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June 19, 2017

End of the Obstetrics and Gynaecology Block

It’s hard to believe that we’ve come to the end of our fourth specialist clinical placement. This is officially our halfway point for Phase III, which means that we’ve got four more six-week blocks to go. It’s such a cliché, but time really is flying past. Seeing all of the first-year students celebrating the end of their exams recently has brought home the uncomfortable realisation that my cohort was in the exact same position already two years ago, and it’s become even more difficult to believe that a new cohort is starting in just a couple of months! Thankfully I can rest comfortably in the knowledge that I will never, but never repeat my first-year exams again.

Obstetrics and Gynaecology is really quite a diverse speciality – much more than I realised before starting. Obviously the focus is largely on women’s health (but not entirely…) but the clinical requirements on the doctors are really varied. It’s one of the only specialities I’ve come across which is a healthy mix between clinics, ward work, hands-on medicine and more than a little bit of surgery all in one role. Depending on the day of the week, doctors may find themselves performing hysteroscopies/colposcopies (visualising the vagina or uterus with a specialised camera), doing ward rounds, conducting caesarean sections, running clinics (either obstetric or gynaecological) and likely all of the above.

Being a student in this rotation has allowed us to see all of these and more. Our education department have done a great job of ensuring that we rotate throughout a few groups of learning opportunity: we have a labour week, a theatre week and a special-interests week, and we run through this cycle twice. I’ve probably enjoyed the theatre week the most of the three. It just amazes me to see open surgery (known as laparotomy, as opposed to keyhole surgery, which is otherwise known as laparoscopy). There is so much going on with the anatomy under the surface, and the doctors spend so much time concentrating on this and making sure that everything goes right; and then at the end when they patch everything up, all that’s left is a tiny little incision with invisible stitches which you can barely see. It’s such an amazing concept that it all tidies up so nicely and seeing it happen blows my mind every time.

This week in the theatre we’ve seen lots of gynaecological procedures, primarily dealing with ovarian and uterine disorders. We’ve seen the drainage and removal of several cysts (I’m not going to lie; it’s not for the weak-stomached among us), a couple of hysterectomies and a couple of removals of ectopic pregnancies. As is logical, we’ve seen women of all ages and all stages in life. Every woman is asked to provide her consent to our presence before we go into theatre and if she doesn’t want us there, then we observe her wishes. It’s been such a useful block and I’ve really got a lot out of it – I hope the remaining blocks are as good as this one has been.


John


June 15, 2017

Education, education, education!

You would have thought having gone through an undergraduate degree and then a PhD prior to coming back to medical school I would have had my fill of education but apparently not! Along with another student, I got involved in organising an optional course for third year students in medical education. Attending the course and then organising it this year has been a great experience and I’ve learnt so much about medical education and teaching theories and techniques. It’s helped me understand the different approaches the medical school use in our curriculum-combining lectures with more structured groupwork and then student led case based learning.

Before medical school I had some experience of teaching junior students in the laboratories I used to work in and at medical school I have taken part in OSCE teaching and student seminars, initiatives run by second year students in year 2 for students in first year. There are lots of opportunities to teach if this is something you are passionate about and its certainly something I would like to remain involved in as part of my future career. My enthusiasm for teaching and medical education has been encouraged by the medical school after I was asked to present my work on the medical education course at a regional conference. Myself and other students involved in student led medical education projects presented our work as part of a workshop, engaging with the audience and taking questions about our work. I also got to present my work at the local Warwick medical education conference. At both these events I got to learn so much about the challenges medical education faces and the new developments that are been made to continue improving medical education and training high quality and happy doctors.

Learning more about medical education theories certainly makes you assess your own learning from a new perspective! Having survived my speciality block 3 in Obstetrics and Gynaecology I have now moved onto my fourth block, which for me is Care of the Medical Patient. As the blocks fly by exams seem to be creeping ever closer and a sense of panic is starting to set in amongst myself and my fellow students.

Along with 3 other students I am placed at UHCW (the big hospital in Coventry) for my Care of the medical patient block. This block is designed to give us a broad overview of different medical specialities and allow us to fill in gaps we have from second year. There are a few things that I didn’t experience during core clinical education, so I’m hoping I can see more gastroenterology as I’ve made it this far through medical school without seeing many gastro patients! I would also like to see some procedures like endoscopy and bronchoscopy which I’ve never seen before. I think it’s much easier to explain a procedure to a patient if you have seen it done yourself and as this is a task that we can be asked to do as part of our clinical exams, I want to make sure I know what I’m talking about!

Watch this space to see if my enthusiasm for medical education theory can be translated into my own learning and practice!


May 30, 2017

Obstetrics and Gynaecology continued…

We’re about halfway through our fourth specialist rotation of the year and the pace is still, shall we say, energetic. Things are going well but it takes a lot of effort to keep our noses to the grindstone at times! We look on with envy at the students in the year below us who had the last week off, bringing back fond memories of 2016! (We haven’t had a break yet.) Anyway, we are still on our Obstetrics and Gynaecology rotation right now and it’s been really interesting to see all of the issues that clinicians in this speciality confront on a regular basis.

So far, the block has been going well. Although the focus is heavily on female anatomy for obvious reasons, I’m also liking the fact that the Genito-Urinary Medicine clinics are for both sexes and cover lots of different presentations. Aside from a week with midwives and on a labour ward in our second year, we aren’t provided much exposure to the O&G side of medicine from a practical and real-life perspective until this clinical rotation. We have loads of lectures, but it’s all been very conceptual and didactic – and not very hands-on. But this all changes once we are in Phase III. At our hospital, the education coordinators have been doing a great job of giving us extremely varied exposure to different clinics and theatre opportunities, and it’s been a good form of revision.

