August 25, 2020

Hot Wards and Cold Equipment Rooms

SO we are well into the run of our 10 week block of medicine and as unpredictable as the British weather is, we have had a heatwave on the busiest week of my timetable. Whilst temperatures were hitting 30 degrees outside, we were trying to find the coolest part of the ward which was normally strategically standing near patient’s fans (of which there were three) or running to the equipment room undetected. The masks don’t help either as they just reflect warm ari back into your face but if they keep the patients safe, it’s a small price to pay. However, despite losing all my body water in the first 10 minutes, it proved to be a really productive day on the ward. We had a lovely consultant who was keen to teach us and told us more than once we really should be outside and enjoying the sun and not on the wards. What was an added bonus was that we got all our sign off’s done for the 10 weeks in one morning. Before running off as we were told, myself and my clinical partner stopped at GEH famous ice-cream bar. The ice-cream is incredible and after putting it on Instagram, I was met with lots of jealousy from medical students and doctors at other trusts! I am officially team general district hospital!

This week in all has been just incredible for our learning and progression. We have a lovely F1 and an incredible Physicians Associate who have just included us into the team from day one. On the Friday we had another incredible consultant who literally sent us off on our way to manage a patient by ourselves. I stood wide eyed like a deer caught in headlights but actually, this was the best thing for me as I finished with my lovely patient and actually, for the first time, I actually felt like I was going to be a doctor in 2 years (Covid-19 depending). It’s nice to be praised and have the support there and this week has just been a huge confidence booster, which was needed as my PassMed average is lower than I’d like it to be.

Getting used to an emptier timetable than last block has been a bit of a feat but, I actually like this way as I have a chance to breathe. I can do more of my theory work during the day and not at 10:30pm when I would rather be in bed. It also means I can do more extra-curricular things like inhaling half of the pool water at the gym as apparently my swimming technique is far from desirable. The perks of being in the same ward every week means we become far more integrated into our ward team and we go into the wards with some determination to get things done as we have less clinical exposure time. We have also been encouraged by the doctors to leave the ward and go home if we aren’t learning anything. I really enjoy going to placements now and developing professional relationships with the team and patients is just the icing on the cake.

We start GP next week and I am a little sad not to be going back to our original practise in Nuneaton as we loved being there and our supervising GP was amazing. It is also going to be dramatically different not actually seeing patients which I am sad about. It’s surprised me how much I love chatting with patients during their history and seeing them week after week, which I thought I would never say as someone who has difficulty with communication. I’m sad I wont be able to chat to people face to face and instead just listening to consultations over the phone before performing my own consultations. I know it’s important to learn phone skills as it is likely this is the new way of working for GPs and hospital clinics but it’s still sad knowing there wont be any patients.

So far, so good in the big picture though. I really love being back on placement and it beats sitting at my desk every day typing the same words for my SSC2 over and over again. We are still waiting for results but we are so busy with clinical learning that I forget it is even a thing most days!

That’s it for now! See you in September!


August 10, 2020

General Practice

Monday was the start of my 5-week GP block. Here at Warwick in our third and fourth years we do Specialist Clinical Placements (SCPs), and there are 8 of these which cover the main areas of medicine. During these placements we spend time with these teams in their clinical setting, get practice seeing patients and hopefully gain knowledge to help us pass our final exams and practice as competent doctors. GP for me is my fourth rotation of the year, meaning that once it is over, I will be halfway through my rotations.

GP is a block that I have really been looking forward to in so many ways. During second year we had GP days and they really built my confidence and abilities as a clinician because, more so than any other rotation, you get the chance see and interact with patients in a similar manner to how a qualified doctor would. GP is in a smaller setting and is more generalist, meaning that you see lots of different conditions, from a sore toe to chest pains. I find the variety refreshing and it really tests your knowledge because you need to know something about every area. So far we have seen a bit of everything, and hopefully that continues!

As we are now final years, we have the opportunity to consult independently. This means that as a pair we have our own clinic a couple of times a week where patients book in to see us. We then see the patient, ask them about their problem, decide what we would like to do and then check everything with the GP (who checks the history and may ask some other questions). Our GP practice has been very keen to get us going with independent consults, so we had our own clinic in the afternoon of our first day! Although scary, actually just jumping in and getting going is the best way of learning, and of course we were closely supervised by our lovely GP who seemed happy with most of our management plans. Hopefully our patients were happy as well!

I couldn’t let a blog go by without mentioning the topic on everyone’s lips – COVID.

It has had a big impact on General Practice, with the main difference being that almost all of the consultations are telephone appointments. This has been slightly strange, and can be very odd when the patient calls up with a problem which really you need to see – for example rashes, lumps and other skin conditions. Trying to get them to describe the size and shape can get you so far, but nothing beats that visual recognition. Often these patients have to pop in and see us, but most other things can be managed over the phone – for example blood test results, medication reviews, aches and pains. Its certainly provided the push for General Practice to go virtual, and how much of GP stays telephone/video consultations afterwards will be interesting to see.



