Hi! I'm a clinical medical student on placement. I've been recently struggling with getting flashback (blood) into cannulas and vacutainers and struggle to ascertain patient veins. Do you have any advice about how I can get blood into cannulas/vacutainers and palpate patient veins. I'd be very grateful.
Oh man I HATED cannulas as a med student, although I had the opposite problem, where I would get flashback but couldn't advance and fully site the cannula.
Also apologies for the delay on replying to this, it's been a busy end of placement to get things sorted haha
My tips would be:
take your time with EVERYTHING.
Make sure you've got all your equipment set up and to hand, because just slightly turning to try and pick up the blood bottles or flush or something can cause a slight movement in the needle and cause it to come out of the vein. Similarly take your time selecting the best vein and also advance the needle slowly - it's difficult to judge how deep the vein is just by palpating, especially if its in the ACF, so it's easy to get flashback but advance too far. Stop at the first sign of flashback then advance a small amount (about 1cm unless you're inserting a widebore cannula) to ensure the entire needle tip and cannula tip are in the vein, but haven't gone through the other side.
Also get yourself and the patient into an optimal position. I can guarantee this helps, because the cannulas I most commonly missed are ones where I'm slightly at an angle, trying to get around stuff around the bed, or have tried to do it without the patient's arm being fully straight. Get a second pair of hands to help position the patient if they aren't able to do it themselves. It's not a failure or sign you're bad at cannulas if you have to do this, and means you're more likely to get it first time so that's better for the patient
Rest added under the cut
2. Get the skin taut
Especially with older people who's skin has list some of the collagen, or if the patient is dehydrated. Palpate where the vein is when you've got the skin taut and keep it there. Veins can wriggle especially when trying to get a needle in them, but they move when the skin is pulled so there's no point palpating unless you've got the vein in the position you're going to approach it from
3. Tap, use alcohol wipes and gravity
The hand veins can pop up really nicely with a bit of encouragement. Get the tourniquet close to the hand, get the patient to open and close their fist and dangle their hand over the side of the bed for a bit to get the veins nice and juicy.
4. Think about anatomy
You don't always need to go in the middle of the ACF - I like to feel in the lateral or medial parts because the veins can be more palpable. Also people often have a nice one running from the thumb joint along the back of the hand over the wrist (it's often nice and straight and doesn't have valves/confluences with other veins) image below for demonstration:
5. Don't automatically get a smaller gauge needle
It's tempting to think oh I'll use a blue because the veins are small/difficult, but actually you're more likely to miss with a smaller one and it's more likely to clot when trying to take blood off, and less likely to be properly in the vein if it's deeper.
That's all off the top of my head but basically it's just doing them over and over again until it feels natural and easy. Also US guided is great but I'd recommend not just immediately learning and relying on US because it's slower, there's not always a machine around and it's fiddly (also it does feel really satisfying getting a tricky one in without the US). Get good at it without ultrasound then add that skill to your repertoire later :)
Hello everyone! As we are at the start of a new year, I’ve collated this list of online resources/apps that saved me during my revision at various points of med school. I’ll put the links and why I think they are good. These are UK-based resources as I often found when I searched things that US stuff came to the top of the list and that wasn’t always helpful for learning management because guidelines etc differ.
1. TeachMe Series
These are developing all the time and they have added Obs and Gynae, Paeds and Physiology which are new and I haven’t used. They are kept up to date and written by current health care professionals, and edited to ensure they are correct. The topics have really good diagrams, clinical relevance and key points.
a) TeachMe Anatomy
When: Preclinical years
Pros: colour-coordinated diagrams, each topic has a clear structure, including vasculature, nerves etc. Clinically relevant links
Cons: detail can be a little overwhelming, I would use this to make notes that I then revised from (definitely not for last minute revision!)
b) TeachMe Surgery
When: Clinical years - especially final year when we had a specific surgery placement
Pros: there are two ways you can approach things - by presentation or by diagnosis which really helped me for linking differentials. Also it has topics on the practicalities of surgery and perioperative care which I will probably continue to use as reminders for my surgical job next year
Cons: If you need to know exactly how a surgery works it might not go into specific details about the operation, but it is aimed at med students and we didn’t really need to know that. Also, it is kept up to date but check the date the topic was written and consider triangulating sources for management because guidelines change
2. Geeky Medics
These are again all topics written by healthcare professionals then edited. They have a wide range of topics but are less focused on conditions like diagnosis and management and more about practical OSCE guides or how to be a doctor, with videos and checklists. It also has an app but you have to pay for it.
