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.

Joanne


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!

John


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!

Joanne


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.

John


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!

Joanne


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Our Med Life blogs are all written by current WMS MB ChB students. Although these students are paid to blog, we don’t tell our bloggers what to say. All these posts are their thoughts, opinions and insights. We hope these posts help you discover a little more about what life as a med student at Warwick is really like.

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