Unoffiical Guide to Practical Skills

The Unofficial Guide to

Practical Skills

Chief Editors: Emily Hotton and Zeshan Qureshi

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“This book came recommended to me by several older Medical Students who all said they found it incredibly useful throughout their Medical training. As a first year Medical Student I found this book somewhat overwhelming initially, and would recommend it was targeted for those reaching the end of training as a supplement to Finas and various other clinical examinations.

However, despite this, the examinations that were relevant to my level of knowledge were explained very clearly with an easy to follow guide and were of much benefit to me. The textbook is exceptionally well organised and an enjoyable read.”

Emily Crawley thumbnail

Emily Crawley
Medical Student

“The once daunting prospect of approaching practical skills can now be overcome by using this refreshingly comprehensive and user-friendly guide. Including both skills focused on by the GMC and an array of additional skills essential in the armory of a junior doctor, this book really is a must have.”

Rob Miller image

Robert Miller
Medical Student

“A visually stimulating guide to practical skills. Getting hands-on experience in the wards and acquiring practical skills can be tricky especially when everyone is busy and you are or feel that you are in the way. However, this doesn’t help the fact that this is a hurdle that has to be scaled in examinations. The books format makes it flexible for study situations and the scenarios are tailored to fit common encounters in the wards. Mark schemes help to provide a summary of points to be covered and highlights what is expected of the student.

The pictures are very descriptive and clear and prevents any confusion as to what set-ups look like and there are visual guides for correct techniques. Great flow to the presentation of information and very engaging.”

Onyinye Akpenyi

Onyinye Akpenyi
Medical student

This book covers the core clinical competencies for new graduates, as well as additional practical procedures that are expected to be performed by junior doctors. Written by recently qualified foundation doctors, with review by senior clinicians, we have ensured that all procedures follow current guidelines.

There are detailed explanations of over 50 practical skills stations. Each station includes a corresponding mark scheme, associated questions and answers as well as further areas to explore.

The aim is to give you a comprehensive overview of all procedures, even if you have yet to witness them in your training. Covering both basic and more advanced practical skills, we hope this book will prove to be a handy study companion for your undergraduate and postgraduate training.

Key Features

Written in line with the other books in the series, stations contain:

A scenario for the candidate
A step by step guide on how to perform the skill
Over 200 high quality, professionally taken photographs and professional illustrations
Fact boxes highlighting important information to support the skill
Tip boxes from students and doctors
Clear and thorough mark schemes, to aid focussed learning and to help assess your peers in group learning
Typical questions and answers for the candidate
Additional questions to consider and explore

Do you want to save time learning and perfecting your practical skills? To massively improve your confidence on the ward? And impress your patients and your seniors by knowing exactly what to do for each procedure, straight away, every time?

The Unofficial Guide to Practical Skills is a step-by-step guide for junior doctors that will teach you, will guide you through, and will give you unprecedented confidence in the Core Practical Skills required to excel in medicine.

Emily Hotton image
Emily Hotton
Junior Doctor

This book has been created for you. We aim to ease the stress of studying and assist in making learning enjoyable to help you become a better clinician.

The book is split into eight chapters, following a logical order from simple procedures to those that are more challenging. Each practical skill station has a method outlining how to perform the skill as well as detailed objectives, general advice and facts dispersed throughout. This is followed by a matched mark scheme and a series of questions. This format allows for individual study or group work. There are three roles that may be adopted: the patient; the examiner and the candidate. The roles of the patient and examiner can be combined if working in pairs. Scenarios are real life instructions that would be found in OSCEs or on the wards. Take your time to read the passage and note any salient points.

Woman holding cannula

Cannulae are sized by gauge (smaller the number = bigger the size), all with corresponding colours. Bigger cannulae can achieve higher flow rates. For administering IV medication and IV maintenance fluids, smaller cannulae (pink/blue) are fine. In an emergency, a large cannula is preferred (green or bigger) since this permits more rapid administration of medications and fluids.

Patient comfort is very important in considering where to place the cannula, particularly in non emergency situations. Put it in the left arm if they are right handed, use a small cannula if that is all that might be needed, and remember that although the antecubital fossa is tempting, placing a cannula here makes moving the arm more difficult.

Introductions and General Advice

Introduces self (cleans hands)
Identifies patient (3 points of ID)
Explains procedure, identifies concerns and obtains consent
Checks for allergies and arm preference


Obtains equipment and checks expiry dates
Washes hands and puts on gloves
Assembles equipment

Preparation of IV Flush

Draws up saline flush using NTT
Safely stows syringe in tray


Positions arm appropriately
Applies tourniquet, selects vein, loosens tourniquet
Washes hands
Puts on non sterile gloves and single use apron
Cleans puncture site (30 seconds) and allows to air dry
Reapplies tourniquet
Appropriate insertion technique
Removes tourniquet
Removes needle (whilst occluding vein) and immediately disposes of sharp safely
Attaches cap and cleans any leakage of blood
Applies sterile dressing with date and time

UGTM PassingOSCEs Candidate Briefings“A cannula is a small plastic tube that remains in your vein allowing you to receive fluid and medication. It is inserted using a needle, a bit like having a blood test.You will feel a sharp scratch but the needle is removed once the plastic tube is in place. It is held in place with a sticky dressing.

The cannula will be changed every three days if you need it for a longer period of time. It may take a few attempts to ensure the plastic tube is in the correct place.”

Cannulation - Apply Tourniquet image
Apply tourniquet
Cannulation - Clean Insertion Site image

Clean insertion site

Cannulation - Enter Skin image

Enter Skin

Cannulation - Push Down On Vein image

Push down on the vein whilst withdrawing the stylet to prevent blood leakage


What cannula would you use for a blood transfusion?


If it was a scheduled blood transfusion, a pink (20G) cannula would be sufficient, but a green cannula (22G) is recommended. If it were an emergency, a larger cannula would be preferred.


What factor is the most critical determinant of flow rate through a cannula?


What are the complications of IV cannulation?


In an emergency, if you cannot gain IV access, what other routes are acceptable for drug delivery?


When might you remove a cannula?


What should you advise a patient to watch out for if they have a cannula?

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