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.


July 07, 2020

A holiday, of sorts

Working for the NHS during the COVID-19 pandemic has certainly been a rewarding experience, not only for my education and life experience but also financially. Before I started medical school, I worked full-time for two years, so returning to life as a student was certainly an adjustment! Having the opportunity to earn a bit of money has been really helpful as the nature of our course means that it is difficult to earn money, so my overdraft has definitely thanked me in recent months!

I finished working at the beginning of June, to give me time to get some academic work done before resuming placement. Over the last 2 weeks, I have been using some of the amazing online resources available to us. Many resources are now free to medical students due to COVID-19, and one that I have found really useful is the K2 Obstetrics and Gynaecology website. We currently have access to all of these resources, and the K2 packages are very good, interactive introductory courses on Obstetrics. I am a very visual learner and love pictures and videos to help me to remember things, making the online resources a really useful way of reintroducing myself to the world of medicine.

I have also been using Warwick Medical School’s own online resources. All of the lectures delivered at the medical school are automatically recorded and uploaded for us to re-watch whenever we want to. As my next block is Musculoskeletal, I have been revisiting some of the anatomy lectures delivered in our first year. I thought I had forgotten all of my anatomy knowledge, but actually once I start watching the lectures, all of that information comes rushing back. It really does demonstrate that actually whilst there is a lot of content to learn at medical school, actually a lot of the information is revisited in every phase of the course, with actually little new information being added. Thus, by the time of final year, there is less new information and lots of revision. Let’s hope I feel that way when I go back to placement on Monday!


Hanging up my PPE (for now!)

The last two weeks have brought a partial reversion to normality. Last Saturday was my final shift on the Gerontology ward at University Hospital and the end of my COVID-19 work placement. Reflecting on my time, it has certainly been a worthwhile and enlightening experience. Whilst it has been a struggle (and a worry) to step away from the usual studies and placements of a medical student, the COVID pandemic has still provided key learning opportunities that I will carry forward as I pursue my medical career. My fellow students and I have taken on roles with more direct patient care – such as bathing, feeding and helping to mobilise patients. These are jobs that we have not really trained for, so it has been a steep learning curve at times! We have also been doing some observations, which are normally done by the nursing staff. I feel as though while I haven’t done much medicine for the last 3 months, I have learned a new and complimentary set of skills. Interacting with confused patients is something I was very anxious about before my time on the Gerontology ward. Now, I feel as though I can look after these patients much better. I hope that when (if) I pass my final exams and graduate, that the acclimatisation to clinical practice will be that small part easier because of the work I have put in now.

I’ve now left my job and it was really sad to say goodbye! I have really gotten on well with the nurses and other staff members I have worked with and they’ve said that I’ll be missed. I feel as though the one big change in me over the course of the COVID situation is my confidence. Everyone has wobbles and doubts from time to time, but I think that maybe I’m more prone to these than most. There probably hasn’t been a day since I started the course that I haven’t secretly wondered if I’m good enough to complete the course and graduate and be able to be a doctor. I think from the positive feedback I have received while working from my colleagues, I may finally feel slightly more confident (get it!) at putting those doubts to rest. I think the lightbulb moment came during my last week at work. It so happened that two patients needed cannulas putting in and someone needed to do it. Despite my nerves, I managed to do both. I think the nurse could tell I was terrified – they cheered when I did it successfully and gave me some sage advice from their experience. They said to me – it doesn’t matter how scared you are – say yes to every opportunity to do a skill or put a cannula in or examine a patient as this is how you build your confidence. I think I was quite good before at getting stuck in, but now I will approach these clinical opportunities with less fear, and less self-doubt.

Since finishing work, I have really gotten stuck back in to my medical studies. I start my Musculoskeletal block at the end of June and I am determined to do everything I can to be prepared and do well during the block. I’ve decided to revisit my anatomy teaching from first year to prepare – I definitely need a refresher! Anatomy teaching at Warwick is superb, and I have been watching the lectures again, and am slightly reassured that they make a lot more sense in hindsight, and that a lot of the detail has come rushing back. What I once knew, but had forgotten, has been (at least partially) remembered. Clinical practice really is so dependent on that basic anatomy and physiology knowledge that you learn in First year of the course. Going back to basics provides a strong foundation on which I can hopefully build during my musculoskeletal block which begins soon.


June 02, 2020

Getting in a tangle

I’ve been trying to keep some sanity outside of Covid and try to keep my brain occupied, so, I’ve decided to learn some new skills and try to sharpen my existing ones.

Firstly, I’ve picked my books back up. I used to be an avid book worm, but I’ve lost it in the past couple of years. I have read an incredible book called The Rosie Project which just blew me away. I did not expect the protagonist to be on the autistic spectrum (made even funnier as everyone knows he is but him). I devoured the book over a week and I have bought the rest of the series. It’s given me a sense of closure as I can pretend it’s a follow on from the Curious Incident of The Dog in the Night-time, my favourite book. I have also used up my audible credits and listened to The Prison Doctor. I loved wandering around campus listening to this as it tells the tale of the type of Medicine very few of us will get to experience.

I have also taken my crocheting up a notch by trying to crochet bumblebees. If you know me, I am obsessed with these creatures and I am hoping to create a little bumblebee bunting for my friend who is having their baby this month! It’s going ok, I just seem to be creating bumblebee fish at the moment… I am also trying to create a blanket for my dog back home. He prefers blankets to beds, so I am trying to make him a thick, comfy, soft blanket for winter. Progress is slow. I have also started knitting but I can’t for the life of me figure out how to get my work off my needles. So, for the past month, I’ve just had a square of material sitting on them. I’ll figure out soon!

A&E has been its usual self. I am getting slightly better at putting in my cannulas and can generally get a pink in most of the time. I had a brilliant nurse the other day who was showing me tips and tricks with cannulas, so I am hoping to get better and nail it for OSCEs next January.

The impact of Covid on our studies really has hit home. We had a whole year meeting the other day about coming back to training and placements. My third year placements will be one week shorter and won’t start till April, when we would normally start them in January. It’s scary to think we will have 8 weeks less to complete our learning than previous years, but I suppose in the end, it’s just a case of working slightly harder to get it all done. We don’t know if our finals will be affected yet and if the dates will change however, one thing is for certain(ish), our SJT will be in December 2021. Next year, I will be taking an exam that’s worth one half of my final mark... I was not ready for THAT hit of reality.

WMS have been brilliant throughout all this time and have been nothing but supportive. The Teams app has a virtual common room and a virtual café where we can chat. They have also been sending weekly updates including a spotlight on staff members. Shout out to Colin Macdougall for having the best taste in comedy (Foil, arms, and Hog) and for Emily Reid in making me feel bad that I have barely done any form of heart rate raising activity by doing every single episode of Joe Wicks PE class. I also like the fact we still have academic days as I get to talk to my year in my isolated bubble. It also gives me a chance to put my brain to use rather than writing notes from year group meetings.

We are meant to be returning to normality on the 27 July depending on how the country copes and how the third years get on as they go back one month before us. However, for now, I‘ll be working on my summer glow (hopefully without getting burnt) and trying to get my head around my SSC2 project!

'Til next time.


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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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