Junior doctors in Bristol are now learning their skills on models rather than patients. VICKI MATHIAS joined them in a training session.

A PAIR of feet poke out from a hospital trolley. At first glance the scene looks like a hospital corridor.

It is only upon closer examination that it becomes clear the patient is not human but a realistic mannequin used by doctors to practise their skills.

Inside the rooms at the Bristol Medical Simulation Centre there is also a collection of limbs and several disembodied heads that enable trainee doctors to try out techniques before they are carried out on real patients.

Andrew Jacques, specialist registrar in anaesthetics and intensive care, a course director, said learning in the simulation centre is really important.

"We try to get as high-fidelity models as we can.

"A model is never going to be the same as a human being but they are the best we can do."

Training sessions are held for junior doctors in the second year of the foundation programme they have to complete in a working environment after medical school before working as a doctor in the UK.

Rebecca Aspinall, consultant anaesthetist and foundations programme director first developed the course and over the past five years more doctors have been involved in the training programme.

"It is not completely realistic," she tells me.

"But it is about the technical skills, for example physically holding the spinal needle, recognising it and the need to be quite quick and having equipment ready.

"We also talk about considering the patient and explaining what you are doing and managing a contact to ensure they are not suffering any pain."

A pair of doctors stand over a torso as they attempt to put a line into an artery.

To make the training realistic the exercise is carried out as if for real, with the doctors wearing surgical gloves and aprons. Coloured liquids are used so that they can check the line is in the right place. In another room doctors practise the suturing skills they will use to stitch wounds on pieces of foam with a covering that has the feel and texture of skin, and can be cut and sewn up again and again.

Another room focuses on how to give patients oxygen.

Doctors are talked through the best way to support patients' breathing using a mannequin with head lungs so they can look down at the model to see if they are filling with air.

They are also shown a ventilation mask and try it out so they have an understanding of how patients will feel when the device is put on their faces.

Two models representing the human spine are used to demonstrate lumbar punctures, where a needle is inserted between the spine to take a sample of fluid or to administer medication.

The first shows the relevant anatomy and enables junior doctors to work out what they need to be feeling for along the spine. The second model does not show the spine, but as in reality the bones can be felt through an artificial skin. If the doctor inserts the needle in the correct place, a clear fluid will come out in the same way as in a patient.

Models of the lower leg are used by the junior doctors to practice draining fluid from the knee, featuring fluid that can be drawn out to add to the realism.

Dr Jacques said: "The idea is that when training opportunities arise in the ward, these F2 doctors will have been through a course like this and have more experience and confidence in doing procedures," he said.

"They are not reading in a book and are learning some of the pitfalls by physically doing the procedures.

"They will not be unsupervised on the ward but this means that they are getting it right first time."

Junior doctor, Ruth Thompson said: "Sometimes in the hospital you are a bit nervous about maybe doing things for the first time and it is nice to be able to do something that gives the confidence to do it for real."

Chloe Broughton said: "It is useful to go through things with someone going through and talking through the complications and what can go wrong and how you can rectify things if it is not successful."

Sarah Sibley, assistant director of clinical skills services said that the support of the Severn Deanery, which is in charge of training in Bristol, Somerset and Gloucestershire, is invaluable.

"This is brilliant for them to be able to have the opportunity to come around and practise," she said.

"They can learn the clinical skills required, making them safe doctors, which helps patient safety."