Most of the procedures we have seen have been relatively routine, including hysteroscopies (inspection of the uterus with a little camera at the end of a tube – very similar in concept to a colonoscopy), excisions of suspicious cervical tissue and even caesarean sections. It’s been like Block 5 (Reproduction and Child Health from year 1) come to life!

Theoretically, a woman can progress through an entire pregnancy in the UK and never need to see a doctor, provided that the pregnancy is low risk and that everything progresses normally and without issue. As I’ve learnt, normally patients are referred to specialists only if there are concerns about the mother’s or the baby’s health during the pregnancy, the delivery or the post-partum period. These are the cases that we tend to see these days – and this has taken a lot of getting used to for me, since midwives don’t really exist in my country of origin, in which almost all babies are delivered by doctors. Anyway, when women are referred to neonatal clinics staffed by registrars or consultants, they usually have a condition that requires additional monitoring and support (although sometimes it’s the baby who requires attention). I’ve seen lots of endocrine issues, some obstetric cholestasis, some social-care issues and even saw a baby with a very high chance of being born with Down Syndrome who required some extra monitoring. All in all, it’s been a fascinating glimpse into the variety of humanity and I’ve loved what I’ve seen so far.


John


May 16, 2017

Obstetrics, Gynaecology and So Much More…

In our fourth clinical rotation, my clinical partner and I are focusing on obstetrics and gynaecology for the next six weeks. It’s a very interesting lead-in from the paediatrics block, although in some ways it might make more sense for us to have done this block first – paediatrics focuses on (among many other things) babies once they’re in the open air, whereas O&G looks at them from conception through birth. But of course we have already learned a lot about both topics anyway in previous years and this is just getting stuck in more deeply. Block 5 in our first year specifically focused on reproduction and child health, and Warwick’s spiral curriculum means that we are (as always) building on knowledge that we have already gained. Needless to say, I’ve spent a lot of time revising hormone axes and reproductive anatomy from year one!

So far, a lot of our time has been spent in clinics and in teaching, and we are seeing a lot. It’s good to spend some time seeing a variety of gynaecological presentations, especially because the sensitivity of the presentation means that our opportunities to learn from observation in real life have been limited in the past. We’ve seen a lot of textbooks and Power Point presentations. Gynaecological details can be very personal, but of course they are an important part of medicine and so it’s really helpful that we’re getting such exposure throughout this block.

We don’t just pay attention to gynaecological health, of course. Our block also focuses on obstetrics (the health of pregnancy and childbirth) and sexual health as well. Obstetrics is a fascinating part of medicine to me for many reasons. Foetal embryological development plays such an important role in our health throughout our lives. We saw some childbirth and midwifery in our second years, but that was five days in total – this is six weeks, complete with very well-defined learning outcomes and lots of focused teaching. And at the risk of sounding obvious, being born is literally the most common human condition – everyone goes through it. The maternal-health aspect fascinates me as well – when I hear about some of the conditions that some women present with, it makes me grateful that we live in an age of modern medicine. Even one hundred years ago, lots of these conditions could have been a death sentence.

As mentioned above, we also look at sexual health and have spent some time in genito-urinary medicine (GUM) clinics. This is an area that I’ve been interested in for years – and maybe after qualification I will try to pursue it as a career. Dealing with presentations in this area is a fine art. Since it’s so personal, it’s necessary to be extremely sensitive and ensure that you have a patient’s trust at all times. But of course clinicians can’t be embarrassed or ashamed of discussing intimate details with patients. It’s all part of the (very interesting!) job. All of the people I’ve worked with so far have been models of professionalism, and I hope to be the same when in their position. I’m really looking forward to seeing more in this block!


John


April 25, 2017

Paediatrics and Prescribing

We’ve had a few nice weeks so far on the paediatrics ward as part of our Child Health rotation. It’s been a really interesting experience and our timetable has given us a nice distribution between clinics, ward rounds and teaching. The hospital we’re based at has a substantial paediatrics ward, and patients come there for all sorts of reasons. We’ve seen patients with serious infections, patients with severe asthma episodes, patients with mental-health problems and lots of other issues that cause them to be hospitalised. Some are routine, and others are a lot less common – which is of course really cool for us students!

Most hospital wards have the reputation of being functional places without much emphasis on décor or surroundings. The paediatrics ward at our hospital is nothing like that, though. The designers have given a lot of thought to making it a friendly, welcoming and non-intimidating place for children. It has a jungle theme, and there are pictures of wild animals and even palm trees throughout. The floor has a long snake and lots of lily pads for frogs to jump off of! The nurses’ uniforms have a little bit of extra colour around the collars and sleeves to make them seem less severe and more playful. As a child, I definitely would have thought it really cool to spend time in such a nice ward and it’s great to see that so much effort has gone into helping the patients and their families feel comfortable.

We don’t just spend time on the paediatrics ward, of course. We also have spent a lot of time on the Special Care Baby Unit (SCBU), in which newborns with specific problems will spend some time after birth. A lot of the issues relate to either congenital abnormalities, infections or complications brought about by prematurity. We’ve seen some pretty strong babies, and the care that they get from the nurses and doctors is absolutely stellar. It’s also a great opportunity for us to see conditions in real life that we’ve only read about – including some very interesting heart malformations and manifestations of infections.

We have bi-weekly academic days as well, at which we address general topics applicable to all students in all rotations (not just paediatrics). Most of the time, this covers prescribing for core medical systems – as this will be a large part of our jobs as junior and senior doctors. I remember as a first-year student (and even before I enrolled), I honestly thought I would never be able to keep all of the drug names straight. But with time and exposure, it gets much, much easier to remember them all and their indications (I’m still working on contraindications, and interactions, and side-effects, and doses, and everything else). But the instruction that we get on academic days is very useful, and I expect it will serve us well into the future.