August 04, 2020

SSC2 Lockdown

HELLO I am back!

I apologize for the two months silence. My blogs were getting harder to write as I was mainly sitting at my desk completing my SSC2, so it would not have been hugely interesting for you guys but, I have officially clicked that submit button and the relief is immense!

As we couldn’t go into hospital, Warwick made us third years for 3 months and we completed our third-year research module a couple of months early and we will be completing our second-year placements later on in the year. Again, because we were not allowed in, we all had to do systematic reviews, the one thing I specifically did not want to do. However, after frantic searching of PubMed and Google scholar, I found a topic of Medical Education that had not been reviewed as far as I could see. I must be careful with what I say as our reviews are marked anonymously so I can’t give anything too specific away about my project as our marks haven’t come out yet.

It was… let’s say… trying. I came across so many hurdles including a panicked afternoon where I thought my project would have to be scrapped and re-started again, four weeks before the deadline. However, looking back, I am so proud of getting through it and now have another skill under my belt for my future career (all be it a rather shaky skill). I also developed a bit of a better idea about the world of research, something I ran away from in my undergraduate. I was offered a paid-for masters by my supervisor (I have no idea why, I was useless, all my cells kept dying!) and I shuddered as I had no idea about this world beyond undergraduate. However, through connecting with others on twitter and developing ideas, I am excited about including research into my career. Twitter has been my saviour throughout lockdown. I have developed connections across the UK and it has landed me some of my closest friends. I have a friend in Cardiff who I have never met but I consider like a sister! It’s also shown me the different ways I can incorporate research and how to develop my portfolio (just by spying on other people’s lives!).

This has meant I have begun to think about what I want to do post Warwick. I may be starting the final phase of the medical degree here seven months late but I am still in the mindset that I am nearly a third year. I’ve decided I want to do an AFP programme incorporating medical education however, I want to work at home in Kent. Unfortunately, Kent does not have a separate AFP programme and is incorporated into the South Thames programme which includes London. Kings College (where I want to apply) requires me to be minimum third decile of the cohort to even get short listed, so it’s clear I have a LOT of work to do.

However, I have keeping steady process with my extra-curriculars to be prepared for speciality applications. This year I helped with the GOSH Summer School running their social media account for the conference. I love the team I work for there and got to have a shout out at the end of the conference via zoom which felt amazing. I love GOSH and all the staff there are just amazing as well as welcoming to any medical student and they have added fuel to my fire to get into a paediatric speciality…. I’m just not sure which paediatric speciality yet! I have also been chosen to be on the JASME (Junior Association for the Study of Medicine) national committee as part of their media team which I am over the moon about. Their conference at Warwick got cancelled this year but I am excited to help run it in 2021!

Lockdown has been hard. I lived on my own for 10 weeks and I could go a week without directly talking to anyone and adding this to the sleep deprived state my brain was in due to night shifts and the stress of SSC2, I really did struggle. However, this was beneficial as I realized the importance of having a good social network around me. I ended up going home and continuing my project there. It was chaotic but was the best option for me. I had my dog around to distract me and the cats to walk across my keyboard. It also meant I got some free meals that I didn’t have to cook!

I feel like I have kind of cheated my medical degree. When we started back in 2018 I never thought we would have 21 weeks out of education and now, I am going back to a totally different degree. We are only in clinical two days a week which means we must make the most of every opportunity we can get, and clinics are mainly over the telephone which reduces the amount of patient exposure we get. GP placements will be the same with patients only coming in if absolutely needed. It does worry me that this reduced patient contact may impact my skills, however, this new way of doing things may be the new future for the NHS so it’s important we train to be adaptable to this. Covid-19 really has changed the UK beyond what my January self would believe.

Anyway, that is enough for now. I’ll see you again Mid-August!



July 29, 2020

Simulation and the Sea…

The last two weeks have seen my Musculoskeletal specialist placement continuing. A regular feature of our placement has been attending ‘fracture clinic’ every Tuesday. Fracture clinic is exactly what it says on the tin – if you’ve suffered a fracture and been to A+E, they will often pop a cast on to stabilise the injury then refer you to fracture clinic the next day for review by a specialist orthopaedic surgeon. As the specialists they can easily decide if a fracture will heal fine by itself or if it needs an operation to aid recovery. It was fab to see patients in fracture clinic and we got the chance to take a history here and there which was good practice to brush up our skills. A large part of the work of Musculoskeletal healthcare is to treat fractures and trauma and we’ve learned some important principles. By far the most important principal is that any treatment must maintain the a) length, b) rotation and c) rotation of any bone or limb. In short, this means that after the bone has healed, the limb should look and function as much like it did before as is possible.

