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Sreedhar's design narrative: Teaching medical students how to take blood

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Sreedhar Krishna
21 March 2013

Title

Teaching medical students how to take blood.

Narrator

I oversaw the session and provided technical assistance as necessary. 

Situation

During my last post in rheumatology, I was assigned a group of four medical students to teach on Friday afternoons. Students have previously intimated that much of the teaching they receive is not perceived as clinically-relevant. Therefore, after consulting with the students, I decided to teach basic clinical skills which they will need to master prior to qualification.

Thus, I invited a group of students to meet on the rheumatology ward since I needed to be in relative proximity to the patients in case of deterioration. The ward was somewhat cramped which meant that we needed to be mindful of the space we were taking up (e.g. patients and nurses need to be able to pass by unhindered).

Students have completed two years of pre-medical science and therefore have a basic understanding of anatomy and physiology. There is a general lack of confidence in clinical skills owing to the fact that they simply have not practiced the task sufficiently, and there is the fear of having to take theory-to-practice on a real patient. Students who attend the session may be different in terms of prior experience with taking blood, which can make the less experienced members reticent to participate for fear of being ‘exposed’.

Students recognise the importance of mastering blood taking in their future clinical practice and are therefore keen to learn/attend the session.

Task

The aim was to produce medical students who can take blood from patients using a Vacutainer blood collection system. Students who could successfully take blood from a patient without causing undue distress would be deemed to have passed the session.

 Actions

  1. Students were contacted in advance and advised to consult clinical skills textbooks (and YouTube) to learn how this task is performed.
  2. I demonstrated taking blood from a banana. Students found this highly entertaining, especially when I carefully took consent for blood taking from the banana.
  3. Students were advised that by the end of the session, they would be offered the opportunity to practice on a real patient. Students were not coerced to take blood if they did not feel confident, but the offer of a remedial session was made. This helped reduce panic amongst those students who may feel out of their depth.
  4. Students took turns taking blood from the banana with feedback provided by their clinical partner (and myself).
  5. Students took blood from one another (and myself if any participant is reluctant to participate). I made it clear to the students that there is no pressure to allow another student to take blood from them.
  6. Students were offered the chance to take blood from an inpatient on the ward. They were supervised solely by myself in order to reduce the panic associated with having three more students watching.

Results

All four students were able to take blood from patients. Patients appreciated the opportunity to participate in the training of medical students. Students felt more comfortable with patient-interactions as evidenced by their greater willingness to participate in all aspects of patient care. For example, one student who was almost silent on the ward soon became very genial as she felt that was ‘able to do some good’ rather than passively observe activities on the ward.

Reflections

I learned that it is key to make students feel relaxed during the session. For the majority, this is the first time that they have taken blood and they may feel unprepared. It is also important to find patients who are happy to have blood taken by students in advance, to avoid any uncomfortable refusals which may affect the student’s confidence.

Extra content

Embedded Content

YouTube - How to take blood

YouTube - How to take blood

added by Sreedhar Krishna

Contribute

Colin Brown
7:53pm 26 March 2013


Hi Sreedhar

I was attracted to this by the promise of the video.  Overall, I thought you provided a clear, logical and systematic account of your approach to clinical teaching covering all key dimensions of the scenario.  I note the more 'human' elements of what could be a very fraught Friday afternoon by way of your use of humour (consenting the banana) and ensuring a student-centred approach to designing the learning activity.  I also noted the collateral benefits with regard to direct patient engagement and communication skills in a live setting.  Two particular points I noted were (i) your reference to 'taking theory to practice on a real patient'; and (ii) the way you had consulted students and asked them to undertake some work in advance.

A few points (i) did you capture their feedback for the purposes of evaluation; (ii) how does this compare with your introduction to taking blood and was it at the same stage of training; (iii) the use of YouTube worked really well in terms of providing some additional texture - did any of them have it running on their iPads/iPhones while undertaking the task?  Could this have been helpful?

It's interesting to note your thoughtful teaching design with the You Tube clip as an adjunct rather than just giving students the link and then letting them loose.

Finally, apologies I may have somehow brought up the wrong YouTune clip here for others - I was too busy looking at geekmedics.com!

Colin

Lynne Dixon
10:27pm 27 March 2013


Sreedhar, I'm interested to know how the group of four students was selected. Was this the whole group of students at this stage of their training at this hospital, or were they 'high fliers', or volunteers for additional clinical ckills training?

Like Colin, I think this sounds a really useful approach to the learning activity. I can also see that recording it in this way would make it easy for you to refer back to (or for fellow trainers to consult) when designing future activities.

Sreedhar Krishna
12:58am 28 March 2013


Hi Colin and Lynne,

Thank you very much for your feedback and insights. With respect to the points that you've raised:

Colin

1. I have to confess that I didn't formally capture their feedback by means of questionnaire or otherwise. During my previous attempts at seeking feedback, I felt that I've not really garnered a true flavour of the group's opinions. The amount of feedback that these students have to provide by questionnaire often leaves them feeling 'feedback fatigue' resulting in students merely ticking the same response throughout the questionnaire. 

2. These students were in their third year and had very limited clinical exposure. During the first year of my training, I had a laboratory session where we practiced taking blood from a mannequin. We then practiced on one another, but it was not until my final year until I tried taking blood from a 'real' patient. 

3. No, but I think that's a fantastic idea. In fact, I might steal that one for next time. :)

Lynne

All students spend two weeks in the rheumatology department. These four students were randomly allocated to my tutor group, just as the other eight were divided amongst two other tutors. 

 

Deborah Judah
7:47pm 28 March 2013


Hi 

I think you have described the situation really well and shown that you gave a lot fo thought to the reasons for the teaching.

Lynne Dixon
1:57pm 2 April 2013


Thanks, Sreedhar. The positive outcome is all the more imrpessie, knowing that these were 'standard' students randomly allocated to your group.

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