John


April 10, 2017

Starting on the Paediatrics Ward

We’ve just started our third specialist clinical rotation and it’s focused on Child Health. This is actually a really diverse block. The medical school in combination with our base hospital puts a lot of effort into making sure that our timetables show expose us to various different aspects of paediatrics, so I’ve been to allergy clinics, development clinics and a few others so far – and it’s only been two weeks. We’ve got a lot more of this coming up over the following month. I wasn’t quite sure what I was expecting, but the care and the patients’ needs seem much more varied than I realised. I guess that’s what medical education is for.

In addition to clinics, we are also expected to spend time on the paediatrics ward and on the special-care baby ward (known affectionately as SCBU), among other places. I’m really looking forward to SCBU and to seeing some of the neonatal presentations. We will get to learn how to perform baby checks and see lots of the presentations that affect babies who are born unwell. Although it’s not an always-pleasant thing to confront, it’s part of someone’s health journey. I know that they’re in the best hands possible when admitted in the SCBU and each patient’s best shot at a happy and healthy life comes from being looked after by the staff there. I cannot wait to see it in action.

Taking patient histories (a mainstay of clinical contact, and something we learn from the first week of the first year) can introduce a different challenge with paediatrics patients: I’m rarely talking to one patient, I’m talking to a patient plus a parent and sometimes two! Sometimes the child is non-verbal, sometimes a grandparent comes along, sometimes the parents don’t speak English as a first language, and so on. These are all real-life factors that can make clear communication a more vital and significant part of the history. Furthermore, it can be really intimidating for a child to have lots of adults paying looking at them and asking questions about their health. We really have to ensure that we make it as non-threatening an environment as possible for the best interests of the patient, and all of the doctors on this ward are experts in this and teach us well.

Additionally, there are lots of components to a paediatric history that don’t have so much relevance in adult histories. For instance, we gather information where possible from parents about the child’s pregnancy and delivery, immunisations, developmental milestones and other social factors such as family life, schooling and siblings. These all contribute to a complete health picture for the patient and help us understand their background better than we otherwise would. It’s really good that the med school give us this practice; we need to have it down to an art by the time finals roll round!


John


April 03, 2017

The End of the GP Block

My clinical partner and I have come to the end of our GP block and it’s been a lot more enjoyable than I ever expected. The doctors at our surgery have all been lovely and extremely keen to teach us, and we’ve seen all sorts of different things come through the door. It’s been extremely eye-opening and educational in equal measure.

It seems that everyone expects GP surgeries to see coughs and colds and little else, and whilst we have seen our fair share of upper-respiratory-tract infections (URTIs, as we know them), we have been involved with a whole lot more. I think the less-than-entirely-complimentary way in which the profession can be viewed by other doctors is not always entirely justified. We have seen extremely vulnerable people who depend on their carers and doctors to help maintain their quality of life. We have seen difficult situations with depressed or anxious patients managed expertly by excellent and empathetic doctors. We have dealt with gynaecological problems, with issues involving sexual health and problems caused by deprivation – and all this in just one day.

The beauty of the GP role is that many times you just don’t know what’s going to come through the door. Just because a patient has a history of ovarian cancer doesn’t mean that she’s going to come in about that; she very well may have just stubbed her toe the night before (more than likely she has an URTI…). It really does require a nimble and agile doctor who is able to think on his or her toes. I liken it to having a massive flowchart in your head, which starts to be followed from the moment you lay eyes on the patient. Of course, every consultation starts with a “Please tell us why you’ve come in today…”, but ideally assessment of the patient comes about from the moment you lay eyes on them. We’re taught this from our first week at med school: does the patient look weak, ill or frail? Do they walk with a frame, stick or cane?, and so on. It really is a huge, complex and multifaceted profession – and one that I have perhaps a little begrudgingly come to love.

I remember one survey which we conducted not long after we started at med school; of the 170-odd people in the cohort, no more than five or six said (or would admit?) that they were interested in becoming GPs. And going into med school, I never thought I’d find the profession attractive. I still am not very, very interested in it, but even I cannot deny that this role is a lot more attractive than I once thought. I guess that’s one point of the block: we have spent several weeks seeing how the career of a GP operates and the myriad things that go on behind closed doors – not just the ten-minute consultations, of course! – and it has been an integral part of our education. I hope that every student who is lucky enough to take part in a GP block at some point in their WMS career gets as much out of theirs as I have out of mine.


John


March 27, 2017

2 blocks down, just 6 more to go!

I can’t believe I’ve reached the end of my second specialist clinical placement, 2 down, just 6 more to go! I enjoyed my time on the paediatric ward. Paediatric history and examination is obviously very different to adult medicine, the differential diagnosis can also be completely different which takes some getting used to! I’m also not used to being around babies or young children so I was quite nervous around them at first but over the 6 weeks after taking lots of histories and examining lots of children of all ages I’m pleased with how much I improved. I can make a neurological exam a fun game and can see the tonsils of the iratest of toddlers and even get nods to yes or no questions from a stubbornly silent child.

I’m now leaving the relative safety of the children’s ward and moving back into the world of adult medicine, starting with the Obstetrics and Gynaecology block. Last year in Core Clinical Education we spent several shifts on the labour ward and with the community midwives, I got to see lots of babies been born and attended antenatal and postnatal check-ups with the midwives. In the O&G speciality block in Phase 3 we will spend some time on the labour ward but will also be in the clinics seeing women with problems during and after their pregnancy. On the gynaecology side, we will be in theatre and clinics seeing a variety of conditions that affect women of all ages.

