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September 27, 2017

The End of the Surgical Block and the Passage of Time

Our sixth block, officially known as Care of the Surgical Patient, is coming to a close already. I swear it just started the other day, and yet it’s already almost over. Like lots of specialist-placement blocks, it’s been a very self-motivated learning experience. This is something I wasn’t quite expecting about the course: as a student, we are given a framework of learning opportunities and then, depending on the block, we are expected to fill in some portion of our timetables by ourselves. This requires a very proactive student who isn’t afraid to get stuck in and talk to the right people, but can also take some getting used to as well.

I spent the first few weeks of the surgery block really enjoying vascular surgery (really, it’s very cool!) but then branched out to learning about other forms of surgery in the last couple of weeks. You really have to do this in the trust where we did our surgery block. I spent some time with colorectal teams and going to lots of follow-up clinics in other areas – breast surgery, urology, even the ENT (ear, nose and throat) clinic for an afternoon. It was absolutely fascinating to spend time in underexposed parts of medicine and surgery, and I’m acutely aware that these might be the last opportunities for a long time that any of us students get to see such a wide variety of disciplines.

One big surprise of this block was that, interestingly, it contains a lot less exposure to actual operations than I initially expected. This kind of makes sense, however. I guess that a lot of what we as students and foundation doctors have to know has far less to do with actual surgery and far more with knowing about conditions that would cause an operation to be necessary (and there are plenty), how to assess a patient immediately before an operation, how to treat them afterwards, and of course the anaesthesia care before, during and after as well. I don’t think foundation-year doctors even make it into theatre for operations, so that realm is basically reserved for registrars and consultants. Even though I found surgery really interesting to watch, I’m glad to have had the opportunity to gain knowledge in other related areas too as it feels much more relevant to our education at this level.

Soon we will be starting the acute block, which means that our seventh – and penultimate – block will begin. A new cohort of medical students (I remember when we were that young and excited!) will be starting and we’ll now be top of the heap. I’ve been interested in emergency medicine for a while, so this block is really exciting to me. Although we have our fair share of overnight and odd-hours shifts, I think it will be really accurate and a good opportunity for us to understand what emergency medicine is like – plus I want to see if it really is like 24 Hours in A&E! I am very excited about this next block and anticipate a lot of excitement.

September 21, 2017

Spending time in clinics!

Well, the pace of the fourth year hasn’t slackened at all, and things have picked right back up after our summer break. I’m still really enjoying the Care of the Surgical Patient block and am learning loads at the same time. I’m not only spending time in the theatres and on ward rounds, but also attend my fair share of clinics. A clinic is (usually) a half-day session where the doctor has appointments to meet patients alone in a treatment room and discuss their condition. Clinic appointments can be either new referrals or follow-ups; the nature of the follow-up appointments varies depending on the discipline. Some people with lifelong chronic conditions will check in with their doctor every six months or every year or something. But others, for instance after surgery or a broken bone, will come in for a meeting just to make sure that everything is OK before being discharged.

I like the nature of clinics and find them very useful to attend. It’s much easier for me to remember details of a condition when I can attach a person’s name and face to it. I can almost walk through the consultation in my head after the fact, which helps me remember investigations and management. You’re not guaranteed to see everything in a clinic, but you’ll definitely see more by attending than if you don’t go at all, and that’s what I like about them. In this block, we have the opportunity to attend a great deal of post-surgery clinics and some pre-surgery clinics as well – including vascular clinics (lots of foot ulcers and artery blockage), colorectal clinics, ENT (ear, nose and throat) clinics, breast clinics, urology clinics and more. It’s great that the organisers of the block are giving us so much of an opportunity to take advantage of what our huge hospital has to offer.

In addition to a main surgical consultant, we are also assigned to an anaesthetist (or two…) for the block and are given a lot of anaesthetics training and tutorials. I have had the privilege of spending some time in theatre with my assigned anaesthetist and have learned a great deal about the science of anaesthetics and how a lot of our physiology needs to be taken into account when anaesthetists do their jobs. It’s not all about making people unconscious and then waking them back up – so many things need to be monitored and kept within safe ranges whilst a patient is being operated on. The list of things to monitor and that can go wrong is really endless.

