April 09, 2018

Halfway through the Elective Period

Our post-finals elective period is six weeks long, and we’re right in the middle of it. It’s going well – I’m seeing loads of notifications from social media about my coursemates in all sorts of exotic places around the world and I have no doubt that lots of medical experience is being gained regardless of location. After the stress of finals, it’s been a wonderful opportunity for us to experience clinical care in a new surrounding.

We have the option to spend all six weeks in one placement, or we can split it into two – application-approval dependent, of course! Submitting the different forms was a module in and of itself! I have elected to split my elective, and have just finished the first half, which was three weeks in an A&E department in outer London. It’s been really interesting and eye-opening. Our acute block gives us some exposure to A&E (majors, minors and resuscitation) but we only have five or six shifts over six weeks. The great thing about the elective was that it allowed me to spend time doing exactly what I liked and doing it every day.

The doctors – and all of the healthcare professionals, for that matter – in the A&E department were all very helpful and lovely and were keen for me to learn. A typical day involved me turning up in mid-morning and finding a doctor to shadow for the day – usually an F2 or a reg. I would choose a patient from the list of new arrivals, take a history and do an exam, present back to the doctor and then we would see the patient together to talk about investigations and management. It was very similar to the acute block, but as I became more stuck in with the team I found that I was taken under the wings of the doctors and taken very seriously. It was a nice feeling of semi-autonomy. Occasionally I would spend the days in the resus department helping the nurses and stationary paramedics (qualified paramedics who spend time stabilising patients in hospital instead of driving around in ambulances), and it was very good to help with the most acute cases. I really loved A&E and am looking forward to my placement there in the Foundation Programme.

One thing stuck in my mind from this placement: a young patient presented with complications from a serious and notifiable disease, for which his mother chose not to get him vaccinated when he was a young child because of unfounded risks which have since been widely debunked. I found it very unfortunate that diseases, which we think of as relegated to our grandparents’ generation, are still affecting people in our very rich society. Although parents have the choice as to whether or not to have their children vaccinated, if they choose not to then they have to accept that their children very well might contract life-threatening diseases later in life and live with the complications. I had never seen this particular disease in a person before, but I don’t think I’ll forget it anytime soon.



March 22, 2018

Post–Finals and Medical Electives

After a seemingly unending course of exams – clinicals, writtens, and then practicals – we finally got our results from our finals last week. After having been through this process a couple of times (both Phase I and Phase II results periods were similar), we were pretty used to the drill. Still, this didn’t reduce the anxiety and uncertainty in the buildup to results day. It’s like this big clock constantly ticking in the background and you barely notice it getting louder and louder until eventually you can’t ignore it any longer. Knowing the exact date and time that results will be released – whilst appreciated and necessary – doesn’t make the anxiety any easier! I don’t know a single person who was entirely certain that they’d made it through. Everybody was on edge. And just like Phase II results, we didn’t have much of a buffer zone between results day and getting ready to go off on the next stage: this time, it was our elective – we found out the news on Thursday and our elective period started four days later on the following Monday. Those who were successful on their finals were permitted to proceed to their elective.

I’m delighted to say that I passed. More than elation, I’m just relieved. Although it is a bit strange to know what to do with myself – I’m so used to being in the revision mindset that I am having a really difficult time just relaxing without the compulsion to be doing something exam-related. I’m really glad my passmedicine subscription expired the other day – otherwise I’d probably still be doing a few dozen questions a day!

Lots of people in my cohort elected to spend their elective overseas, so I’m already hearing stories of fabulous times in the most exotic locations. The purpose of the elective period is to experience medicine in a different surrounding, thereby allowing us to compare, contrast and grow as clinicians when we return to a more familiar surrounding. As you can imagine, after forty-three months of extremely hard and intense work with very few breaks, most people apply the ‘different setting’ rules rather liberally – and with good reason. It’s a great opportunity to travel somewhere exotic and new and experience some better weather than what we have in England – and why not? All electives require approval from the medical school, so it’s all perfectly legitimate, but once that approval is given then we’re good to go.

