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Hi New Graduate having scalpel difficulty : ( Any tips?

Discussion in 'Introductions' started by holah123, Aug 27, 2011.

  1. holah123

    holah123 Member

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    I got a new job as a Podiatrist and was over the moon, however have just qualified and been told I am way to slow and need improve scalepl technique and get quicker. I seem to have lost confidence and am worried I will haem with scalpel so going way too slow, any tips? I try good skin tension, bigger blade to get more off and have been told change blade more often, I find if skin is v hard takes while and blade blunts v quickly.
    What can I do to get confidence back and to be quick at what Im doing? If anyone knows of any video links that be great, I really dont want lose my job :(

  2. hannah.lamond

    hannah.lamond Member

    Ruth, all podiatrists if they are human have this problem, how I combated it was a 10 blade to do larger areas then 15 to ennucleate. I am pretty bad with skin tension but it means I don't haem as much and often rely on diamond deb file to smooth after I have removed callus/corn. Remember you have the control of client/patient and you are providing them the relieve not the boss. Time will improve just see every nipper movement every scapel slide(!!) As a productive move and you have dressings there if there was a haem.
    Hope this helps and welcome to the career
  3. twirly

    twirly Well-Known Member

    Hi Ruth & :welcome: to Podiatry Arena.

    Your boss sounds like the one who needs to adjust their technique! Bullying a new graduate into speeding up before they have gained confidence is most certainly not the way to help you or to improve your technique. Your confidence at this time has taken a knock, making you question your skills. There is no point in rushing as all that will be achieved will be increasing your stress levels. I would suggest that you ask your employer to increase your patient appointment time for a few weeks to allow you to settle in & gain confidence in your skills.

    Being like Zorro won't make you a better pod' it will just make you unhappy. ;)

    All the very best.

    Kindest regards,

    Last edited: Aug 28, 2011
  4. Perthpod

    Perthpod Active Member

    Hi Ruth, that is very dangerous of your boss. I remember a lecturer telling me once that i had a 'ring of no confidence' around an area..and few years out thinking.. better than the haem of no confidence. I was always very cautious and very precise, causing next to no haems in the first few years - but not very speedy. I was employed by a man that gave 10-15 min appts for everything (30 ppl one day including biomechs) so just sped up with a large learning curve. You just go as fast as you need to A) Not Harm the patient and B) do a satisfactory job. The employer will not be on your side if you slice into someones foot. I recommend using a Moores disc (very carefully at first - maybe on a slower speed) to get the callous down, then debriding and then Moores again. I am actually faster with a 15 blade now, for everything (except mens cm thick, diffuse heel callous)- guess its personal preference. Tell you boss that you will certainly speed up, as do we all (it will happen), but you will not risk harming anyone. If they dont like it, there are a hundred other pod jobs out there. Maybe prove yourself in other ways too for now - prove knowledge - most new grads have a lot more fresh knowledge than experienced pods. You may even teach them something. Good luck fellow pod, I have every confidence in you even if youre not feeling it yet!!
  5. Perthpod

    Perthpod Active Member

    oops - I should have said - better than the haem of false-confidence
  6. Catfoot

    Catfoot Well-Known Member

    Hi holah123,
    I agree that your boss is out of order. If they want someone who is speedy then they shouldn't take on new graduates.

    When I first qualified it took me half an hour to do a "basic" patient and longer if there was a lot of scalpel-work. This was after some 1,500 hours of supervised clinical training. It took me at least a year to cut the time down to 20 mins. So don't be too hard on yourself.

    I think you should have a chat with your boss and explain how you feel. Otherwise I would suggest that you do as much as you can in the time-slot allowed and ask the patient to return at a later date to complete the job. Repeat appointments for dental work/physiotherapy are quite common, so I can't see this would be a problem.

    I wouldn't use a bigger blade as they are more difficult to manoeuvre. If the callus is very hard it is not unusual to change your blade several times.

    Don't be pressurized into working faster if you don't feel confident to do that. If you have a haem it will be your problem, not your employers.

    Hope that helps



    (makes me wonder how confident FHPs can be after only 5/14 days practical :eek:)
    Last edited: Aug 29, 2011
  7. MJJ

    MJJ Active Member

    I was also told that I was too slow with the scalpel but was never pressured to speed up. My clinical instructors knew that with experience my efficiency would improve. As was mentioned above sometimes I use an umbrella burr to get rid of the hard top layer, or smooth things out afterwards, or both. Sometimes I use Footlogix Callus Softener spray.

    As a student my instructor at one of my clinical sites warned us that the scalpel blades that they used were very sharp. I thought "Yeah ok, all scalpel blades are very sharp." I couldn't have been more wrong. They used Personna Plus blades and they are indeed very sharp. They are pricey but I still use them more often than the cheaper blades that I also have.

    The bottom line is that you will get faster, your confidence will improve, and yes, you will draw blood. You will figure out what techniques and products work for you.
  8. I was lucky that my first job out of uni was in a public hospital. There was no 'time pressure' and I was able to increase my speed with my skills. As Perthpod mentioned, I also find it easier and faster with a 15 blade - less 'cutting area' to keep track of, though I will use a 10 for heavy heel callus. This will sound stupid, but feel the callus through the blade. Once you are able to do this, you rely on feel as well as sight and you should get your confidence and speed up. Trust in yourself, and the benefits you're providing to your clients :)
  9. RachWadd

    RachWadd Member

    Hi there hola123!

    Don't be too hard on yourself! Confidence comes with time and experience and the occasional casualty is part of that.

    I don't think your employer is being fair by pressuring you - I would think that a patient that is happy with the service and thoroughness of a treatment would be more likely to return than one who isn't!

