In these stations you may be asked to perform or teach the skill. Adopting a generic approach will help maximise your marks even if you are a little rusty on the knowledge side of things. A large proportion of the marks are given to the generic approach of the skills rather than the minutiae.
The main thing candidates often run into trouble with is their timing. With stations aimed primarily at demonstrating skills, easy marks are often lost if candidates fail/run out of time to express their post procedure plan.
- Not stating what investigations you would send post lumbar puncture; joint aspiration; etc.
- Not confirming how you would conform correct tube placement in endotracheal intubaton and how you would maintain sedation.
For stations which also contain a teaching element see Chapter 10.
“Hello, my name is Dr Smith I am one of the Senior Doctors working in the Emergency Department today.”
“Please can you confirm your name and date of birth, while I wash my hands, put on my PPE and ensure we are somewhere private.”
“Are you comfortable currently. Do you need any pain relief or a drink?”
“I believe you have come in because of…?”
“What is your understanding of what has happened and what we need to do next?”
“Clarify any issues”
- Ensure you clarify any issues that arise
Brief past medical history
“Do you have any medical problems I need to know about?”
“Regular medications and allergies?”
- E.g. for penetrating procedures – bleeding/platelet disorders or anticoagulants
Explain procedure and obtain consent
Briefly explain the procedure
Obtain consent (see Chapter 4)
“If at any time you want a break or want to stop please let me know”
- review appropriate investigations (e.g. chest x-ray for chest drain insertion)
- calculate any drug doses needed (e.g. local anaesthetic)
- ensure any monitoring needed
- patient position
- assistant (if required)
See list of example procedures below
Post procedure management and close
“Well done. that is the procedure complete”
“Are you ok? Do you need any further pain relief?”
“To complete the procedure we need to…”
- Perform the following tests to ensure everything is ok (eg repeat chest x-ray for chest drain; bloods for joint aspiration).
- I need to give you the following information for you to take home (e.g. follow up advice post pneumothorax aspiration; wound care and suture removal advice post wound management).
“Does all that sound reasonable to you? Do you have any questions or concerns?”
Skills listed in both the ACCS and HST curriculum may be assessed. The following section provides a table of procedural skills listed in the 2021 RCEM ACCS and HST curriculums. Where available links to learning resources for these skills have been provided. Skills listed in the ACCS and HST curricula may be assessed.