I recently saw an operation on a patient who was having an adrenal tumour removed; an excess level of adrenaline and related hormones were being released by the adrenal gland directly into the patient’s bloodstream. So before the gland was removed, the anaesthetist had to administer drugs to counteract the effects of the adrenaline: the patient’s heart rate and blood pressure had to be brought down and kept within safe ranges to avoid the effects of high blood pressure. But – and this is where teamwork with the surgeons comes in – as soon as the gland was removed (and ideally a few minutes before), supplementary adrenaline had to be given for a while to counteract for the sudden deficit that the patient’s body was now experiencing. Watching the physiology literally in action was absolutely fascinating and an extremely worthwhile use of my time. I cannot wait to see more!

September 12, 2017

In Demand…

Having started my acute block on the acute medical wards, clerking relatively stable patients, I have spent the last two weeks on the Intensive care unit (ITU) and in A&E where stable is not a word used to describe many of the patients!

The ward round in ITU was one of most fascinating ward rounds I’ve been on as a medical student, many of the conditions you read about as a medical student thinking you will never actually see were there, as well as patients recovering from major traumas with multiple injuries. On ITU patients conditions aren’t just identified and treated, patients are only on ITU if one or more of their organ systems need support. That might be blood pressure supporting drugs in the case of a patient with life threatening sepsis or in more severe cases patients may require multi-organ support, for example, dialysis for kidney failure as well as mechanical ventilation to allow them to breathe. Patients in ITU have 1:1 nursing and are constantly monitored, as such a stay on ITU is very expensive and there are only so many beds, dictated by the number of staff available. ITU beds are in high demand; deteriorating patients around the hospital are referred to the ITU registrar who can then discuss potential new admissions with the consultant. In addition as UHCW is a major trauma centre there is also the possibility of a major trauma arriving that may require admission. Deciding who to admit to ITU is a murky area with no strict rules; does the patient need organ support right now, are they likely to survive even with ITU support? Unfortunately using a crystal ball isn’t an option.

Patients often get referred to ITU from A&E and while it’s much easier for patients to get through the doors of A&E, demand is so high that getting a cubicle to actually assess a patient is not so easy. In just a handful of A&E shifts I’ve seen queues of patients on ambulance trolleys, paramedics waiting to handover their patients to the nurse in charge while the nurse is frantically trying to find a space. Reading about this in the newspapers is disheartening but actually seeing it is shocking. Demand is so high and while some A&E attendances are inappropriate the vast majority aren’t and need to be seen. It was nice to feel useful as a medical student in A&E by helping the doctors clerk patients, take bloods and insert cannulas (my success rate has now improved to 50:50-good for me, maybe not so good for the poor patients!). Seeing a wide variety of presenting complaints was really interesting and used lots of different skills. In Minors I saw lively children injured in various trampolining /climbing incidents, a few sports injuries ranging from badly sprained ankles to fractured bones and even a builder with a chemical injury to the eye. In majors I saw first-hand what happens when social care fails our elderly patients, patients discharged from hospital one day and then back again the next. I was able to observe the treatment of an acute asthma attack, something which can be quite scary but didn’t seem to fluster the experienced A&E consultant. I was also excited to be asked to see a patient had been referred urgently by their GP for a possible stroke, which I correctly identified as Bell’s palsy-a relatively benign condition that will improve in time on its own.

I don’t think there is ever a dull shift in A&E and despite some of the problems with the system it was inspiring to see the Nurses and Doctors in A&E working as a team-and actually feeling like I was a contributing member of that team! I have more A&E shifts over the final two weeks of this block, here’s hoping my cannula success rate improves!

September 01, 2017

Finals countdown…

After a relaxing two week break I have emerged from my chrysalis as a fully-fledged final year medical student. Do I feel any different? Do I look any different? People certainly seem to be treating me differently, all the focus is now on job applications in October and final exams in February next year. Doctors teaching us in hospitals have high expectations and seeing students from the year above us now working as FY1 Doctors is inspiring fear rather than confidence! I don’t think I have felt this nervous since freshers week, nervous feelings about the task ahead have resurfaced now that my ambition to become a Doctor is almost a reality, with a few final hurdles to overcome.