When: Throughout medical school (and beyond!), particularly for practical or data interpretation exams (I go back to their interpreting LFTs and also death verification and certification posts a lot)
Pros: good for demonstrating how to do various examinations and for revision because you can test other people and use a checklist. Also have lots of free quiz questions on geekyquiz and also loads of cases to take histories from each other without having to make it up yourself
Cons: not comprehensive when it comes to revising, and the search function i find can be a little...erratic with what it shows you.
3. BNF
There are two places you can find the BNF - NICE or Medicines Complete. There’s the same information on both, try them out and see which you like better in terms of layout. Also download the app, because the interactions checker is a lot quicker to use than on the web.
When: whenever you’re learning about management of conditions and in the run up to the PSA you’re going to need to be very familiar with this website, so may as well start early (and you will carry on using it beyond med school)
Pros: The treatment summaries are up to date and based on NICE guidelines so are UK specific. I liked to refer to them in revision because it’s a good single reference point when doctors give you conflicting treatment ‘preferences’. The pages for the drugs are set out in a uniform format and it’s really easy to find the information you need.
Cons: the website is not always great for the pharmacology of drugs/saying which class a drug is part of. The treatment summaries are wordy and you have to sift through them sometimes, so not for last minute revision.
4. Almostadoctor
Again articles are written by doctors and then edited and ensures they are up to date. They have references at the bottom of the page for more detail but are a very good summary of conditions.
When: all through med school. Has basic clinical skills, diagnosis and management
Pros: The drugs section is very helpful for common drugs and has some simple pharmacology in there, and has flashcards for each topic if you find it helpful revising off those
Cons: tends to be split by condition rather than symptoms, there are some ways of comparing differentials for example chest pain but it makes a big table which i find confusing
5. NICE CKS
Oh boy is this site my saviour in GP, but I did use it in final year for some core conditions. It has referral criteria, decisions for management but it does allow for plenty of your own clinical judgement.
When: definitely more for finals to aid your revision, but after that if you end up on a GP rotation this is like a bible.
Pros: It’s really good for reminding you of red flag symptoms to check and also gives contraindications to certain management options
Cons: Not necessarily good for telling you what examination findings to expect and the site can involve clicking on lots of links taking you to other pages and then you can’t remember which part you came from.
If anyone has any others that I’ve not mentioned feel free to add! sorry for the long post, but I hope these are helpful and good luck everyone starting a new year of med school!
Studyblr photo challenge - day 3/30 [Brainstorming]
I’ve never really done a lot of traditional brainstorming, I’ve never found it particularly useful, however in third year I revised by making these - fitting everything i needed to know about a condition onto a single sheet, splitting it into important parts like symptoms, management etc.
Hey, would you be able to explain the UK training process. I know you do F1 and F2, and then go on to further training but I’m not sure how it works. I know there’s different grades (sho/ct2/st1/registrar/etc), but I don’t really understand it or the training process, especially as it’s different for different specialities and I get very confused and overwhelmed. Please could you help/direct me to good resources?
Hi!
This is something that really confuses me as well, so I’m not going to attempt to explain everything because there is a good chance I’ll get it wrong. I think a lot of it comes when the same “grade” of doctor has more than one title, or some of them are general terms, for example “registrar” means anyone after F2 year, but not a consultant, but then different specialties/years have other names as well.
The number after the CT/ST indicates how many years into the specific training it is, i.e. the higher the number, the more experience they have and are referred to as “senior” registrars, so they are more likely to take cases without any input etc.
After F2 you can pick specific specialties, for example if you know you want to be a GP, then you go onto the specific GP training program, although I admit I don’t know what the registrars are called, or you can pick “core” medical or surgical training, and specialise further on in your training.