As well as being in hospital I’ve been busy in my role as president of the Psychiatry society. We’ve had two events in the last few weeks that we organised with the GP society. Both events were on topics that we don’t receive much teaching on in medical school, sexual abuse and eating disorders, both taboo subjects that we as future healthcare professionals need to know about. Our Sexual Abuse Awareness evening had a talk from a Paediatrician who specialised in safeguarding children as well as a talk from a representative from a local charity CRASAC that supports victims of sexual abuse Hearing practical advice about how victims of abuse are assessed and supported by the health service and powerful stories from survivors who receive ongoing support from CRASAC was really powerful and generated a lot of discussion. Hearing personal stories helps us as medical students to understand these sensitive issues so we can be better prepared to help our patients in the future who may have experienced these issues first hand. The same was true of our Eating disorder awareness evening, where we had a talk from a Psychiatry trainee who has worked at an eating disorder treatment centre and a talk from a BEAT (an eating disorder charity) Young ambassador. Hearing from the young ambassador about their own personal experience of suffering from an eating disorder put the medical information from our other speaker in context and was incredibly moving.  The turnout for both these events was great and everyone had lots of questions. It’s great to be involved in organising these events and inspiring other students to be passionate about often neglected subjects.

I think I’ve said before that one of the best things about medical school is that there is always a society or club that you can get involved in no matter what your interests or passions. Getting involved extracurricular activities does help your CV, but for me it keeps me motivated and stops me getting bogged down in medicine too much. Sometimes you can get to wrapped up in the seemingly never ending cycle of placements, sign offs and exams and having something else to focus on helps me keep some perspective. So here’s to block 3 of 8-bring on Obstetrics and Gynaecology!


Joanne


March 13, 2017

Vulnerability

We’re just over halfway through our six-week GP block, the second of eight Specialist Clinical Placements. Our surgery is a lovely, pleasant place in an area which draws on a very diverse population. We get to see a variety of problems and presenting complaints – although as it is wintertime, we are definitely seeing more than our fair share of coughs and colds. I am slightly relieved, however, as we have been told that hayfever season is just round the corner- it’s such a shame, but unfortunately we are going to miss it!

A lot of GP work involves what we typically think of a GP as doing: there are consultations in surgeries in the famous ten-minute slots (or fifteen minutes, if you’re a medical student). Some surgeries have also started introducing telephone consultations, where they assess patients over the phone (where appropriate, obviously) or home visits, for patients who are very infirm. Our surgery does all of this, and more, and it’s been really interesting watch the different ways in which they engage in the community and serve the members.

It’s probably less well known that many GPs also see patients who are at care homes or nursing homes as part of their daily or weekly routine. We accompany the GPs along on some of these visits for several reasons. We go to get a good feel of how care homes are run and patients’ problems present there. We go to see different ways in which GPs’ knowledge is put to use. We also go to gain an understanding of other patients’ experiences and to see how they live and are cared for.

Recently, we visited a care home which houses patients who have suffered brain injuries. It was very interesting and – I can’t lie – it made a profound impression on me. It made me think of many things at once. I am so happy and we are all so lucky to live in a society where people who are vulnerable (or in some cases completely unable to look after themselves) are still treated with dignity and care. It made me proud that they are still able to get care from the NHS. (I come from a country in which such a thing absolutely does not exist.) Finally, it made me realise that being a good doctor, a good GP, is not just caring for those people with coughs and colds and allergies; it is looking after everybody in society. We are trusted to help and care for those who are vulnerable and it is a massive responsibility. I will never forget visiting that care home, and I will never forget the dignity those patients are given, day in and day out. It made me proud to continue doing what I am doing.


John


March 07, 2017

Life on the children’s ward

Well I survived my first graded OSLER which took place in the last week of my General Practice block. It was hard to take the history in ten minutes and answering lots of questions about differential diagnosis and investigations from the examiners was daunting but I received really positive feedback and I’m very happy with that after my first senior rotation! 3 weeks on and I’m now half way through my child health block at Warwick Hospital. It’s strange been back in hospital having not been in full time since before second year exams. In some ways it feels like a step backwards, from conducting entire consultations and delivering management in GP, I’ve now gone back to loitering behind a consultant on ward rounds and standing sheepishly in the corner waiting to present cases.

At Warwick hospital our placement is organised around time on the children’s ward, the special care baby unit and in outpatient clinics. The children’s ward is a very busy place and very different to other wards. There is a playroom and all the walls are covered in animal paintings and each bay or cubicle is full of family members and a variety of toys. Many children are sent straight to the ward and bypass A&E so there are lots of new patients every day, which means there are lots of people for medical students to clerk! Conducting histories and examinations in children can be tricky to say the least; histories often come from multiple people, parents, grandparents, school staff and the child themselves if they are old enough. Histories are taken while shouting over the top of a screaming child and examinations are opportunistically performed on children trying to wriggle away!

The special care baby unit (SCBU) in contrast is the quietest place in the hospital. This is for premature babies (under 34 weeks or under 2.5kg) and term babies who need additional care. We have lots to learn about common problems that can occur in premature babies and in the immediate postnatal period so there is lots to learn on SCBU. It’s also a great place to get to grips with how to look after newborn babies-something which most of us have little experience of! We can also visit newborns on the postnatal ward and help with the newborn baby checks which is always fun.

In contrast to UHCW, Warwick children’s department is very small but there are still lots of clinics to attend. There are some specialist clinics, for example for children diagnosed with Type 1 diabetes and there are general clinics with a wide variety of conditions. For example in clinic today I saw children presenting with bed wetting, abdominal pain, and headaches as well as children who just weren’t gaining weight. A lot of what paediatricians do is reassure parents and give advice about normal development in children, this may seem a bit dull at first but they have to always consider more sinister causes and ensure these are ruled out. Children can often present with non-specific symptoms and it can be difficult to take a good history, so from what I have seen so far I think you need to be a good detective in order to succeed in paediatrics-something I will need to practice!