I embark on my final year by starting on my Acute Medicine block. This block is split between UHCW in Coventry and Warwick hospital. We spend time in the emergency department and the acute medical wards, doing a variety of shifts so we can see as many patients as possible. I’ve spent the first two weeks of the block on the acute medical wards at UHCW. These are interesting places to be as a student as you get to see lots of patients presenting with common medical problems that will come up in finals. Patients are clerked in A&E and once its decided that they are stable and need medical treatment as an inpatient or are waiting the results of investigations they come to the Acute medical ward (AMU) at UHCW. The doctors on AMU then clerk the patient and then arrange or follow up investigations and start treatment. There is a huge variety of patients on AMU at any one time. Patients may have come in with chest pain and shortness of breath so things like heart attack or pulmonary embolism need to be ruled out even if you suspect a chest infection. Some patients may need to be admitted under a particular medical specialty and will move once a bed becomes available and for others they can stay on AMU and leave after a few days of treatment. As a student you can clerk patients, help take bloods, insert cannulas and attend ward rounds and because its AMU, every day there are new patients to figure out.

Another area we have been assigned to is the Medical decisions unit (MDU), where patients are referred in by their GP for tests or treatment only available in hospital. These patients are usually not acutely unwell or unstable but they have presented with a problem that could be serious. For example if a patient presents to their GP with central chest pain that came on after eating a large meal, the GP simply doesn’t have the tests available in the community to rule in or rule out a heart attack even if it sounds like heartburn, that patient needs to come to hospital for further tests but they don’t necessarily need to come in an ambulance and wait for several hours in A&E. In MDU the tests can be done quickly and so patients can either be reassured confidently or brought in for further treatment. MDU is one of my favourite places to be as a medical student and it is great practice for finals. You can take a fresh history and examine the new patients and decide what your differential diagnosis is and what tests you want to do and then present it to one of the junior doctors who will agree (or disagree!) with you and who can organise the appropriate tests. Over the course of your shift you can chase up the results and actually find out if you were right and can decide on the management with the juniors and consultants. It’s a great chance to present cases to seniors and get feedback on your clinical reasoning skills and management.

Aside from getting to grips with the acute block I have also made a revision planner for finals, having the next 20 weeks before my first exam planned out and stuck to my study wall is terrifying! Hopefully when I start my A&E shifts next week that will provide a welcome distraction from my revision planner and the countdown to finals!

August 31, 2017

Care of the Surgical Patient – and the Beginning of Year Four

When I first became a medical student, being a fourth-year student seemed such a distant place to be. Before getting there, we had lectures to sit through, ward rounds to attend, and – who can forget? – exams to pass. I used to look in awe at the fourth-years I knew and think, “Wow – they must know so much. I wonder how I’ll ever learn enough to make it into the fourth year.” Well, odd as it may seem, last week we started our fourth year – it’s a bit anti-climactic, however, as it’s really a continuation of what we’ve been doing in the third year. Nevertheless, it’s hard to believe that I’m in that position now. I certainly don’t feel as confident and knowledgeable as those fourth-years seemed to me, way back when. But maybe I just don’t realise how much I’ve actually learned in the intervening three years. I’ll have to wait and see how I do on finals!

Along with our fourth year of medical school, we have also just started our sixth Specialist Clinical Placement block – this one is the CSP block (Care of the Surgical Patient). I’m thrilled about it for a couple of reasons. First, my clinical partner and I are at the largest of our teaching hospitals. I am taking full advantage of the huge variety of cases and the opportunities for teaching that are sometimes present at smaller hospitals but are definitely routinely present at ours. There’s just so much going on here. Second, I’m teamed up with a vascular-surgery team for most of this block. In previous blocks, I’ve spent time in orthopaedic surgery, colorectal surgery, urological surgery, gynaelogical surgery and loads of other disciplines, but I’ve never actually spent time watching operations on blood vessels, so this is an area entirely new to me.

So far, it’s been really interesting. I thought a lot of vascular surgery was occupied with conducting bypass operations, but there’s so much more to it than that! A lot of the patients we’re treating are elderly people who have diabetes and/or a smoking history, as these are two of the many risk factors for peripheral vascular disease. The issues that the surgery team deal with are much more varied than I expected: there are lots of bypass operations, some toe/limb amputations, a lot of wound debridement (removing dead tissue from wounds that have not healed fully) and lots of other things that you probably wouldn’t discuss over the dinner table with your mother – unless she is a vascular surgeon. Let’s just say there’s more gangrene than I expected.

And of course, although we’ve had our fair share of shadowing operations (I even got to make a stitch the other day!), there’s much more to the CSP block than just time spent in theatre. We have post-take ward rounds, clinics and lots and lots of teaching around surgery-related topics. We’ve had anaesthetics sessions, suturing workshops, teaching on wound dressing and care, and many other topics. I wasn’t too keen on a career in surgery before coming into this block, but who knows? There’s still time to change my mind!

