

• Complete the form at the time of your assessment.

• Understand that doing core procedures is to benefit your learning and experiences, not just a tick box.

• Prepare beforehand – identify an assessor when the opportunity crops up and organise a time to do the procedure together. Trying to find an assessor last minute may not always be possible, neither is it the best thing to do.

• Failing to complete the procedure or missing certain components does not mean you are not competent. Instead, it will provide an opportunity to learn from your mistakes and do better next time. You may have to repeat the assessment of the procedure, but experience will help reconsolidate your skills. This highlights the central theme of formative assessments, which is to demonstrate the progression of competence.

• The take-home message is that you do not necessarily have to start your F1 year competent in all core procedures. The whole idea is to learn a little more everyday so that by the end of the placement you are better off than when you started, and can carry out the procedures safely and competently.

Whichever career path you follow, core procedures are a set of skills that you will most likely need to perform again. Performing them as a foundation year 1 doctor will provide us with valuable opportunities to receive objective and personalised feedback so that we can learn from this experience. Try to complete as many core procedures as you can in your first placement as this will allow you to further build on your skills in later rotations.

Dr Anli Zhou is an F2 in acute medicine based in Bolton