It’s important to note that a lot of specialities have many different routes to get into them. The GMC have this page about specialty training, and the BMJ have an explanation of doctors titles.
Another good resource would be the Royal Colleges websites, all of which have information about how to train in their specialty.
If there are any current doctors who can explain this a bit better/add to the resources please do! Hope this has helped you a bit :)
Hey, do you have any books you’d recommend for anyone wanting to study Medicine?
Hello!
I would definitely recommend reading things for interest, not necessarily textbooks to learn things. I picked topics that interested me, and read books about that, there is one book that I can’t actually remember the name of, but it was a book about the history of medicine, and medical discoveries. Read things for you, make sure they are engaging and fascinate you. That being said, here are a few specific recommendations if you really don’t know where to start.
Bad Science - Ben GoldacreNot focused on medicine, but a great read. It is funny and interesting, leaves you contemplating lots of things and will make you think about science and the media, advertising and other things like that.
Do No Harm - Henry MarshThis is written by a neurosurgeon, looking at some of the cases he has operated on and tries to show the human side of being a doctor. I know a lot of people that have read this and loved it. I had mixed feelings about it.
On one hand, it does give a good insight into the life of a neurosurgeon, but in some ways I kind of felt like he was trying too hard to make himself seem human, but almost in a flippant way. I don’t know, there was something about it that didn’t sit right. However, I am really glad I read it because I could reflect on what I’d read anyway, even if I didn’t love the book.
This is going to hurt - Adam KayI haven’t read this yet, it is doing the rounds in my friendship group but my housemate has and she absolutely loves it. There are a lot of books about being a junior doctor, and they all look good, but this one is apparently funny and engaging yet realistic. My friend says it says it how it is but it hasn’t managed to put her off doing medicine.
The Man Who Mistook His Wife For A Hat - Oliver SacksHe is a neurologist who has written many books, on several different topics, but this one is a compilation of cases and is written in a way to be accessible to the general population, not just people from a medical background. His other books are brilliant as well though, so have a look.
It’s All In Your Head - Suzanne O’SullivanA really good insight into patients with medically unexplained symptoms, which can be distressing for the patient and frustrating for the doctor.
There are so many books out there, I have spent a long time wandering through the medical sections of bookshops just picking up random books and seeing if they appeal. Don’t think you have to learn lots of facts from these books, but if you are going to put them on a personal statement, reflect on them and think about whether you can learn something that you could apply to your future career or medical school.
If anyone has any other recommendations please add them :)
I am a first year medic studying in the UK and despite only being in for 2 months i am already feelings overwhelmed. I find that i spend a lot of time writing up notes after lectures which are very detailed and help give me a better understanding on the topic, however i never find the time to look back over these notes and commit them to memory. So i just have a fat stack of notes from all lectures on my desk that i havent looked over yet i have no time to! what would you advise i do? thank u!
Hello :)
First things first. It’s okay to feel overwhelmed, I did in first year, in fact I’ve felt a bit overwhelmed at some point or another every year of medical school. You’re transitioning between very different ways of learning and it can take time to find your feet and work out the best method for you.
The most important thing is to know what you need to know. Medicine is huge and you can’t possibly learn everything, that’s why there’s specialties and why the course is so long. Your medical school should have learning outcomes, whether they are linked specifically to lectures of just general learning outcomes for the topic you are studying. These define what they can put in an exam. Sometimes lecturers go way beyond the learning outcomes and it can feel like you need to learn all of it, when in reality they are putting it in for added information.
It’s annoying, but they often are giving you information that will be useful when you’re a doctor, or in later years at medical school so it isn’t relevant to you right now. My first bit of advice would be to find the learning outcomes and use them when you are writing up lectures, so that you can focus on those topics.
It is good to make sure you understand a topic, because if you don’t understand it you won’t remember it. however if you’re spending all your time going into detail, you won’t remember things anyway, because there is just too much.
I like to make notes on lectures quite soon after we’ve done them, however I type them up because it’s quicker. If you make notes on the computer you can add to them if you have small group sessions as well, so you’ve got a good set of notes to look over. Typing up isn’t as good for remembering things, but it is quicker and you can copy diagrams etc into it as well, which is quicker.
