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


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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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