Joanne


February 24, 2017

General Practice Rotation

We Phase-III students are now well into our second Specialist Clinical Placement (SCP) of eight in 2017. After six weeks learning all about Musculoskeletal Health, my clinical partner and I are now on the General Practice (GP) block through the end of March. It’s been an overall wonderful experience so far, and we both hope it continues to be. Every clinical-partner pair in this block is assigned to a local GP surgery, most of which are local to the medical school and South Warwickshire. Our practice is a very diverse one, and we have worked with five or six different GPs so far – and we’re only two weeks in! We of course had GP placements during our second year (Phase II) as well, and we rotated through three different practices over the course of our 30-week Core Clinical Education block.

There are some similarities to our consultations in Phase II but it’s also different in many ways. First of all, our time slots are a lot shorter. We’ve generally only got fifteen minutes per consultation (much shorter than 20 minutes – or sometimes 30 – during CCE). Secondly, we know so much more this time round! It’s amazing to think of how much we’ve learned in such a short time period. And finally, and most importantly, we are much more actively involved in the entire consultation – from history to management and safety-netting (ensuring that more-serious conditions are accounted for when discharging a patient). I feel like we are taken very seriously by our supervising doctors these days; this gradual increase in responsibility (and accountability) will help us well when we qualify.

We also spend time observing the consulting styles of different GPs at the practice, which is extremely valuable for our development from students into doctors. It’s really important to see how different people handle different situations with patients, and it’s also a vital part of our medical education to learn how to be flexible and adaptable. I cannot count the number of times that a consultation has come to an end and I’ve been amazed by the way a GP has dealt with a tricky topic or adapted a message to a specific situation; I know that this can come with years (and sometimes decades) of practice, but it really useful for us to observe these skills so that we can develop them for ourselves.

And of course, the GP block isn’t just sitting in on consultations with live patients. We have a lot of skill-building exercises and off-site teaching as well. Our block gives us two days per week at the medical school. Once per week we have teaching in very small groups, where we spend the day talking to simulated patients who present with a specific set of problems. For instance, the theme this week was “difficult consultations”, where we had to deal with very sensitive diagnoses and figure out the best way to discuss them with the (simulated) patient. My session had an actor playing a woman who had just tested positive for an STI, and I had to discuss the diagnosis and possible causes with her. It was a little awkward to discuss these issues for the first time, but I’d much rather it be awkward with an actor than with a real-life patient. Broaching sensitive subjects with patients, and bringing up topics that they might not want to hear, is of course a skill which is not used only in general practice; these are skills that are useful to doctors of all disciplines.


John


February 13, 2017

The End of SCP1 and Farewell to Musculoskeletal Health

It’s so hard to believe that we are already in Phase III. I swear that we started our induction week just the other day. But as we are now in the final push, we will be spending the rest of 2017 in our Specialist Clinical Rotations (SCPs). These are six-week deep-dives into eight specialist areas of teaching, which are intended to make us all well-rounded medical students and doctors and give us sufficient education and knowledge about a very wide variety of topics. Our cohort is divided into eight evenly-sized groups, and we cycle through our different rotations throughout the year. This is probably my least-favourite time of year, however, as the mornings in January are so dark and it’s so difficult to find the motivation to wake up when the entire world seems frozen! I’m really looking forward to summer – or even spring – when thins brighten up a bit and we leave home at least when it’s not pitch black out.

My group is just coming to the end of the Musculoskeletal Health block, in which we have spent the past six weeks working closely with consultant orthopaedic surgeons and rheumatologists. It has been absolutely fascinating, and I've been enjoying it far more than I thought I would. I’d seen a few joint replacements and sterile injections in the past, but this block was so much more than this. Our time has been more or less evenly split between both sub-disciplines, and we've been spending a lot of time in clinics, teaching sessions and have had the fair bit of theatre time thrown in. This block seems to be far less ward-based than any one I've had so far, probably by the nature of the patient contact. And we have a specific sign-off list that ensures we get as broad an exposure as possible.

The MSK faculty team at the hospital we’ve been based at have been really engaged in teaching and have all been really keen to help us learn. It’s really helpful. We’ve had all sorts of formal and informal teaching, and because I really like anatomy and the mechanical functioning of the human body, I’ve really got a lot out of this block. And I feel that we are taken much more seriously as end-stage medical students than we were in CCE (in Phase II). We have attended several teaching clinics, which are clinics in which we see patients, under the supervision of a doctor, and then are given feedback on our performance. It’s really useful to have this feedback, because even though we won’t have final exams for a year, every bit of constructive criticism helps.

The best part of the block has almost certainly been the direct attention we get from consultants – the experts in their fields. It’s so humbling to see these people who are absolutely excellent at their trade working well with patients. I’m really motivated to work hard now, because I’ve been working really closely with people who are just so good at their jobs; it’s really awesome to see. We start the GP rotation next Monday, so I’m hoping that we’ll have another great round and learn a lot more!


February 07, 2017

First feedback then feedback some more!

With just one week left of my first senior specialty placement, my time in general practice is almost over. I can’t believe it’s only been 5 weeks, Christmas holidays seem like a lifetime ago! I’ve really enjoyed my placement in general practice and am so pleased by how much I have improved. In my first few weeks I wasn’t sure about even my history or examination and now I am able to conduct an entire consultation and deliver the management plan. I’ve been able to tell patients that they don’t need antibiotics or the scan they were expecting and have been able to explain why to ensure that patients are happy with the plan going forwards. In the past week myself and my clinical partner have even been conducting our own independent consultations. Conducting a consultation from start to finish but without the supervision of the GP is really nerve-wracking. Even if it’s a relatively simple problem it feels strange to not have the safety net of the GP’s presence to check you are doing the right thing! It’s also strange as in most other areas of medicine we are a long way off from independently manging patients, been given that responsibility in GP is a privilege and a great learning experience.