People learn differently, I don’t actually start ‘revising’ until a few weeks before the exam, especially if we are still learning new things. I guess I do ‘cram’ a little bit, but I find if I start too early I forget it again anyway, and I don’t like to go over things more than once really, because it gets too repetitive for me, and I lose interest.
One of my housemates, on the other hand, has to go through things 3 or 4 times, but gradually making fewer and fewer notes (she types up rough lecture notes, then writes them on paper, then makes flashcards or mindmaps). She is very disciplined and this would overwhelm me, but we both get similar grades (well above the pass mark).
Hopefully you can see that there isn’t a ‘correct’ amount of work, or way of doing medical school, and hopefully this will put your mind at rest a little. If you are feeling overwhelmed, change how you are doing it. Get advice from friends, students in the year above or staff. If you have a personal tutor, talk to them about how much work they would expect students to be doing and if they have any tips specific to your course.
I was ‘behind’ through first year, because I have very high standards for myself, but I still did well and over the years I have worked out how to learn better. It is tricky at first but you should know that everyone feels like it during medical school. It’s high pressured thing, and people understand. I advise you take a step back and work out if you are doing more than you need to to do well and pass.
Hope this helps, if you need any more advice let me know and good luck! :)
So I was asked by @studylizziee for tips on personal statements and I’m sure that with results coming out this week, people are starting to think about medicine applications properly and writing a personal statement. Here are my tips on how to write one, specific to medicine! I’ve split it into advice on writing in general, then specific sections you may or may not want to include
Getting started
Note down in bullet points the general parts that you want to cover and an order that you’d like to put it in
Write down everything you’ve done in a list - outstanding academic achievements, extracurricular activities, books you’ve read, work experience, any volunteering, jobs, literally everything. You won’t put it all in, but you can then work out what you want to mention etc. and you won’t get to the end of your final draft and suddenly think of something else!
Don’t worry too much about your first sentence, you don’t need to start from the beginning if that makes sense! Write paragraphs about work experience etc, even if they will come further down in the statement. It means there’s something on the page, and it will help you to get your first paragraph sorted later!
General advice
Tell the truth - seriously, don’t try and exaggerate, you will get caught up in it at interviews, and if you get a place on a course/at a university that you are not suited to then it is a real waste, both for you and for other people who may have missed out on a place. It is not worth it.
Don’t worry if you are applying to a fifth option - keep it all tailored towards medicine, most biomed/science courses will not discount you, they know they will be fifth choice, they are used to it
Don’t send it to one of these professional paid for writing/editing services - a personal statement is better if it sounds like it’s been written by an enthusiastic 17 year old, I know it’s cheesy but that’s why it’s called a personal statement!
Get someone like a parent or teacher to read through it - not to check the content, but to do a spelling/grammar check, and to make sure that the sentences flow well and make sense (sometimes non-medical people read them at universities, so try not to go too technical)
Use simple sentences, don’t try and use complex impressive language etc. If a personal statement is hard to read, the admissions officer will switch off and may miss important points
Write drafts, and especially for the first one, don’t worry too much about the character/word limit. Write down the main points that you want to get across, order them coherently, fill out the points and write it. After that, edit it several times before you start to cut things down.
When you are trying to cut it down to the limit, reword sentences rather than cutting points and make sure you haven’t repeated yourself.
Avoid lists - i’ll talk more about this in the experience section, but lists are boring to read in a sentence, and for medicine, it’s all about what you have learnt rather than what you’ve done.
Why do you want to study medicine?
This is an important section, because they want to see that you understand what medicine is about and you aren’t going into it for the wrong reasons. Don’t forget, it’s personal! If you have always wanted to do medicine that’s great, if you only decided this year it’s just as good! As long as you can show you have researched it and decided it’s the career for you, and why you’d be a brilliant doctor, there is no right or wrong thing to say in this section.
I told a story, about how I’d been fascinated by science, wanting to have a direct impact on people’s lives and enjoying problem solving. It was true, and I could talk about it at interviews passionately. If you have wanted to do it because of a family member or any other reason, tell the story behind it. It makes the statement individual to you and the reader can see a person behind the words, rather than the stock phrases that people think the admissions officers ‘want to hear’.