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August 10, 2017

End of third year…

If I close my eyes I can still picture the second year exam pass list, seeing my name there and relief flooding over me, it feels like only yesterday. Since then I’ve started and completed a research project (student selected component 2), had a refresher course of hospital life (advanced cases 2) and had five of my speciality clinical placements. So far I’ve completed 6 week blocks in General practice, Child health, Obstetrics and Gynaecology, Care of the Medical patient and Care of the Surgical patient. There are no exams in third year (phew!) so the main thing to worry about is making sure you have submitted all the correct forms and assessments for every block on your e-portfolio.

It’s been a busy year since we started our speciality placements in January and I’m really looking forward to a break, every block has had its good and bad points, but all have been enjoyable and interesting in different ways. In General practice it was a great confidence boost to be able to conduct entire consultations on our own for the first time. In both child health and O&G we were exposed to a lot of intense emotions from both the patients and staff, helping care for sick children is about reassuring and supporting parents as well as providing medical care for their child and in O&G caring for the same patient over the course of a long labour is stressful for everyone involved. Care of the medical patient wasn’t just about the theory, our consultant always made us think about the person behind the disease and the effect on their life. Care of the surgical patient has been about when not to operate just as much as any of the surgical procedures, something which surprised me!

Learning when to intervene or not is a huge part of medicine but I suppose in surgery it is vital to ensure that if an operation is performed it is for the right reasons. The last two weeks of my surgery block at George Elliot hospital have been with a Breast Surgeon. The breast clinic is a one-stop clinic, patients are examined and can also have a mammogram and ultrasound of the breast and get the results on the same day. This means lots of patients can be reassured and others can be referred quickly for further investigations. A lot of the results are then discussed at the breast surgery multidisciplinary team meeting where histo-pathologists, oncologists and surgeons, radiologists and nurses all decide together the best course of treatment for patients. In some cases it could be a simple benign lump that needs no further treatment, or in others it could involve deciding what type of surgery or systemic treatment is required for a cancer. It’s great to see how these complex decisions are made as a medical student, I’ve certainly learnt not to believe everything I watch in Greys Anatomy!

Following our break I come back to the acute medicine block. I’ll be working evenings and nights in A&E as part of the team. This will be followed by the Psychiatry and Musculoskeletal blocks. During this time I will also apply for my foundation doctor jobs (i.e. decide where I want to live!) and sit the situational judgement test, which plays a huge part in what job I will get. It’s going to be a busy autumn for me but what’s important now is that I have 2 weeks off, time to relax, ready to come back as a final year medical student.


August 08, 2017

Time flies…

Now that we've finished the Care of the Medical Patient block, our fifth six-week block in a row in 2017, we finally have a couple of weeks off to relax and re-charge our batteries. This is our official Summer Vacation. I worked for many years in the private sector before coming to medical school, but this thirty-week stretch in Phase III with only (three) bank holidays off is the longest I have ever done without a break in my professional life. I really hope that it's worth it in the end! I'm relaxing and not doing much and in between the lie-ins and catching up with old friends, I'm taking my time filling in the gaps in my notes from some of the earlier blocks. I'd rather do it now than spending time panicking over Christmas.

Slightly more alarming is the fact that we're now the oldest cohort at Warwick Medical School. When did this happen? It feels like we had our induction week just last month, but now we're just weeks away from yet another cohort starting. And the people who have been just one year ahead of us the whole way through the course have now got their degrees and are now actual, real-life F1s in hospitals up and down the country. It's wonderful, inspiring and more than a little daunting that this will almost certainly be us in a year's time. I have faith that we'll be fine, though. The environment for junior doctors to learn is very supportive, and the medical school has trained us well in what to expect.

When we start back, we'll be on the Care of the Surgical Patient block, which is intended to teach us as medical students everything we need to know for a firm basis in surgery and anaesthetics. I'm actually really excited - it's not a part of medicine I know much about from a practical standpoint. We've observed lots of operations and procedures but our (minimal) involvement up to this point has been on an ad hoc basis from consultants who kindly ask us to scrub in; this is rare. I hope in this block we will get a much better, hands-on view of what surgery actually entails. I believe that every foundation doctor is required to do at least one surgical rotation (although don't quote me) so this will be excellent practical backing.

