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Clinical tips for student pods

Discussion in 'General Issues and Discussion Forum' started by PC_Pod, Feb 28, 2013.

  1. PC_Pod

    PC_Pod Member


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    Ahoy all. I'm a 2nd year student podiatrist & currently compiling a list of tips & hints for other podiatry students (& myself) to help with skills/ decreasing patient appt times etc

    Any tips/ hints that anyone reading this has to offer will be gratefully received

    thanks all
     
  2. N.Knight

    N.Knight Active Member

    The biggest tip of the all is just practice practice and practice, the more hours you can get under your belt the more effective you become with your treatments.

    Nick
     
  3. W J Liggins

    W J Liggins Well-Known Member

    Always go through the full patient interrogation/clerking procedure carefully, and listen to the answers. In 80-90% of cases (anecdotal) the patient will tell you the diagnosis. Send for necessary tests only and treat according to diagnosis.

    Keep your mind,open and when you qualify expand your techniques.

    All the best

    Bill Liggins
     
  4. fishpod

    fishpod Well-Known Member

    what tests will a newly qualified pod send for all nhs test go via primary /secondary care all results are sent to a doctor . in private practice you can send for any test but persauding a pt to pay 500 nicker for an mri scan might prove difficult.unless of couse you happen to have a scanner / xray machine, nobody will pay for blood tests their gp will do all the diagnostic testing free.
     
  5. W J Liggins

    W J Liggins Well-Known Member

    If working in the NHS, then, for example, Xray, bloods, blood gasses, CT, MRI, histo-path. If not, why not?

    In pp pretty well all of the above. If not, why not? As my posting stated, only when necessary, but if necessary tests are not carried out and a serious condition is missed, then welcome to court, and I hope that I am on the opposing side as an expert witness!

    Bill Liggins
     
  6. Lorcan

    Lorcan Active Member

    Know your anatomy. Obvious but first essential step. If you don't know what your looking at your on to a loser.
     
  7. linda.j

    linda.j Member

    Absolutely agree with Lorcan. The other good advice I got is if it looks like a pigeon, sounds like a pigeon and acts like a pigeon it probably is a pigeon!
     
    Last edited: Mar 1, 2013
  8. efuller

    efuller MVP

    Know why you are doing what you are doing. Be able to explain, at least to yourself, why you choose a certain path. Don't just do something because that is what my mentor/teacher did in the same situation.
     
  9. Here are my top 10.

    1. If you don't know, ask.

    2. See one.

    3. There are no stupid questions, so ask.

    4. If you don't know, say "I don't know" rather than flailing around.

    5. Then ask.

    6. Remember that a good tutor will keep asking you questions UNTIL he/she finds something you don't know, so don't take it personally.

    7. You're there to learn, not to prove how much you already know.

    8. Learn your anatomy. There is no magic or mystery to it. Its not hard, it just takes time and discipline. Nobody is going to learn it for you. Really, it does help!!

    9. If your tutor tells you something about your practice, they're not doing it to be cruel or capricious, they're trying to help! So take it on board.

    10. The best way to learn is to ask.
     
  10. Rob Kidd

    Rob Kidd Well-Known Member

    I take on board the comments above re: know thine anatomy, but it is more than that. It is understand thine anatomy. Example: why does the elbow flex forwards while the knee flexes back? Why does the femoral nerve derive from the posterior part of the plexus yet supply the anterior of the thigh (it doesn't in the upper limb). Why does stapedius and tensor tympani had different nerve supplies, yet they are only 2mm apart in the middle ear? Answer - different pharangeal arches.................. To understand - and yes, you are totally correct. Rob
     
    Last edited: Mar 3, 2013
  11. Pod Shin

    Pod Shin Member

    Be comfortable using both 10 and 15 blades when it comes to debriding. But what Nick Knight said is so true. The more practice you gain, the more efficient you will be with your time management. But don't worry, it will all come together in time.

    Shin
     
  12. Lab Guy

    Lab Guy Well-Known Member

    Tips for student pods:

    1. Worry not about decreasing appointment times for you are a student paying tuition; your goal is to gain experience and learn.

    2. As others have said, practice is paramount. I remember taking an hour to treat a patient but as my skills improved, so did my time. Never ever rush, allow the treatment time to be dictated by the level of your skills. Do not let your ego be bruised if others are faster. Stay within your comfort zone and your zone will widen as your experience and knowledge increases.

    3. Practicing with different blades is also a good idea as you never know what the clinic will have. The 313 blade is my favorite to debride calluses and the 64 blade is my favorite to enucleate the core out of an IPK or corn. I use the 15 and 10 blade primarily for surgery.

    4. Practice by shaving off wax off a candle and remember to always use negative pressure. Always use negative pressure to control the depth and avoiding injury to your patient. Do no harm, another reason to take your time.

    5. On very thick nails and calluses, apply 3 WEA solution on gauze and place on the nails and calluses for 5 minutes. Nails and calluses will be much softer and be much easier to treat for both you and your patient. The goal is to provide treatment in the most pain free manner so your patient continues to return for treatment.

    6. If your debriding corns and calluses, look at at their shoes, as often times, patients are wearing inappropriate shoes that do not even fit properly. A proper good fitting shoe and insert can go a long way in helping your patients in between visits and even resolving the problem.