I spent a month for our SSC2 block (October 2016) in the Gambia, researching TB investigations. For this reason, I was less motivated to have another big overseas elective experience – also because I couldn’t have borne cancelling it had I not been successful in my finals. So instead of going somewhere like India, Sri Lanka, Colombia or New Zealand (all destinations of people in my cohort) I decided to return to my old home in Greater London. For the first three weeks of this six-week block I’m based in the A&E department of a medium-sized district general hospital in an affluent area of the capital, and am enjoying myself tremendously. The acute block in Phase III was my favourite block, and being able to relive these experiences in a different setting and get properly stuck in is so much fun, and really what I understand the elective period to be all about.


John


March 13, 2018

There’s Light at the End of the Tunnel – or is that the Approaching Train?

As we are now in our final year, we have been experiencing the joys of final exams over the past month or so. If the truth be told, the exam season actually kicked off at the beginning of December with the Situational Judgement Test, and we had the Warwick Safe Prescribing Assessment (SPA) exam at the beginning of January (plus the odd mock exam here and there) but it really got underway in earnest with OSCEs (structured clinical exams) on 12 February. With just a month separating the OSCEs and our last scheduled exam in the first sit (this is the national Prescribing Safety Assessment), it’s been a tough old run and most of us just want a few days to sleep and hibernate.

After the written component of our assessment (SAQs and MCQs), our cohort was assessed via the OSLER (Objective Structured Long Examination Record) method. There was a very famous Canadian physician called Dr William Osler (he of the eponymous nodes) and I have often wondered if there is a connection between him and the rather clunky acronym for our exams. Maybe I’ll make it my mission to find out when we’re all done – that is, if I still have the energy!

We haven’t got our results from any exam yet aside from the SPA, so these could be my famous last words, but all in all I found the OSLER process quite manageable. We each were assigned a full day and a half day of OSLERs. I was in a group of people who started our OSLERs very late in the week and thus most of my cohort had had their full day before I did. Of course nobody shared specifics of their cases with anyone else, but I was told that the time does pass quite quickly during the day when you’re actually doing it – and I found that to be the case as well. All of the patients whom I examined were really nice and friendly, and it seemed like they really wanted each student to pass and do well. I am always grateful to patients who give up their time to help us medical students learn and be assessed – they seem to enjoy themselves and it must be great fun to watch students come through all day. I might get tired of being examined repeatedly, but none of them seemed to mind that much. Maybe there was more variation in exam technique than I realised!

Recently our allocations to the Foundation Programme were released. This is the region of the country – known as the deanery – in which we will be doctors for the next two years. This was really exciting for everyone, as it’s a combination of a few things – both our educational performance ranking (for which we get 50 points out of 100) and the results of the SJT exam sat back in December (for which we get the remaining 50 points). Our combined score decides our ranking against all of the other 7,000-odd applicants from all over the country (and even the world, as there is a sizeable international component) and this in turn dictates which of the programmes we are allocated to. It’s very exciting to ponder the next step of our lives, and it’s really hard to believe that in a few short months, we will be sent to all corners of the country to start the next phase of our careers!


John


February 22, 2018

In the Thick of It

We are in the middle of our final exams period, and, as expected, it is quite full-on. These are basically several sets of comprehensive examinations covering everything that we have learned at medical school since starting on the course, and so the topics are understandably really vast. It’s so difficult to even begin to prepare for these exams and I think that everyone has basically just been reading and covering anything and everything that they can, and practicing our examinations all the time, in the hopes that any work is good and useful work – and by and large it seems to be.

By now we have already had our OSCEs (Objective Structured Clinical Examinations) and sat our written papers, and we just have our OSLERs (long cases) to go – more on those below! In previous phases, our exams have consisted of fifteen OSCE stations, and 180 marks each for SAQ (short-answer) and MCQ (multiple-choice) papers. But this time we only had 10 OSCE stations and 150 marks for the MCQ paper (although the SAQ paper was the same 180 marks). It has been really tiring so far, and I’m glad that we have the rest of the week to relax/recover from these exams, especially the written ones – as looking after our mental health is a very high priority at this stage.