For the rest of my break, however, I'm going to concentrate a little more heavily on the 'life' part of my work-life balance. This will be the last time before final exams that I get to relax and have a lie-in occasionally (or frequently)! I'd be lying, however, if I said that I wasn't revising a little bit at times. There is so much information to learn, and I cannot afford to forget any of it. But maybe I'll think more about it after I wake up from my nap!


July 31, 2017

Perks of the job…

Being a graduate entry medical student is pretty tough, hours are long and the work never really ends so feelings of guilt are always present, having said that studying medicine is a real privilege and there are some excellent perks…you just have to know where to look for them! One of the perks of being a medical student is the opportunity to go to conferences. There are always bursaries and prizes available for medical students to attend conferences. At the start of third year all students must complete a research project and lots of my colleagues have been able to present their work at conferences. Some around the UK, to exotic places like Newcastle, and others have gone a bit further afield to present at conferences in Canada! Presenting an oral or poster presentation at a conference not only looks great on your CV but is a great opportunity to network with other students and doctors who share your interests.

This year I’ve had the chance to present my work on a medical education course for students at a regional medical education conference. This was not only great practice at delivering oral presentations but I got to meet lots of people interested in medical education. Many of the attendees were clinicians who also worked in medical education, I was able to quiz them about their jobs and how they got into their roles over coffee. I was also able to get to know senior members of the medical school better and understand what it’s like to work in management roles within a large medical school. The most recent conference I had the opportunity to attend was the International Congress for the Royal College of Psychiatrists which took place in Edinburgh. Although I wasn’t presenting at this conference I was able to attend fully funded as I had successfully applied for a fellowship from the RCPSYCH that supports students interested in psychiatry for 3 years, and as part of this you can go to the annual conference for the duration of your award! Being able to attend such a large conference was really exciting but also quite daunting. I took the opportunity to attend sessions on topics that I’m particularly interested in such as perinatal mental health, getting into research and improving medical education and recruitment to psychiatry. In between sessions I met lots of other medical students as well as psychiatry trainees in a special refreshment area reserved for Students and Trainees- a very friendly and welcoming place to enjoy the free conference food!  I was introduced to the Chair of the Psychiatry Trainees committee and learnt about opportunities to get involved in this in the future. I also made contacts with people in Warwickshire who I could get additional clinical experience with in sub specialities like Forensic psychiatry.

I’m looking forward to attending the conference again in the future and been able to present some of my work that my fellowship is supporting me with as part of my elective project. The medical student elective is another major perk of medicine-6 weeks to go and experience medicine in any part of the world! Our elective takes place after final exams in March/April and I’m hoping to go to Ethiopia and conduct a research project in perinatal mental health. We had to submit our proposals for approval last week so fingers crossed it will all be approved and I’ll be off to Africa! Medicine isn’t all that bad after all!


July 27, 2017

Coming to the End of Year Three

Starting the Care of the Medical Patient block felt like staring into the great unknown – how could we possibly cover all of this information in just six weeks?! – but it’s actually been great, if hard work. I’ve seen so much – it feels like all of medicine compressed into one six-week period and it’s hard to believe it’s almost over. It feels like a whirlwind tour!

Despite the time constraints of the block, however, our tutors have put a lot of thought into our timetable and, whilst it’s very broad in its focus, sometimes it feels like we’re jumping around a lot. I guess this is what being an F1 on A&E feels like! For instance, it’s not rare at all to spend the morning on an endocrine ward, have haematology teaching at lunchtime and then spend the afternoon in a neurology clinic! But thankfully we have developed a very strong base on core medicine in the second year – our hard work in Core Clinical Education is paying off – and so this block is allowing us to build on that.

I spent some time last week in an oncology clinic. I’d somehow never been to one before and it was really interesting. All of the patients were follow-up patients, so I was not present for any new diagnosis or any situations in which bad news was broken – but of course that’s not all that medicine is about. We spoke a lot about follow-ups and ongoing treatment and how different upper-GI cancers can present. I got to hear about a really uncommon presentation over the phone (as my consultant was also on call) and we saw the patient’s scans on the internal imaging system. The patient’s superior vena cava had been almost completely occluded by an undetected growth just under the sternum, which was detected incidentally after imaging for a different problem – this is apparently very rare and everyone got very excited by this. How interesting to see!