I’m sure I wouldn’t have improved as much over the course of my placement without excellent feedback from both my tutors and my clinical partner. As we often see similar cases you have the opportunity to improve your performance, ask the questions you forgot last time and improve your examination technique. Another great source of feedback are the activities during our GP academic days. We video some of our consultations and then discuss them in small groups, critically analysing our own performance and our colleagues. This sounds really cringe worthy, and while it takes a while to get used to how your voice really sounds on camera, it is really helpful to identify what you did well in a consultation and also where you can improve. We also get to use SIM patients (actors) to practice difficult consultation scenarios such as breaking bad news and multiple problem consultations. In our small groups we all get the chance to practice and receive feedback on our performance. This is also quite scary at first but it’s so helpful to both give and receive feedback. It makes you start to look at your consultation skills in an analytical way which again helps you improve.

In our last week of our placement we will be conducting a finals style OSLER exam. This is where we conduct a consultation under exam conditions and receive a grade on our performance, just like in finals! I’m really nervous as taking a quick and efficient history isn’t my strong point but it will be helpful to know where I am at the start of our speciality placements. Keep your fingers crossed for me!

Joanne


January 26, 2017

Musculoskeletal Health Care…

Our cohort is a few weeks into the first of our eight Specialist Clinical Placements (SCPs) and 2017 is stretching out before us. Although it seems long, the time is actually going by quite quickly. I wouldn't say it's exactly fun, but I'm enjoying myself tremendously on this block and am learning a great deal.

My first rotation is the MSK block (musculoskeletal health), which is pretty self-explanatory. In this block, we become more familiar with problems of joints, muscles and bones (and nerves and connective tissue and some skin and so many other things as well...). Many people run a mile when they think of anatomy and memorising lists of muscles and bones, but block 4 in the first year (Locomotion) was actually my favourite block and I'm loving the MSK placement. We've seen so many things that I wasn't expecting and we're only just over three weeks in.

As is probably fairly obvious, a lot of the work revolves around bones and joints - so we see fractures and their treatment, joint replacements, and that sort of thing. But of course they don't exist in a bubble - for instance, fractures are often accompanied by soft-tissue injuries and we have to know all of the repairs that come along with them. Getting a new knee or a new hip is a major operation and can take weeks or months to recover from fully. A lot of the learning we've done in earlier years around the biological, psychological and social impact of health conditions has come in very handy in understanding the lives that our patients live and how injuries might change them. It's proven incredibly applicable now that we are seeing more patients in a clinical setting than we did in the first years of the course.

I was not expecting that we'd be taught rheumatology as much in this block as we have been. It's a very diverse field and there's so much going on! The more I see of it and the more I learn about the speciality, the more interested I become. The patients are very interesting and diverse, and being an effective rheumatologist requires extensive knowledge of many branches of medicine and the ability to pull them all together very quickly. Since rheumatological diseases can affect multiple body systems, specialists in this field need to be quite broad in their knowledge and approach. We have seen patients with rheumatoid arthritis (of course) but also psoriasis (and the multiple effects that it has), polymyalgia rheumatica, systemic lupus erythematosus and several other conditions that we've only seen in textbooks before now.

I'm enjoying the block so much, I'm really gutted that it is coming to an end so soon. But of course new adventures await in the next placement, too.

John


January 16, 2017

New Year's resolutions…

The start of a new year is always filled with hope and ambitious plans for the year ahead. For myself my new year’s resolutions were to continue to maintain a good work/life balance so I had time to exercise and look after myself and I also wanted to work consistently throughout the year so I could avoid the exam panic that I experienced in my second year. Two weeks in and my first specialist clinical placement (SCP) is creating problems for both my resolutions!

My first SCP is in General Practice. I was lucky to get my top choice of practice which means I can cycle or walk to my placement, this helps with my new years resolution to keep active, however the days in GP are very long so the work/life balance is a bit skewed at the moment. I really enjoyed our GP placements in second year, so was looking forward to it this year. Now that we are 3rdyear students we are expected to be able to complete the whole consultation (including management) for most cases. This was really scary at first, but even just two weeks in I can see how much I have improved. In my first week I wasn’t even sure of my examination findings and would let the GP take over for the management part of the consultation but now I am happy reporting my findings and saying what I think, safe in the knowledge that the GP will correct me if I’m completely wrong!

I’m also really enjoying the variety that comes with GP. Not only do you see medical conditions affecting all the different systems of the body but there is also a big range in terms of severity. It’s certainly not just coughs and colds! I also enjoy getting to know patients better, something we are encouraged to do in GP. The social aspects of the history are very important in GP, the job a person does may affect their illness or pain management and their situation at home may have a bigger impact on their mental health than any medication we can give. As a GP you need to understand the patient and their illness in the context of their life, something that is often forgotten in other specialities.

One skill in particular that is very important in GP which I still need to develop, is learning that it is ok to do nothing. It’s sometimes much harder to listen to a history from a patient who has been really unwell with a terrible cough and who is short of breath and tell them that they don’t have a chest infection and just need rest and paracetamol, than it is to hand out a prescription. During medical school I’ve been trained to recognise signs of illness and what to do when I find them, but saying to a patient that you don’t think anything is wrong and being confident in that decision is a skill in itself. Knowing when to do nothing and stopping unnecessary medications are a huge part of a GP’s workload. We have visited local care homes with our GP tutors and most of the visit has been crossing off unnecessary medications which might actually be doing more harm than good. All Doctors take the Hippocratic Oath which says “Do no harm”, I now understand that “Do no harm” isn’t just about treating disease, it’s knowing when not to treat, and that is actually much harder.

Joanne


January 06, 2017

The Start of Specialist Clinical Placements

We third-year students have successfully navigated a lot in our medical career so far, but it looks like 2017 is going to be the busiest – but most exciting! – phase yet. We’ve had a year and a half of pre-clinical work, covering all major systems of the body and lots of multi-system disease presentations. We’ve had a long spell of core clinical education. We’ve all done our own research projects, complete with lengthy write-ups and, of course, reflection. We’ve been through two cycles of exams and have made it out the other side. And now we have just started the final push: earlier this week, we began the first of our Specialist Clinical Placement (SCP) blocks, where our education now focuses on particular areas of medicine in preparation for finals and practice beyond.