Without giving away any information on the actual content of the exams, I can say that the people setting them up did a very good job to ensure that they have all been very comprehensive and that many aspects of the Specialist Clinical Placement blocks that we had in Phase III were covered adequately. We weren’t tested on everything, of course, but there was a sufficient amount represented from various different aspects of our medical syllabus to feel like it wasn’t too concentrated in any one area. Whilst OSCEs seemed to cover more adequately the clinical side of medicine (these are the common, everyday tasks that F1s and beyond will have to do in hospital), the written papers tested our book knowledge about lots of different conditions, as is expected.

It seems like we are all old pros at sitting written papers and at doing OSCEs, since we’ve all done a few rounds of each, but the OSLERs (Objective Structure Long Examination Record) are a new kettle of fish for all of us. We’ve had several practice OSLERs (some more realistic than others) since clinicals started at the beginning of 2016, but this is of course a different scenario – among other things, we are being examined with a real, live patient instead of an actor. And there are other components to the OSLERs as well that we’ve not yet encountered before in the exam setting – having a mini-viva where we are asked about the presenting condition, having to explain a medical procedure to the patient, etc. – so it will be interesting to see how it goes. Hopefully the next time I post, I will be on the other side from all of these exams – wish me luck!


February 12, 2018

Before the End, the Beginning

Next week marks the start of our finals-exams period, and with it comes the usual mix of emotions. Because so much is riding on the next few weeks, I’m nervous and anxious (I think there’d be something wrong if I weren’t), but I’m also pretty excited and looking forward to seeing what it’ll be like. We’ve put so much effort into the past few weeks, months and, yes, years that it will be interesting to see what sorts of topics we are examined on, and how it comes about. I’m looking forward to applying my knowledge.

On the one hand, it’s daunting because the scope of material we can be asked about is just so broad: the body of knowledge that a medical student is expected to have upon graduation is truly vast. I don’t quite know what I was expecting, but there is just so much to know! On the other hand, we have spent years accumulating knowledge, building upon it and putting it into practice. This in itself is really important to bear in mind when coming up to exams: sometimes it feels like we’ve not learned a lot, but in reality we all know a lot more than we realise or give ourselves credit for. And yet on another hand, I think that by this point most people just want exams to be behind us. We want them to start but, more importantly, we also want them to end.

Our first round of exams this time is the OSCE segment. This stands for Objective Structured Clinical Examination. Normally we have our written exams first, but it’s swapped round for finals – I don’t know why. For this exam (as in Phase II), OSCEs take place on one day. The entire cohort is split in two; half the cohort is assigned to a morning slot and half the cohort gets an afternoon slot. We are split into groups of about 12 students and each of these cycles through a set of ten stations (with a couple of rest stations built in) – and of course several cycles run concurrently. Once the morning group are done, they are sequestered in a room until the afternoon group starts – the purpose of this is to avoid anyone from the morning group sharing information about stations with anyone from the afternoon group. The set-up of doing all stations in one shot is actually fantastic if not exhausting – in our first year, OSCEs were three or four stations spread over four days and everyone was very tired of it by the end of the last day. This way, at least they will all be out of the way at once and we can focus on the written component, which is coming up next week.

One key element to our education process that often gets overlooked is that we as students need to pay due attention to our own mental health as individuals. Since this is such an all-consuming point in a pretty demanding course, it is really easy to let the little things slip – exercise, eating well, taking breaks, etc. We all want to do so well (or even just make it through) that we focus perhaps too much on revision to the exclusion of much else. I’ve started forcing myself to go swimming again a couple of times per week, if nothing else just to make sure I have an outlet for my energy and that I sleep better at night. So far, it seems to be paying off!


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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