    I agree with Catfoot that maybe an honest talk with them may help. Let them know that you are trying to be thorough but you understand that time management is also important and perhaps an increase in your appointment times or a 15 minute break in the middle of the morning and afternoon may asist you in catching up. We did this for a new graduate that joined our clinic at the beginning of the year and she found it very helpful. If your employer is considerate enough they shouldn't have a problem with this.

    A Moores disc can be your best friend - don't spend time trying to make the debrided area too neat (you can work on this), instead run a moores disc over the area after debridement to smooth things off and away you go!

    Good luck my friend and :welcome: to podiatry!
  10. fray

    fray Welcome New Poster

    keep practising - only makes perfect
  11. podtiger

    podtiger Active Member

    Hi Hola123,
    Trust me your speed will improve with time. Just concentrate on doing a good job and speed will follow. Good luck with your future career!
  12. toughspiders

    toughspiders Active Member

    Same here, i sometimes use something to make the callus softer (not sure if this is an option for you, yes in private practice, probably not in NHS!) and also go over lightly with a fine moores disc. We aren't all fabulous with the scalpel no matter how much experience. Some are better than others its just one of those things.
    I personally prefer a 15 blade and limit the 10 to large areas only such as the calcs.

    You'll get there... carry on taking your time and try not to stress :)
  13. tiffa89

    tiffa89 Welcome New Poster

    Hello! no worries you're not alone. I'm a new podiatrist as well and I'm not fond of haeming the patient. So there are times when I felt that I might not have removed enough especially with corns. One tip my senior taught me when debriding callosities is to use chlorhexidine. I believe you do pre-post chlorhex, thus might as well spray some on a piece of gauze and apply to the area. It really softens the calluses up quite a bit and allows you to do quite a smooth debridement.

    Hope this helps.
  14. IVHB

    IVHB Welcome New Poster

    Practice makes up everything. Why not try practicing using pig's ears or feet purchased from any butcher shop as porcine skin has the closest resemblance with human skin? That's what we use in our training courses in injection therapy.
  15. kal

    kal Member

    Hi Ruth, this is when friends come in real handy!!! Practice is the key, and if you cant cut a friend who can you cut!
    Ask them can you practice on them as they get their feet done free and you get the all needed experience. You will speed up in no time! Dont let the boss get you down. No one walks out of uni as an expert so give it a little time and you will be fine.
    Also find a blade that suits, I prefer 10 blades but have friends who are just as quick using 15s and 11s. its all about what suits you.
    Keep at it and you will be fine.
    good luck
  16. Gracie

    Gracie Member

    Practice... And pick your patient, it might not be wise to 'try' going a little faster on the ischemic 90 year old with thin glassy callus. But if there is a good thick callus try using a bigger blade, take off the worst and then finish with a 15 until you're more confident? I like 10's for concave type callus and an E11 for convex (eg, plantar 5th MTPJ). An E11 is so much easier to use than an 11, but more costly.
    How are you getting on? It's amazing the difference a few weeks make to both confidence and skill!
  17. andersonkchan

    andersonkchan Active Member

    Hi Holah123,
    I completely know how you feel! I was in that phase not too many years ago!
    Speaking from someone who had the SAME problems as you , I would start with size 15 blade, dont even try to take on size 10 yet.
    Use 15 for corns, callous, warts, anything that needs to be debrided.
    Eventually though.. you'll find that 15 isn't even efficient , and you would WANT to go size 10.
  18. Hi Ruth,
    I agree with everybody on the time issue. You will get faster with time and confidence. As for blades I think it is a personal thing. I have been practicing for 18 years and use either a #15 with a nice rounded tip and occasionally a beaver blade. I have tried 10s and 11s and just don't like them. But that is just me. Other people as you can see on the board has other tastes. I find I can work as quickly with a 15 blade as others with a 10. So just try some different things. Just remember you are a new grad and you will improve.
    Good luck
  19. rachel.liminton

    rachel.liminton Active Member

    I take way too long...but my clients are pleased that I don't rush and do the job properly.....try not to worry...your diligence and attention to detail will pay off in the long run:morning:
  20. Jbwheele

    Jbwheele Active Member

    Hey one thing tha can make you quicker is holding the scalp closer to the bladeand pivoting at the knuckle and wrist.
    Also using a no 4 or similar dental burr in light brushes across the dry callus can thin it down and allow access to underlying "moister" callus and corn.
    As for thick heel callus, have the Pt lay on tummy and go out the back and grab the Angle grinder with some 90 to 140 grade abrasive...... Ive had to do this with one Pt as the small disc I have was stalling the machine !

    Improvise and dont get stuck in the UNI training that scalpels do all the work....use water or alcohol to get a visualisation through the callus/ corn will tell you how deep it is, deburr the hard dry centres first for access the rest.

    Use KOH to soften really dry callus (careful_) Use no4 or smaller burr for seed corns and burr out soft corns using a Freeze spray to help chip the wet corn away instead of scalp as its easier and "Safer" than shoving a No 15 in between two tight toes.
    Also Keep your thumb of the opposite hand out of scalping range, Always assume you will slip!
    Think ahead of the blade and use and action like getting margarine from a container working your way outwards instead of cutting across or down into the callus as it will just self deepen
  21. brekin

    brekin Active Member

    I had a friend who was learning to be a brick layer. He was put in touch with an experienced brick layer for guidance. When first seeing the experienced brick layer he was told to go and lay 5,000 bricks and then come back to him. After laying 5,000 bricks he once again went back to the experienced brick layer who told him to go and lay 5,000 more.

    After completing 10,000 bricks he once again went back to the experienced brick layer who told him, "Congratulations, you're now a brick layer."

    The way to get faster is through practice. Though I disagree with the advice re the number 15 blade because if you become adept at using a 10 blade you'll be faster than using a 15 blade and that's what this thread is about.


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