One of the other timetabled sessions last week gave us the opportunity to follow the Diabetes Specialist Nurses around the hospital. As med students and future junior doctors we don’t interact much with Specialist Nurses on a day-to-day basis (at least at the hospital where I am, they tend to move between wards), so this was a great opportunity to see healthcare from the shoes of people whose roles were slightly different to ours. We went on a massive, great ward round around the entire hospital, seeing diabetic patients and making sure that they were all supported in their needs. Some were newly diagnosed and some had lived with the condition for years, but the Specialist Nurses gave them excellent support; I was really amazed how well-versed they were and the strength of the rapport they had built up with their patients across the entire hospital.

We’ve not got much time left but I feel like we’ve got loads out of this block. And even though we had CCE in the second half of year two, all of the knowledge from that 30-week chunk has created a very strong base for this block. I’m really glad we did it as we did. And when this block ends, so will our third year! I just cannot believe that we’re almost fourth-years. This sounds so terrifyingly old. In the meantime, I’ll just concentrate on enjoying my summer vacation.


July 21, 2017

Scrubbed up…

It’s now Specialist placement 5, the last block of year 3, and for me it’s my care of the surgical patient block. Despite all those years watching Grey’s Anatomy I’m not particularly interested in surgery and have spent most of my time in theatres so far thinking about lunch or how much my feet hurt! At the start of the surgical block I was definitely less than enthused and thinking more about my upcoming holiday in august than the anatomy of the abdominal wall, but I must say I have been pleasantly surprised!

I’m based at George Elliot, which is a small district hospital. Over the 6 weeks we rotate round 3 different surgical specialities: Urology, Colorectal and Breast Surgery. I’ve been with urology for my first 2 weeks, learning about different types of disease that can affect the prostate, bladder or kidneys that may require surgical intervention rather than medical intervention from the nephrologists. Clinics in urology are really varied; there is some overlap with gynaecology in women suffering from incontinence due to pelvic floor damage and there are lots of patients referred through the fast track system for worrying symptoms such as blood in the urine. Learning about the different investigations for these patients was something we covered last year but this year there is more focus on learning about the surgical management options, and how you decide which is best. Being able to get scrubbed up in surgeries means you can get much closer to the action and see the anatomical structures, and really appreciate the complexity of some of the operations. One operation to remove a patients kidney that had a tumour, lasted 6 hours, watching the surgeons avoid major blood vessels and control bleeding as they dissected the large tumour was fascinating. In contrast, another operation I observed was to remove a bladder tumour, which took less than half an hour-but to the patient these are both major, life saving operations.

As well as spending time in clinic and in theatres with the surgeons and anaesthetists we have also spent time with the junior members of the team while they are on call. The surgical senior house officer (not an FY1 but not a registrar yet) carries a bleep and sees all new patients that come into A&E or are referred by GP’s who may need to see a surgeon. This was a great opportunity for my clinical partner and I to take the history, examine the patient, come up with our differential diagnosis and decide what investigations we would want. The SHO was brilliant and gave us really useful feedback and helped us understand things we might have missed and importantly asked us to justify our investigations, something we have to do in our exams!

So 2 weeks in and I fairly sure I still won’t ever be a surgeon but so far I’ve learnt lots, which is always good with the prospect of 4th year approaching, and as an added bonus I haven’t fainted in theatres (yet)-win win!


The Broad Church of the CMP Block

It’s hard to believe, but we have passed the halfway point in our Specialist Clinical Placement (SCP) blocks, although I wouldn’t yet say that the end is in sight yet! Our fifth, and current, block is called “Care of the Medical Patient” (CMP) and is the block with the broadest focus yet. The purpose of this block seems to be to cover the general-medicine topics that we don’t see in a lot of our other blocks. For instance, we’ve already had blocks covering musculoskeletal health, paediatrics and obstetrics & gynaecology, all of which are very focused in nature. This block is much broader in approach, and the hospital where we are working has done a very good job of distributing us very widely across multiple disciplines.

What I’m really liking about this block is that we are exposed to a lot of topics in more detail than we ever were in Core Clinical Education (the latter two-thirds of Phase II). It’s great, and I’m really glad that (finally) so much of my work in Phase II seems to be bearing fruit. For instance, we are getting focused haematology teaching for the first time – so we are learning about lymphomas and leukaemias, factor deficiencies and all sorts of stuff that we briefly skimmed over last year. And the best part is that now we get to go to clinics and see patients in the flesh who live with these conditions. I learn best when there is an actual human being with whom I can associate a particular condition. It just helps tremendously when I can picture a patient in my mind to recall presentation, examination and treatment. As a case in point, I feel much more comfortable with lymphomas and leukaemias than I did before starting this block.

