Bank holiday Friday. Technically I should be in work in 30 mins but I have been asked to work a late tomorrow to help with the anticipated large numbers of patients.

It's been a really productive week. I have been working with some great people and realised that more often than not the way your day goes is closely linked to who you have worked with. That said, I did have a bit of a dissapointing day last week. I was working with someone I had not worked with much before and asked them to review one of my patients with an injured foot. Fortunately I did nothing that was dangerous or was likely to affect patient outcome but I didn't really present my case as well as would have liked and felt like a bit of an idiot. He assured me it was no big deal but I am aware of the importance of reputation and credibility and feel I have a bit of a way to go to make it up. Annoying having worked so hard to create a good impression.

Rest of the week was really good. I have had much more of a free reign and people have been putting their trust in me to select my own patients from minors, majors and resus, assessing, managing and treating their conditions. I have selected trauma cases, SOBs, chest pains etc but am still erring slightly away from the elderly complex medical patients. I am happy with initiating emergency treatment but complex pathologies and co-morbidities mean that a more medical view point is required. Whilst I am keen to push my self and step outside my comfort zone (where real learning takes place) I think it is important not to step too deep onto the turf of the more medically minded doctors, especially when I am trying to gain their confidence and carve out a role that others can follow.

Morning all, (again apologies for grammar/ spelling, blame minute iPhone keypad)

I seem to say it every week, but that was another busy one! Lots of learning this week. One of the consultants spent quite a bit of time going through epistaxis management. Not just nose packing , but using ENT techniques to evacuate anterior chamber, isolate bleed, cauterise and repack if necessary.

I have also relocated a couple more anterior shoulder dislocations under N2O, propofol or midazolam ( depending on condition and consultant) which is extremely satisfying. One young fit lad came in with a painful shoulder, I assessed it, x rayed it, identified an anterior dislocation, went into resus and relocated it under guidance and discharged patient with a follow up clinic appointment. I later saw the same lad down the pub, carrying his shopping in his injured arm, nursing a pint with the other. He cheerfully thanked me and informed me not to worry, his sling was in the bag!

Friday was entertaining as I attended the ED plastering and minor treatments study day. We spent the day learning how to apply volar, below knee, scaphoid and full leg backslabs, as well as brushing up our skills in thumb spica application, future splints, ankle strapping and other techniques. Really useful skills for the road and expeditions as well as ED! A good day, lots more learnt.

Combined with the weekly consultant led junior doctors teaching sessions, daily lunch time 'teaching bites' and optional middle grade training sessions the formal learning opportunities are endless and are definitely things we could do more of in the ambulance service! It really does create a learning culture that I feel we sometimes lack. This culture really motivates people to search out new techniques and develop best practice hence making the job much more rewarding for the clinician to say nothing of the benefits for the patients. OK, soap box moment over.

In short, many skills learnt this week.

Thoughts of the day;

1. Ongoing work based teaching/education is a very good idea for many reasons
2. Continuously self critiquing own practice makes for a better, more confident and contented clinician
3. Simple practical skills can keep people out of hospital