All 51 entries tagged John
June 11, 2018
Now that final exams have become nothing but sweet memories, we are currently making our way through our final block at Warwick Medical School. This is Assistantship, in which we learn everything that foundation doctors in their first year (commonly known as F1s) actually do. It’s a transition period where we put all of our accumulated knowledge into practice, so that we can hit the ground running in August when we start working as qualified junior doctors. It’s all becoming a bit real now!
The great thing about Assistantship is that we have a sign-off list of tasks that we have to be certified as having completed, but we don’t have the stress and pressure of exams hanging over our heads. This means that we can throw ourselves into learning in a supportive environment without feeling like we are missing out on revision or learning elsewhere, or feeling bad because there’s something else we should be doing (like burying our noses in books). And of course we get to trail F1s, who were in our places just one short year ago. It’s very collegial. The sign-off tasks include things like being present for death certification, shadowing nurses on drug rounds, making sure that we can complete an electronic discharge summary (a major part of the F1’s jobs) and many other day-to-day tasks on medical and surgical wards.
We are also required to complete a couple of out-of-hours shifts with our F1s. This is to prepare us for our medical on-call shifts when we are junior doctors and show us what it’s really like. I spent an overnight shift with my F1 earlier this week and it was really useful. Many people are understandably apprehensive about these shifts, because we’ll be on call overnight and the first doctor that most nurses will contact. But the good thing about having a couple of these shifts under our belt during assistantship is that we really see how well supported the F1s really are throughout the night. There are senior nurses on almost every ward, and loads of people (like registrars and even consultants) whom you can phone to ask questions if you need to. It’s all about knowing when you need help and whom to contact. I wouldn’t say that I’m going to be an expert by any means, but shadowing in this role during Assistantship has definitely helped prepare me and set my mind at ease – and that’s really the point of the entire block, isn’t it?
It’s hard to believe that it’s all coming to an end now. We are all packing up our houses and our lives and getting ready to move to another part of the country and be actual doctors! I think it’s really helpful, however, how the medical school manage the transition. Assistantship is exactly what it should be: a post-exams period to help bring us up to speed with the daily tasks and role of the junior doctors we will be in a few short weeks.
May 30, 2018
Now that we’re done with finals, elective is over and most of the difficult assessments are behind us, our cohort members are able to relax a tiny bit and enjoy the final tasks of medical school: trailing F1 doctors, getting stuck into teams in the hospitals, and learning the practicalities of how doctors actually do their jobs on the wards. This is the Assistantship phase, in which we learn what it takes to be a junior doctor, and prepare properly for our role in two short months! It’s hard to believe that we’re so close to finishing now.
The medical-school admin team try to match up students who are staying locally for their foundation years with the team that they will do their first rotation with. This way they can get to know the actual team and wards they’ll be based on when they start. It seems such a nice way to ease into the world of working on the wards and relatively stress-free. Those of us who aren’t staying around, however, are unfortunately not so blessed. I am planning to go to a hospital in the Southwest of England and therefore my experience on Assistantship, like the majority of the cohort, is sadly more generic. It’s absolutely fine, however, and every bit as useful as I would expect.
However, I think I have been lucky with Assistantship in some respects: two of my rotations in my first year of the Foundation Programme are respiratory medicine and upper-gastrointestinal surgery, and these are the two areas where I have been placed for Assistantship. This means that I will have some idea of what to expect next year and what F1s are expected to do in these roles. Although each trust is different (this is stressed a lot), some things will be common between all hospitals in the UK. I imagine this includes things like the types of procedures that are carried out in surgery, the demographics (roughly), the types of conditions that are present on respiratory wards, the general treatments and so on.
Outside of Assistantship, I still try to teach students in younger years when I can for a couple of reasons. First, I honestly believe that nobody should be in competition with one another in medical school – we are all here to help one another out, because if we become better doctors, then our patients are the ones that win. Second, I have certainly attended more than my fair share of peer-support sessions over the years and the least I can do is repay the favour in kind. A few weeks ago, I taught some second-year students at a weekend (people give up their weekends to be taught – amazing dedication!) and, I have to be honest, I’m quite glad that that part of my life is behind me. Although medical school has been fun, there are some parts that I’m quite happy not to repeat! Now I’m looking forward to the future, and enjoying the last parts of the journey along the way.
