March 13, 2017

Vulnerability

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

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

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

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


John


March 07, 2017

Life on the children’s ward

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

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

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

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

Joanne


February 24, 2017

General Practice Rotation

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

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

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

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


John


February 13, 2017

The End of SCP1 and Farewell to Musculoskeletal Health

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

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

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

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


February 07, 2017

First feedback then feedback some more!

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

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

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

Joanne


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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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