For my first placement in the first CCE block of Phase II, I spent about ten weeks on a respiratory ward at a local hospital. At this point, I had been a medical student for about fifteen months. It seems so very long ago now! This was probably my favourite placement, and I really felt at home in this learning environment. I was lucky enough to spend another day in a respiratory ward again just this past week, and it reminded me of how much I liked it. The presentations were fairly common (exacerbations of COPD, advanced pneumonia, bronchial carcinoma, etc.) but it was great to come back to a respiratory setting with a lot more experience under my belt. I felt much more comfortable working with the doctors and nurses and also felt much more comfortable understanding which investigations were being done and way. I hope to see more respiratory medicine in the future.

I have also spent some time observing neurology clinics for the first time; this was another area in which I had read a great deal but had seen hardly any patients. Now I can confidently say that I have seen and can hopefully recognise cases of myasthenia gravis, epilepsy, early-stage Parkinson’s disease, multiple sclerosis and many other common neurological conditions. Attending neurology clinics definitely brought more than one flashback to Block 3 of Year 1 (Brain and Behaviour), especially the direct and indirect pathways for movement regulation and how they can become inhibited. Thankfully I didn’t have to worry much about the various tracts that go up and down the spinal cord – that’s a headache for another day!


July 05, 2017

Fly on the wall

As a medical student, I spend a lot of my time hovering awkwardly behind consultants and other doctors as they see patients on the ward. In clinics, myself and my clinical partner are also squeezed into the room, often sat across from the patient, it feels like a follow up appointment in the form of a panel interview! I am always so grateful to patients and their relatives who are happy to put up with a committee of people on ward rounds and very crowded clinic rooms all so we can learn. I have been even more grateful over the last few weeks during my care of the medical patient block to patients and their families who have allowed me to sit in on clinics where doctors are regularly breaking bad news: the oncology clinics.

Cancer biology was not my strongest subject during my biomedical science undergraduate degree but in medicine it’s not just the underlying cellular and molecular biology that’s important, we need to know all the clinical manifestations so we can diagnose cancer, when to refer and what investigations are needed. So, in this block I decided to make a concerted effort to try and improve my clinical knowledge of both the diagnosis and investigation of cancer and of oncology as a speciality.

One of the clinics I attended was a fast track clinic for suspected lung cancer. GP’s can refer patients with symptoms or signs indicative of lung cancer and they will be seen in hospital within 2 weeks. Patients attending this clinic have often had a chest X ray and in some cases a CT scan before they attend so the consultant can in either reassure the patient or show the patient where the problem is that they need additional information from, perhaps in the form of a biopsy or a different scan. What struck me most in this clinic was the number of patients who were told that they had a suspicious mass in their lung but decided not to have further investigations, many were elderly and were quite clear that they didn’t want to undergo any further procedures. Having these conversations requires a very sensitive and perceptive type of doctor and is a very different type of medicine to what medical students probably envisioned before medical school.

Attending the oncology clinics, patients already knew they had a diagnosis of cancer but often didn’t know what treatment if any was available. These appointments lasted up to an hour and the doctors were clear that the appointment lasted until the patient wanted to leave, they encouraged questions from the patient and their family, and took the time to explain things multiple times. They comforted patients and relatives as they cried at the prognosis and then did it all again for the next patient.

All the time I’m sat in the room, a fly on the wall, observing how the doctor handles the different consultations, learning how they manage these complex patients, but all the while I’m trying my best to not get emotional too and reminding myself that it is a real privilege to be invited into people’s lives to experience their best and their worst times.


June 30, 2017

Starting the Care of the Medical Patient Block

We have just started our fifth specialist clinical rotation of Phase III and it’s really hard to believe that the time is flying by so quickly (this seems to be a recurring theme). This block is called Care of the Medical Patient (CMP for short) and I think we’re lucky to be doing it at a very big and busy hospital with lots of learning opportunities. Whereas most of our blocks have focused on more focused topics (paediatrics, musculoskeletal health, and obstetrics and gynaecology), the flavour of this block is more on general medical topics than many other blocks. This means that we see lots of traditionally core-medicine topics in quick succession and have many varied learning opportunities.