Our cohort is split into eight groups of roughly equal size, and these groups rotate through eight placements across our main hospital sites. My clinical partner and I are in the Musculoskeletal Healthcare (MSK) block, which is actually extremely interesting – much more interesting than I was expecting. The great thing about the Warwick curriculum is that it is spiral learning, which means that we are encountering topics and building upon knowledge that we’ve got several times throughout the course. For the MSK block, this means that a lot of knowledge we gained in Block 4 of the first year – the one called Locomotion – is really coming in handy now. Our knowledge of muscle and bone anatomy, innervation and blood supply is being called upon with alarming regularity!

Of the five blocks we had in the first year, my favourite was actually Block 4. I liked the tangibility and unchanging nature of human anatomy. There are some structures that are complex, but they just need to be learned. And once the difficult material has been learned, it really isn’t going to change. Now I’m most looking forward to seeing how specific pathologies present and how they are corrected, and spending some serious time in clinic with specialists. I’m also looking forward to surgery and watching some hands-on reconstruction work happening.

And even though I was expecting this SCP block to be heavily anatomy-based, there is a great deal of rheumatology taught as well. This is a topic area to which we aren’t exposed very much in Phase I and Phase II, but we are making up for it now in Phase III. We are scheduled to attend several rheumatology-teaching sessions and have already spent lots of time in rheumatology clinics and so on. It’s been really interesting and we’ve seen a wide variety of cases – obviously there is rheumatoid arthritis, but also polymyalgia rheumatica, psoriasis, osteoarthritis and lots of other conditions. Patients of course will also have several comorbidities as well. I know this sounds naïve, but I had no idea the field of rheumatology was so varied and interesting. I might have to look into it further for possible career options...!


John


December 13, 2016

It's beginning to look a lot like Christmas…

For myself and the other 3rdyears it’s the start of our Christmas holidays. The 2ndyears have already had a week off, the poor first years still have a week to go and the 4thyears are in finals revision mode! I managed to conquer the data analysis of my SSC2 project and handed my project in on time (phew!), however the work on my project doesn’t stop there. My supervisor wants us to publish which would be very exciting but this will inevitably mean more writing and more stats (boo!).

Since our 8 week project finished we have been on Advanced Cases 2 which has been a mixture of lectures and time in hospital to refresh our clinical skills before our specialist placements in January. The lectures in AC2 have mostly been revision as well as information about our upcoming specialist blocks. It’s been really exciting to hear what we will be doing in our specialist blocks but also terrifying. My last block is the Musculoskeletal block, and hearing about the OSLER (a clinical exam) we will do at the end of that block terrified me. At that point next year I’ll be 6 weeks away from finals! My first block in January is GP, which I think will be a really good introduction to all aspects of medicine and a chance to practice all my examinations and histories. The GP block is going to have dedicated teaching days which sounds really helpful and we are also going to have filmed consultations. This sounds horrible but it’s actually really helpful. You might realise that when talking to patients you are always nervously biting your lip or that you say “like” in every sentence (I can’t help myself!).watching yourself on video gives you a chance to work on these bad habits as well as identifying things that you are good at and need to keep doing. The scary thing about the GP block is the “independent consultations”. This is where my clinical partner and I will take an entire consultation with a patient and only consult the GP at the end to see if we did everything right-eek!

Also during AC2 we started working with our new CBL groups. Having been with my first CBL group for 2 years I didn’t really want to change as we all got on so well but as a Doctor you will be changing teams every 4-6months so it’s important that get used to working with different groups of people. Our first task as a new CBL group was a small presentation on complementary and alternative medicines, not everyone’s favourite topic but certainly an interesting one! Although I didn’t know the people in my new group very well we all worked well together with the help of some home baked cookies thanks to one of my new CBL colleagues!

Over the last few weeks I’ve also been busy with The Psychiatry Society as we prepared for our December event “The West Midlands Forensic Psychiatry Symposium”. We had students from Birmingham and Keele attend, and a great turnout from Warwick Students. It’s been great working with the committee on such a big event and I’m excited for our upcoming events in the new year! Working with other students on the committee from other year groups reminds me of how far I’ve come, I can’t believe I’m now a 3rdyear medical student entering my final year of clinical placements. Here’s to 2017!!!


Joanne


December 09, 2016

Autumn Term drawing to a close.

The autumn term of our third year is drawing to a close and it’s hard to escape the feeling of mild terror that surrounds me. It’s been a great term, and I’ve learned so much, but I know that things are going to get a lot busier for the rest of my time at medical school after the coming Christmas break.

First we had eight weeks of our Student-Selected Component, a research project designed to acquaint us with the world of medical research. Students could either design their own projects or use one which was arranged by the medical school. I elected to do my own, and after a herculean feat of organisation and form-filling, managed to spend a month in The Gambia collecting data for an audit on tuberculosis investigations. It changed my life. The research project was very interesting, and it piqued my interest in global health – and especially the plight of those outside of the UK who are far less fortunate than we are. I read a lot of articles about TB diagnosis and spent (probably) far more time than I would have ever thought I would poring through WHO reports.

After SSC, we enjoyed three weeks of Advanced Cases 2, which combined lots of familiar elements of our course. Over the three weeks, we had Monday and Tuesday in lecture, and Wednesday through Friday on the wards. The lectures have been either covering old topics, introductions to the upcoming Specialist Clinical Placement blocks or covering an entirely new topic afresh. It’s been great to spend some time in the lecture theatre again after a few months of being away. I appreciate the structure and have found that it helps me learn better.