May 14, 2018
The logical progression for medical students who graduate from the MB ChB programme at Warwick is to move into the foundation programme. This is a nationwide, structured programme that cycles all recent med-school grads through six four-month rotations over two years within a particular deanery (or region of the country, of which there are currently twenty). Every deanery is different: some will rotate you between hospitals or trusts depending on the job you do, and some will let you stay at the same hospital for the full two years. It all depends on the deanery you end up in and the jobs that are available. I have been allocated to one of my top choices: a large district general hospital in the southwest of England, where I plan to be for the full two years.
The Foundation Programme is relatively uniform across the country, in that F1s (those of us in our first year of the programme) and F2s (doctors in their second year) are expected to complete more or less the same things and cover the same ground over the course of their years. For instance, I believe that all F1s are required to have a surgical rotation, and all F2s are required to have either an A&E, GP or GUM rotation. And all foundation doctors round the country all rotate jobs on the same days throughout the year – it’s kind of scary yet oddly comforting that our careers are planned out for us until August 2020! That will be six years since the beginning of medical school, but at the same time as least there shouldn’t be too many unpleasant surprises in our broad timetable and we can plan accordingly.
By definition, when the current F2 doctors leave their posts, the current F1s become F2s and we medical students become F1s, the collective experience level across foundation doctors drops by a year overnight. I gather that this might have had serious impact in the past on learning curves, efficiency of work, etc. However, in order to minimise the impact of this effect, the GMC, and by extension the various trusts and medical schools, take great pains to ensure that incoming F1s are adequately equipped to step into their roles. Foundation Trusts do this through inductions and shadowing at the beginning of our F1 year, and medical schools do this through including an Assistantship phase after finals.
As we are done with finals and our electives, we are now in that Assistantship phase. This is where we really ensure that we have the skills needed to be competent and functional F1 doctors. Our Assistantship placements are carried out in local hospitals, an arrangement with its plusses and minuses. On the plus side, we are all very familiar with the hospitals, their layouts, their wards and many of the doctors. However, many of our cohort will not be working in this deanery in the autumn, and so we will have to adjust our working practices to those of our base hospitals when the time comes. This might seem a minor point, but so many of the little things that F1s need to know about (how the imaging/patient-data systems work, how the stores cupboards are stocked, how procedures are requested) are completely different. It will require some adjustment. But at the same time, it appears to be a very well-run and well-thought-out block. Most importantly, we can learn on the wards without the threat of exams hanging over our head – always a bonus!
April 24, 2018
We’re nearing the end of our elective and it’s been a fantastic opportunity to explore a different aspect of medicine to the typical hospital- and community-based experiences that we have had so far. Whilst I like being in hospital or in a surgery, a lot of patient contact happens in the field and it’s great to get an experience of this in a supportive and structured setting – especially without the pressure of looming exams. I think I’ve had enough of that pressure for a little while!
I spent the first half of my elective in the Emergency Department of a local hospital in Greater London, which was interesting if not quite similar in nature to the acute block, part of our Phase III Specialist Clinical Placements. I loved it, and felt that I was able to integrate in the team quite quickly, but the format and scenario was not a million miles away from what I have been doing throughout medical school so far.
For the second half of my elective, I’ve done something completely different and am removed from the usual clinical setting. I’m using this opportunity to broaden my horizons and get exposure to a new medium in which medicine is practiced – and that’s what elective is about after all, isn’t it? I’m working with a company which does outsourced work by police constabularies around the country. I am shadowing healthcare professionals (known as FMEs, or forensic medical examiners), who are all either trained nurses, paramedics or doctors and all of whom have loads of healthcare experience. FMEs assess people who are detained by police officers and brought into custody to be held before either being released or brought to court, and the job of the FME is more or less to determine whether the detainee is fit to detain and fit to interview by police, based on either any self-declared health condition or anything brought to their attention by the custody officer.
This is a very niche area of medicine, and one that I have never had anything to do with before – and I’m seeing a whole new side of our society. Aside from having my mobile phone stolen over ten years ago, I can’t remember the last time I spoke to a police officer. It’s been very interesting so far – the hours are tough (twelve-hour shifts, and I’ve had a few overnights) but of course crime can happen at any time. The teams of officers in the custody are very tight, with good reason, and all members are always scrupulously professional in their interactions with the public and each other. It’s very nice to see.
The area of the country that I’m based in isn’t known for its high levels of violent crime, which is just as well, although of course people can be detained for all sorts of reasons. A lot – but by no means all – of the offences seem to involve people taking various intoxicants usually combined with either driving or hurting other people. It’s a very interesting view into a part of our society that I never see, and I’m glad that I’m using this opportunity to broaden my horizons just that little bit more.
April 09, 2018
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.