In Phase II (the latter two-thirds of our second year), our curriculum introduced us to “Core Clinical Education”, the purpose of which, I gather, was to give us a grounding in core medicine and help us students become proto-clinicians without getting carried away by too-detailed topics. At this point, it seems like the CMP block is expanding on these themes. We are getting a lot of teaching on core topics and talking about conditions – their diagnosis and treatment – in far more detail than we ever did in the second year. We seem to be focusing a lot of dermatology, neurology, renal medicine (I actually love kidneys), cardiology, gastrointestinal medicine and respiratory medicine than we have so far in any other block, and I’m really enjoying it. I have always had a great time with the core-medicine subjects and could possibly see my career developing in this direction.

In addition to being assigned to a base ward for the block (my clinical partner and I are on an endocrinology ward, so we see lots of diabetes and thyroid problems), we are also expected to attend lots of clinics of all sorts of flavours and also rotate through other wards for exposure. It’s pretty full-on. So far, I have attending two renal-medicine clinics (did I mention I love kidneys? I love kidneys!), a lymphoma clinic and a diabetes clinic – and we’re just a week into the block. It has been absolutely fascinating to see physiology come to life: when we first learned about the structure and function of the kidneys in October 2014 (Block 1 of year 1), I found it really overwhelming. But I committed myself to learning more about them, and I’ve slowly developed a begrudging yet abiding love for all things renal. Needless to say, the clinics have been great.

In addition to wards and clinics, we also get a fair amount of teaching from consultants and registrars. This is usually very useful. Today we got the first haematology teaching since second year, and I found it fascinating. I think my coursemates all think I’m mad, but I love talking about things like Tissue Factor and the Extrinsic and Intrinsic Pathways. I am really looking forward to the rest of this block and seeing more of what CMP has to offer. Maybe I’ll see if there are any extra kidney clinics as well!


Learning outcome number 1: Learn all of medicine!

My task this year, to learn medicine, all of it. The medical school would say I am exaggerating but this is what it feels like to be a medical student. It’s so difficult to know how much we need to know and in what detail, learning outcomes are supposed to be a guide and can therefore seem vague and textbooks vary so wildly that you start to believe that maybe Wikipedia does have all the answers (note to self, it doesn’t!). This is a universal problem for medical students but it’s especially true of the Care of the Medical patient block which I am just finishing.

In third year, our speciality placement blocks are just 6 weeks long. I’m sure I’m not alone when I say medical students are often quite organised people and are good at compartmentalising their learning. So far this has worked in my favour, Paediatric block, focus on children’s health, then for Obstetrics and Gynaecology focus on women’s health. This theory doesn’t work in Care of the medical patient…which bits of medicine, or just all of it in just 6 weeks? I started the block wanting to see and learn everything medicine had to offer but after trying to sort out a timetable and plan of action going forward quickly realised this was unrealistic and impossible!

Thankfully at UHCW our block lead had taken the time to give us a timetable to guide our learning with some gaps in that we could choose to fill (or not!). Every week we are assigned to clinics from different specialities to give us a flavour of the sort of patients those doctors see. I particularly enjoyed a haematology clinic where I learnt lots about haematological disorders (such as blood cancer) as well as loads about interpreting blood tests. I also got the opportunity to attend a Fast track clinic for suspected Lung cancer, this clinic has patients referred from GP with symptoms that could be indicative of lung cancer. Attending this clinic reinforced the symptoms and signs all doctors should be aware of to identify a lung malignancy and how you would investigate it. One day a week we are also assigned to a different speciality ward. Tied in joint first are my days on the Gastro ward and on the Stroke ward. The Gastro day saw us attend an epic 5 hour long ward round seeing patients with liver and pancreatic disease all over the hospital. On the stroke ward we got to take some interesting histories from some of the patients recovering from severe strokes which really helped me understand more about potential risk factors and warning signs for stroke, we also got the opportunity to examine patients and see neurological signs first hand.

As well as days and clinics in different medical specialities we are assigned to a care of the elderly (or geriatric) ward. Geriatric wards have bad reputation among medical students. Common beliefs are that all the patients have dementia or are confused so no one can give a good history, or that patients aren’t medically unwell so there’s no point in examining them. Having spent 6 weeks on the geriatric ward there is some truth to these beliefs but it doesn’t mean there is nothing to learn as a medical student. On the geriatric ward you learn more about co-morbid disease than anywhere else in the hospital, you learn how a person’s psychological state and their social situation impacts on their health and how this needs to managed by a whole team of people and not just a doctor with prescription pad.

So, I haven’t learnt the whole of medicine in 6 weeks but I’ve learnt a lot about being a doctor that can’t be specified in any learning outcome.


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.


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.


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!


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.


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!