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Issue 7 - The clinical transition, what's new this week & Ben's hijacked the corner...

Issue 7 - The clinical transition, what's new this week & Ben's hijacked the corner...
By Pulsenotes • Issue #7 • View online
Hello all!
Welcome to the seventh instalment of our weekly dose. We’ve had a fantastic week lecturing to all you wonderful people! I’ve summarised the key points from our recent Q&A on ‘the clinical transition’, Sam will let you know what’s new this week @pulsenotes and Smeeton’s hijacked the corner… enjoy!

The Clinical Transition
Worried about the clinical transition? Watch our recent Q&A!
Worried about the clinical transition? Watch our recent Q&A!
The movement from pre-clinical to clinical years can be a daunting time for all students. You’ve been attending lectures, laying foundations in basic science and sleeping in most mornings. It’s student life. Suddenly, you’re being asked to get up at the crack of dawn, traipse on a never ending ward round and get quizzed endlessly on topics you don’t know. Welcome to clinical years.
Traditionally, the clinical transition describes the period when students move from lectures and classroom-based learning to learning ‘on the job’ in the clinical environment. This time point depends on the university, but is usually after your second or third year of studies. It is often met with feeling unprepared, working long hours and having uncertainty about your role. However, we’re here to reassure you it’s not that bad!
It requires a lot more self-motivation and self-directed learning, but that’s not necessarily a bad thing. You have the freedom to learn about a whole manner of topics you see in clinical practice. Remember, it’s our experiences as healthcare professionals, not necessarily our knowledge, that makes us excellent clinicians.
Here’s three messages for anyone entering clinical years!
  1. Prepare for change - The knowledge you’ve been gaining in your pre-clinical years is your foundation to build skills in clinical reasoning and problem solving. Have your history and examination skills down to a tee. Your ability to talk to patients, take a good history and perform an examination is what you’ll be assessed on time and time again.
  2. Expect a difference - The hours will be longer and it’ll be tough initially. That’s okay! You’ll get used to the vocational style of learning. Remember you’re there to learn. If you’re not getting a good learning experience, say! If you’re hour 5 into a ward round, question how beneficial it is! You’re the master of your own learning and time-management.
  3. Take your opportunities - This is your chance to gain as much experience as possible. Take your opportunities, learn from everyone and really discover what happens in healthcare. Assess as many patients as possible. Seeing and discussing patients is your main source of learning. Use it!
Final words
The transition is actually a really exciting time and you’ll finally feel like you’re gaining knowledge and skills to treat patients, enjoy it!
Our top tips:
  • Make the MOST of each placement - Some placements may be the only chance you get to experience a speciality!
  • ASK questions - Each placement is YOUR chance to learn. Ask questions, people love talking about their specialty.
  • HISTORY and EXAMINATION are key - It’s so, so important you can take an excellent history and perform an examination. Practice, practice, practice.
  • Don’t WORRY about clinical skills - Bloods and ABGs cause a lot of anxiety but these skills come with time! A proper history and examination is far more important than an ABG. 
For more info, check out our Q&A video on the clinical transition!
Got a question? Message me on twitter! @medicalreg
Benjamin Norton @medicalreg
What's new this week?
LIVE events - what we’ve got coming up…
  1. Tuesday 16th June 10:00 - Pulsenotes LIVE: Hypothyroidism. Norton’s back, this time he starts his thyroid series. He’s sure to impart some wisdom.
  2. Wednesday 17th June 10:00 - Pulsenotes LIVE: Hyperthyroidism. Norton continues with part two of his thyroid series. Perfect for exams!
  3. Thursday 18th June 11:00 - Pulsenotes LIVE: TB. Our lecture series (in association with SMILE) continues with TB. Certain to be a crowd pleaser. Three days in a row with Norton, what a treat!
  4. Sunday 21st June 11:00 - Pulsenotes ROUNDS: Nec fasc. Pulsenotes resident plastics reg, Ben, will be taking you through another fantastic ROUNDS. This time focusing on nec fasc. Expect a beautiful lecture! - EXCLUSIVE FOR MEMBERS
Remember - recordings of all these LIVE events will be available for members that aren’t able to make it!
New topics…
We’ve been extra busy this week. We’ve added a number of beautiful video lectures to our library:
  • Burns with Ben
  • Sickle cell disease with Norton
  • Diverticulitis with Sam
  • ROUNDS - TATT with Ben and Norton
  • LIVE Q&A - Starting a business at med school with the pulsenotes team
Our content library keeps growing (we’ve just hit 150 topics!) and this week we’ve added all of these:
Smeeton's Corner
Flexor sheath infections of the hand - a very common plastics referral!
Flexor sheath infections of the hand - a very common plastics referral!
Flexor sheath infections of the hand
Infective flexor tenosynovitis is one of the commonest referrals to Plastic Surgery.
As a Plastics SHO one of the most common referrals I took was for suspected flexor sheath infections of the hand. Flexor tendons glide within a synovial-lined membrane ‘the flexor sheath’ - this can become contaminated resulting in a closed infection.
Typically, patient’s present with a history of penetrating trauma to the affected finger, often some days ago. This may be a rose thorn or wound from a knife, for example.
Clinically they often display one or more of the four Kanavel signs:
  1. Pain on passive extension (often the earliest sign)
  2. Swelling of the affected digit
  3. Tenderness over the flexor sheath
  4. Flexed posture of the affected digit
Treatment involves early initiation of IV antibiotics, elevation and typically a washout in theatre (often performed under regional or general anaesthetic). In theatre incisions are made at the tip and the base of the affected finger to expose the flexor sheath (at the locations of the A5 and A1 pulleys respectively). Often this releases some pus - which is swabbed and sent for analysis. The sheath is then copiously washed out with NaCl. The wounds are tacked closed (often with a single stitch) or left open, dressed and the patient sent to the ward for continued antibiotics and strict hand elevation. The patient is closely monitored to see if further washouts in theatre are required - it is not uncommon for multiple washouts to be needed!
In summary, flexor sheath infections are important to identify and manage EARLY as left untreated they can result in irreversible tissue damage and morbidity.
Benjamin Smeeton (@plasticsreg)
Final words
Remember to get in contact with any questions, suggestions, or topics that you wish to be covered!
Thanks for reading, see you next week!
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