    7. As your skills improve your treatment time will take less time. Now take a few extra minutes and ascertian why your patient has a callus sub 1 or sub 5 or sub 3. Maybe your patient has diffuse calluses and hammertoes. What is the underlying etiology? What is the biomechanics behind it? Is the forefoot rigid or flexible? How is the range of motion of the STJ? Take the knowledge in the classroom an what you read on your own, and practice it on your patient. As a student, your goal is to learn as much as possible on every patient you see. Its not about how many patients you are seeing, its about what you are learning from the patients you are seeing.

    8. Do not be myopic, treat the whole patient. As a student Podiatrist, your job is to help your patients walk in comfort. Well, just as your car takes you from point A to point B, so too does your patient's lower extremity. The muscles in the back of the leg is the engine that powers the body forward. The muscles in the front of the leg help raise the foot during swing phase and act as the brakes during deceleration. The muscles on medial and lateral sides act as the struts providing stability during forward movement.

    Learn Biomechanics so you have a greater understanding of what you are observing and can come up with a treatment plan appropriate for your patient. When patients tell you that they never knew they were living with low grade chronic pain, you will know you have done your job.

    9. 10. Never stop learning. Read all the books and journals you can. Podiatry Arena is a great resource for all and I have learned a lot. Remember, we are all students and teachers all our life. Good luck.

    Steven
     
  13. BEN-HUR

    BEN-HUR Well-Known Member

    Five points:

    * Associate your anatomy learning with your biomechanics learning... & the biomechanics to the anatomy i.e. the origin & insertion points of muscles & their roles in influencing a limb/gait... subsequently link the association to pathology i.e. area of pain, anatomical structures in this area & linking the clues to the movement of the individual in question (& vice versa).

    * Sometimes text books don't have all the answers... or at least provide the full picture. What you will experience with one patient in text book fashion may not be the case for another.

    * Be prepared to think outside the square... & be open to ideas... even your educated gut feeling (i.e. which don't violate natural laws & principles).

    * Find a purpose... & enjoy the experience (you learn quicker that way) ;) .

    * If you're not enjoying it - chill out for a while... & find that purpose :rolleyes: .

    All the best.
     
  14. PC_Pod

    PC_Pod Member

    Sorry it's taken me so long to reply, my laptop is on the blink :(

    Thanks v much for all the replies, all been very helpful & I will take them all on board.

    re. the biomechanics relating to general clinic thing.. as it happens, I'm reading all I can on biomech to refresh my memory and to deepen my understanding

    Any more tips very welcome of course
     
  15. efuller

    efuller MVP

    See the classical biomechanics papers thread here on the arena. Read those and ask questions about those.
     
  16. markjohconley

    markjohconley Well-Known Member

    Excellent advice given.

    For students, BE PUNCTUAL! and DON'T FALL ASLEEP AT PODIATRY MEETINGS,

    all the best with your careers, mark
     
  17. Tkemp

    Tkemp Active Member

    Improve communication with your patients, even if this does take longer.
    Read the non-verbal as well as the verbal.
    Explain in words/terms they understand; use models or pictures as required; be willing to repeat yourself. The greater their understanding, the greater their compliance with self-care advice.
    Check their foot wear. They may claim they dont know why they have corns, as they are always in this pair of shoes- which they have had for 18 years, yet there is no wear inside or outside of said shoes! :pigs:
    Practise, practise, practise with all sizes of scalpels. Learn which you find best for glassy HK, ID H.molle, HD in the sulci, etc.
    Know when to refer on.
    Finally, learn how to "de-stress". You will need a coping mechanism to get through the day. It may be: a client you know will not listen; an ulcer which you know will require surgical intervention regardless of your best efforts; a client you have seen for a number of years who suddenly presents with a terminal condition & you dont know if they will make it to the next appointment; or just the elephant in the room everyone is avoiding mentioning. You need to be able to "shake it off" and move on. How you do so is different for each one of us (mine is looking at funny cat pictures) but to continue in any health profession long-term, you need this.

    Well, those are my personal thoughts.
    Don't worry too much about speed at the moment, its best to focus on doing a good job, rather than a fast job...... though I remember as a student thinking I would NEVER be able to complete a full history taking, treatment, care plan & after-care advice in anything less than 2 hours! ;)
     
  18. PC_Pod

    PC_Pod Member

    Thanks very much again folks, definitely some very good advice given

    I'm finding it useful to have a sturdy display folder with all my notes typed up and summarised in a clear and concise format with LOTS of pictures to help not only myself but my patients aswell. Just today I was educating a patient about plantar fasciitis and doing strapping using my diagrams for guidance.

    (not that I'm great shakes or anything, you understand)
     
  19. fishpod

    fishpod Well-Known Member

    because nhs pods are not allowed to order any of the above. nhs pods cannot fill in x ray requests where i work the radiography staff send back the requests unless signed by a doctorl sad but true.
     
  20. W J Liggins

    W J Liggins Well-Known Member

    Per my original question. 'If not, why not?'

    Bill Liggins
     
  21. Peter

    Peter Well-Known Member

    I think it varies from Trust to Trust. I can order bloods, X-rays, MRIs, US (even though we do most of this in-house).
     
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