Medicine is hard. there is no denying it. Medical school requires hard work ad dedication. You’ll still have a life and it’s fun and you are in an incredibly privileged situation, seeing people at their most vulnerable, watching a birth, but some days you will be in tears and wonder why on earth you started this in the first place. You have a long career that is definitely tiring, can be frustrating and is stressful. My advice would be to acknowledge that you realise this, you are going in with no illusions and you are prepared.
Work experience and volunteering
First things first - you do not need to have done GP experience and hospital experience. Don’t worry, med schools understand that it is difficult for people to get consent and that is fine.
If you are lucky enough to go into a hospital or GP, don’t talk about all the different diseases/surgeries you saw, because a. you’ll be taught all that at medical school, and b. you are wasting your word count because they won’t be that impressed. Instead, use the opportunity to talk to doctors about what their job is like, imagine yourself being in that environment. If you can, talk to patients about what it’s like being in a hospital, think about their experience, having to ask for a cup of tea, maybe not having the independence to go to the toilet, and reflect on this in your statement.
Volunteering and other jobs is just as important and shows dedication to becoming a doctor. Talk about the skills you have gained, what you’ve learnt etc. Not all of your experience/jobs have to be related to medicine! I sold programmes at a rugby club for 3 years throughout GCSE and sixth form, but it helped my confidence in talking to strangers, so I mentioned this. Again, it’s about standing out as being a person not a machine generated statement!
Extracurricular activities
Typically, this will be music or sport, but think outside the box. Does your school have tutoring schemes for younger students? Have you organised or been involved in drama, debating societies etc? How have you organised your time to keep on top of your studies and fit things in? What skills have you gained through doing these things?
Yes, you need to be a ‘well-rounded individual’ and but also, could you have shown leadership, resilience etc in these activities?
Again it’s the individual, make them see you rather than a ‘perfect medical student’ (they don’t exist)
Other ideas
Things like medical related books you might have read, have you attended lectures put on at your local hospital, taken part in any academic competitions. Comment on whether they affected you, what you enjoyed about them etc.
You don’t have to have done all these sorts of things, and don’t put them in for the sake of it, but if you think it’s relevant talk about it!
Good luck everyone!
If you have anymore questions, my ask box is open, or feel free to message me directly!
Hi, I want to study medicine but I am scared that I wont have any free time left whilst studying and then working as a doctor...
This is an assumption about medicine that really really annoys me, You can have a life outside of medicine. You NEED a life outside of medicine. Yes it can be tricky and some weeks you’ll feel like you can’t do anything other than medicine but you should stop that. If you don’t do things outside of medicine then you will burn out, it’s not worth it.
Sorry if this sounds a bit rant-y but I’ve had a very long day, incidentally I have done absolutely no medicine. I had a 6 hour rehearsal for the musical I’m performing in next week, then went to the gym, then caught up on watching Strictly with my housemates.
I’m not saying you won’t be busy as a doctor/medical student but you do have time. During my first three years, I was on the rowing team and played in the band. I went to church on Sundays, and a house group on a Wednesday. I went out with friends, went to the gym or ran. It is totally possible, and you have time to do what you love.
It’s about time management. I’m not saying I’ve got it right, but what I think about is prioritising. What are the extra things I want to do, every week. For me at the moment this is wind band, church and parkrun on a Saturday morning. I put them in my diary and unless something else big is happening I will not miss them, even if i feel like I have ‘too much work’. Then look at when your lectures are, whether you can fit things in between them, or get work done in longer breaks so you have time to do things in the evening. Take time to relax, don’t try and work whilst you’re watching TV. You won’t be productive and you won’t enjoy the program. Simply take the time out to focus on the TV (or read or whatever you want to do).
In terms of your actual timetable, it will vary depending on whether you are on clinical placement or not. If you’re on placement, you will often be in 9-5 but again it is manageable. In the first couple of years you may be in less often.
When it comes to working as a doctor, I don’t know what it’ll be like for me, but I’m determined to make sure I still have a life outside of medicine. Perhaps some docs on here have some advice about it? But I know that doctors make it work as well.