Our opportunities to see patients face-to-face has reduced since we have returned to placement since COVID-19 began. There are less clinics running in order to protect patients from exposure to the virus. There are telephone clinics running, but these aren’t that useful for learning how to do a physical examination. Instead, the MSK doctors teaching us have tried to give us the same teaching (as much as possible) and one of the ways they have tried to do this is by offering us more teaching and simulation of examinations. For example, shoulder clinics aren’t running so one of the shoulder surgeons allowed us to practice a shoulder examination on each other while the surgeon watched and then offered us feedback. The surgeon then also showed us some tricks and techniques to optimise our shoulder examination techniques. This was really useful and in the absence of practicing on patients, was a good substitute to make sure we can effectively examine a shoulder in our final exams and beyond.

We also had some simulation teaching for our end of block OSLER. What is an OSLER I hear you ask? An OSLER is a practice patient encounter – so we are observed doing a history, conducting an examination and then it ends with a viva style discussion about what we think is wrong with the patient, what tests we would order and what treatment we would like to offer the patient. We have to do at least one per block. Again, the OSLER is meant to be done on a real patient, but for this block we had a volunteer – the block lead! I won’t pretend that doing a knee examination on the block lead wasn’t slightly terrifying. But it was good practice and he offered some good pointers for improving our technique and also showed us he would examine a knee or hip, which was handy to reinforce the technique.

This week ended with a presentation on the Friday about polytrauma. Every Friday we have a case presentation, where a student does a presentation or brings an interesting patient case to discuss and all learn from. These sessions are facilitated by one of the doctors who specialise in medical education and are generally very good quality. This week, I had volunteered to bring a topic and a case, and the subject for discussion was polytrauma. I did a short presentation on managing major trauma (i.e. a road traffic accident) and then presented an interesting case that we had seen. I was nervous for the presentation, but actually it went quite well and some of my cheesy jokes definitely helped break the ice.

That’s my rundown for my last 2 weeks! I finished Friday afternoon and decided to have a spontaneous weekend in Newquay, made better by the fact we have Monday off. Medicine does have its perks!



July 16, 2020

Business

Placement has resumed. Hoorah! For the last two weeks I have been on my musculoskeletal placement which was delayed for 3 months due to COVID. Thankfully, things are back to (nearly) normal. Monday started with induction, where the administrator of the block gave us our timetables and our new uniform – scrubs! So far in the course for placement we have been expected to wear smart clothes – for me a white shirt with the sleeves rolled up to the elbows, smart trousers and smart shoes. However, due to infection control, we have been told to wear scrubs, which can be washed at higher temperatures and more often to kill any nasty bugs. I’m certainly not complaining – while I like wearing my own clothes, ironing all my shirts on a Sunday night is not the relaxing activity you need before the start of a new week. Scrubs are comfortable and easy to wear, with no thought about which trousers go with which shirt. It does feel very informal to be wearing what basically feels like comfortable pyjamas, but I’m not complaining.

On Tuesday we spent all day in theatre with our consultant working through the trauma list, so the operations were focussed around fixing acute problems such as broken bones. It was pretty cool to be back in theatre and a welcome reintroduction to medicine after 3 months off. I have to admit, I had sort of forgotten….well everything really. But luckily there were some lovely scrub nurses around to help remind me how to scrub in for theatre. “Scrubbing in” is an odd term really, but what it actually means is washing your hands in a very specific way to remove any bacteria or viruses and then donning a sterile gown and gloves in a very specific way to make sure they are clean and don’t infect the patient. I’m sure on TV you’ve seen the surgeon and their assistant wearing a long gown and gloves right next to the patient while everyone else stands further back just wearing scrubs. In theatre we get a chance to put on the gown and stand next to the surgeon, and even help out a bit by holding tools and things like that, which was pretty cool. Our consultant is very good at explaining what is happening at stages of the operation, which really helped. I think all medical students should spend time in theatres seeing common operations. Even if you don’t want to be a surgeon, you should know what an operation involves and by seeing it done, you will be better at explaining it to patients. For example, even a GP will be doing some of the aftercare of a hip replacement, and if you’ve never seen one, it can be harder to explain what it involves and recognise when the patient may have complications afterwards. As well as that, it helps things stick in your memory for final exams!

I also got some news this week – I’m a final year! We were told that we progressed from third into final/fourth year. It was more of a formality than anything else, as we basically just needed to be signed off for our first two blocks to progress with no exams this year, but it was still nice news. It does feel slightly odd to change my introduction when talking to patients from “Hi I’m Jordan and I’m a third-year medical student”, to “I’m a final year medical student”, and hits home that I am on the final stretch. It seems both a long time ago and only yesterday when I was the scared first year trying to understand anatomy and not knowing how to talk to patients other than “Have you got any pets?”. Ironically whether they have pets tells you more about their medical condition than you might suppose…Anyway, In one year, I will have done finals, and (hopefully) have passed and become a doctor. Scary indeed, but I’m ready to face the challenges ahead.


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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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