We also met our new CBL groups – after the first two years with the same CBL groups, we have now landed with an entirely different bunch of people. But the great thing about our course is that (I strongly feel) the people really are selected because of, among other things, their ability to work with others. I don’t know anyone in my group terribly well, but I know that we’ll get on just fine because everyone in the cohort is a very easy and personable person to work with. Initial suspicions have so far proven completely correct.

I’m looking forward to the start of clinical placements but have a little bit of apprehension as well. When I think of what we need to know – and know automatically, without hesitation! – before our final exams, a mere 14 months away, I am frankly terrified. But a very wise GP (also a Warwick grad, of course!) once told me that the key to memorisation is repetition. The more you see something, the more likely it is to stick in your head. I’m hoping she’s right. Now it’s just a matter of getting all that stuff onto paper and seeing it in practice. I know what I’m doing over my Christmas break!


John


November 28, 2016

Back to Lectures and Wards…

The Student-Selected Component phase in our curriculum has come to an end, and despite the fact that we are all feeling a bit more refreshed and ready to dive back into some more structured learning opportunities, there certainly was not much rest for the weary this week. For the next two-and-a-half weeks, we are participating in Advanced Cases 2. This is basically an introduction back into the world of lectures and wards and clinics and preparation for Phase III, which starts next year. In each of these three weeks, we have two days of intense lectures followed by three days on the wards to re-acquaint ourselves with the buzzing hospital world.

The four weeks I spent in The Gambia collecting data for my project seem about a million years ago now. Getting used once again to the autumn weather in Coventry after what felt like a scorching heatwave in Banjul (but was evidently a perfectly normal autumn, albeit one with highs of 35!) was tough, but I was able to gain a great deal of clinical exposure out there alongside my data collection, and I saw first-hand what it was like to practice medicine in a developing country with much fewer resources than we can access here. This has affected my perception about healthcare here in the UK as well, and will definitely colour my approach to practicing medicine in the future. For one thing, I have learned to never take for granted the provision of plentiful, adequate supplies and antibiotics. For another, we are extremely lucky in the UK to have excellent primary-care services which are provided free at the point of contact. This is lacking in many parts of the world.

We had lectures earlier this week about varied topics that we will be encountering next year in our cycle of speciality placements, including things like foetal development and monitoring, gynaecological emergencies, childhood neurological development and safeguarding – and that’s just over two days! It’s been extremely interesting and extremely relevant, and we’ve had a great time re-acquainting ourselves with these topics. Among other things, it underscores the value of repetition to assist memorisation. It’s really daunting to think about how much stuff needs to become automatic before we’re fully qualified, but when I look back over how much I’ve learned since starting med school 27 months ago, I’m confident that we can all do it.

Now, in addition to lectures, we have been turned loose on the wards again. But this time, if only for a short interlude, it’s different to CCE: it’s great to be in an environment where we can refine our clinical skills – and for the next few weeks, we can do so without the pressure of assessment. Once again we are distributed across our main hospitals in this trust, but this time, as opposed to CCE during our second year, it doesn’t feel like we’re dropped in the deep end! We are much more familiar with how each practice works and the layout of each of the wards, and it seems to be going really well. I am really looking forward to getting as much as possible from this part of the course.


John


November 22, 2016

Returning to the wards…

Well it’s the final working day of my 8 week student selected component (SSC2) and unfortunately I haven’t quite finished my project, things always take longer than you expect and data analysis is no exception. I’ll have to work hard over the remaining weeks to meet the deadline but at least the problem I have is too much data rather than too little! I’ve really enjoyed my project, it’s been totally different to any research I’ve ever done before and the results are quite interesting so hopefully I will be able to publish them in a journal. As we have entered third year we’ve already had talks on the application process for the UK Foundation programme, one of the things you can score points on is publications. While I was lucky to publish during my PhD, for other students, SSC2 is a unique opportunity to get involved in a project that they could publish and boost their score (and their CV!).

I’ve also been settling into my new role as President of the Psychiatry Society, we’ve had a few meetings now and had our first event, which was a great success, and are planning a West Midlands wide symposium on Forensic Psychiatry before Christmas. I was already interested in psychiatry due to my previous degree but it’s not the most popular speciality. Been involved in a society puts me in touch with like-minded people and gives everyone an opportunity to get involved in something they are passionate about. There are societies for lots of different branches of medicine here at Warwick so no matter what your interests you’ll be able to find a group of like-minded people to work with. As well as all the extra-curricular activities you’ll find within the medical school if you look a little further there are lots of amazing opportunities out there. The medical school inform us of prizes or conference bursaries we might want to apply for and I myself decided to apply for a Pathfinder fellowship from the Royal College of Psychiatrists, this is a scheme designed to nurture people interested in psychiatry from the end of medical school until they apply for speciality training. After a scary interview in London I was told I had been successful so I’m really excited to be part of this national scheme. All the Royal Colleges have discounts and prizes for students and many of them offer mentoring opportunities. It really pays to keep your eyes open for these opportunities as they are great for your CV and sometimes the purse strings!

Next week the 3rd years return to lectures two days a week and then spend the rest of the week in hospital. This is Advanced cases 2, lectures to prepare us for our speciality blocks in January and a chance to refresh our clinical skills. I’m going to be based at the large hospital in Coventry, UHCW. Myself and a group of other students have been assigned to a cardiologist, gastroenterologist, palliative care doctor, oncologist and some anaesthetists who we can all spend time with. I’ve not spent time in some of these specialties yet so I think I’ll try and make the most of them as next year our timetables aren’t as flexible.

Medicine is really what you make of it, be it how many extra-curricular commitments you have, how you use your clinical placements or how you study from lectures. Sometimes I make life difficult for myself by trying to squeeze too much in, but if I’ll only be a medical student once and I’m determined to make the most of the freedom being a student brings.. at least until I have to start revising for finals!


Joanne