I used to dread hearing that question on placement. This may seem ridiculous, for someone who was just 18 months away from becoming an FY1, when you are famously expected to be able to bleed difficult-to-bleed patients. I would return to the common room at lunch and hear that other students had completed their practical skills, and I would reflect on how I had tried two sets of bloods that morning, and failed. I would even try and avoid returning to the ward that day, for fear of being asked to do anything else.
At medical school, I have often suffered from imposter syndrome, believing I am not as competent as others believe me to be. When someone asks me to perform a “simple” second year skill which I then fail, I sheepishly return to the doctor to admit defeat. Although I have never been met with grievances from admitting this I often felt a fraud, and unable to do even the simplest of things expected of me as a student. In turn, this would affect my confidence in other situations, such as speaking up even when I knew the answer to a question.
During the start of the covid-19 pandemic, I was given the chance to train with a phlebotomist and work in antibody testing clinics. My confidence has increased exponentially since, and this experience has shaped me as a future clinician more than I could have ever imagined. I now strongly believe that training with phlebotomists and other members of the multidisciplinary team such as healthcare assistants should be compulsory during our time at medical school. While my time spent with a phlebotomist was short, it afforded me the chance to really hone my venepuncture skills. Then, with ample practice in the clinics, I no longer dread being asked to take bloods on placement. I sometimes still fail, but it no longer feels like a defeat. When returning to the wards this September I felt more confident, which in turn meant I gave more clinical skills and jobs a go. Consequently, I have been given more opportunities by the doctors and nurses, and spent more time on the wards, learning more and finally feeling “useful;” a comfort that is sometimes hard to find as a medical student.
In the General Medical Councils’ outcomes for graduates, newly qualified doctors are expected to be able to perform several practical skills safely and effectively, and identify the level of supervision they need in order to ensure patient safety. This includes being safe to practice venepuncture under indirect supervision.1 At some medical schools, you only need to sign off a skill once to graduate. I am aware that for myself this would not have been enough practice to deem me able to perform this skill competently as an FY1. By assisting a phlebotomist for one morning, you could take up to 20 sets of bloods. Then not only have you signed the skill off 20 times, you have also communicated with 20 different patients, and are more likely to come into contact with individuals who, for example, are afraid of needles—this exposure in just one morning is undeniably a valuable experience, and highlights the benefits of this training. They are also able to provide ample advice and tips on how best to perform venepuncture successfully and safely.
A study by Hägg-Martinell et al, in which student interactions and learning were observed on an acute medical ward, found that students who showed an increased understanding of how the ward worked and how to perform “patient related duties”, became more curious and less nervous.2 Those students were offered a more active and independent role in patient care, and as a result learnt even more. This evidence, in combination with my personal experiences, demonstrates that medical education can be enhanced by utilising the experience and skills of other healthcare professionals in the multidisciplinary team.
I am aware that some medical schools already offer these opportunities, however, I urge medical students to grasp every opportunity to learn that is offered to them, and not exclusively from doctors. I feel passionately that experiences with other staff members such as phlebotomists and nurses can significantly add to our learning outcomes and make us better rounded clinicians. Why not spend one morning helping-out in a flu jab clinic this winter? As someone who has found herself letting imposter syndrome creep in and affect me, I would recommend trying a shift with a phlebotomist, a flu jab clinic with a practice nurse or a night shift with a HCA…you never know what you might learn.
Millie Perry, Year 5 (final year) medical student, Cardiff University.
Competing interests: None declared.
References:
- General Medical Council, 2019. Practical skills and procedures [online]. Available at: https://www.gmc-uk.org/-/media/documents/practical-skills-and-procedures-a4_pdf-78058950.pdf [Accessed 07/10/2020].
- Hägg-Martinell, A., Hult, H., Henriksson, P. and Kiessling, A., 2017. Medical students’ opportunities to participate and learn from activities at an internal medicine ward: an ethnographic study. BMJ Open, 7(2), p.e013046.