What day of the week is it again?

Week 8 of lockdown, aren’t we? To be honest, everything feels so much of a blur and all the weeks have moulded into one. It does however feel like an age since I was last wearing my stethoscope on the wards trying to appear like I knew what I was doing. Covid 19 has truly changed our lives and we as medical students are no different. As you have probably seen from Jordan’s updates, we have been given the option to work in local trusts and I have been allocated George Eliot's (Geliot) A&E department. I was amazed when I got offered it and I really have enjoyed it. I even have done my very first night shifts which are strange. Trying to stay up the night before is hard and I don’t think I would have gotten through the first one if it wasn’t for my good friend, Red Bull (other brands are available).

I have been lucky as it’s given me the opportunity to practise my clinical skills and I have mastered the art of small talk whilst doing cannulas. I have grown so much in confidence with these, just need to work on putting in the next gage (bigger diameter cannula) up as I seem to struggle with my pinks. One of the best parts has been having a good old chat with the patients. I had a lovely human the other night and we spend an hour chatting about the original VE day, being evacuated, the bombing of Coventry Cathedral (one of my favourite facts about WW2 purely because it was in a Sherlock episode) and the rest of their life. We found out we have families in similar parts of the UK and we chatted about Megan and Harry and baby Archie. It has been nice to get to do this as the department has been…let’s say…. Less populated than usual. We normally get to 3am and one have one patient in majors, so we sit and chat as a team. I even got my ECG done the other day!

The PPE was a novelty at first, but I wish I could get away with not having it on. The mask dries my mouth out quickly and constantly breathing in your own C02 makes a 12 hour shift that much harder. We haven’t had a problem with PPE at Geliot apart from the nice elastic masks running out meaning everyone has to wear the tie-on masks which we all hate. One positive spin is that the team cannot see how much I yawn at 3am! It’s one of the only times I have liked being someone who smiles till their eyes disappear.

I got to experience being in full PPE the other day as we had a peri-arrest Covid positive patient come in. I was only in it for 2 hours, but I was boiling and thirsty. The ICU team are heroes! The patient was fine, and I put in their cannula and took their bloods and before long, they were sent to the wards. I have also seen someone extremely sick from Covid. They unfortunately passed away in the department and I felt heartbroken for the family who couldn’t see their relative in their final moments. It was also the first patient I have seen pass away and it's a moment that will forever stick with me. Night shifts bring everything to the table.

Outside of ward work, we have been given our SSC2 projects to do. We are all currently doing a systematic review. I found a topic similar to that of my original project but I am finding the software…..tricky. Let’s say I have come close to sending my computer on a horizontal trajectory through the window and onto the ground outside. However, it’s no different to the problems I faced in my undergrad dissertation except this time, it’s computer software and not human brain cells letting me down.

We are due back to placement at the end of June pending on how the third years get on. The crisis will impact my degree even beyond this year as we found out our third-year placements will be one week shorter and, depending on any future lockdowns, my second-year placements could also be made shorter. It’s scary to think, but this will affect the future training of doctors. Interestingly, I prefer doing the 12 hour shifts as opposed to turning up onto a ward hoping for something to do. I have learnt a lot more, even my ECGs are coming along! I think we would benefit training like student nurses and having shifts instead of popping in. That is just me though, I have a lot of time on my hands at the moment!

'Til next time!

Hattie Trigg : 15 May 2020 08:12 |  Tags: Abbie Covid19 Mbchb Patients Student Wards Warwick Wms |  Comments (1) |  Close comments |  Report a problem

Uncertainty

For the last two weeks I have been continuing my employment at University Hospital Coventry as a Medical Student Clinical Support. As I discussed during my last blog, this is to help the NHS deal with the increased demand expected because of the COVID-19 pandemic. So, what have I been up to? Well, I am currently working 24 hours a week, which is 3 days of shifts from 12:00-20:00. Whilst at work, I am acting as a Healthcare Assistant, so helping to wash, dress, reposition, feed and just generally look after patients on the ward. In addition, I am allowed to carry out observations. These are done regularly for all hospital patients every couple of hours or so, usually by the qualified nurses on the ward. A standard set of observations includes blood pressure, pulse rate, breathing rate, consciousness level and temperature. We have been very busy on our ward, so I have helped the nurses by doing some of these observations and letting them get on with the drugs rounds and other duties that require a qualified member of staff. Medical students are taught to do observations as part of examinations (i.e. pulse for cardiovascular examination), but we aren’t taught to do observations in the same detail as nursing students. Having the opportunity to carry out so many has definitely increased my confidence and is hopefully a useful skill to take forward into my medical career when we finally go back to placement.

I have been settling into my ward and getting used to working again, as well as learning everyone’s names, which is slightly more difficult when you’ve never seen their whole faces as everyone permanently wears a mask while at work. I’d never realised before having to wear a mask which covers my mouth just how expressive my face can be and how much I use facial expressions to convey meaning whilst talking. I’ve been quickly learning how to use my eyebrows more to express more emotion – an unintended side effect of PPE (Personal Protective Equipment!)

Then I suppose I should discuss what’s happening with our course currently. Things are on hold until the NHS has dealt with the COVID-19 outbreak, at which point we should resume placements. It’s very difficult to say when the NHS will be stable enough to also deal with teaching us, but the University has posited July as a potential resume date, at which point we will have lost 3-4 months of placement. Final exams would be potentially pushed back from February to May and we would then do placement well into 2021 (when originally without COVID-19, placements should have ended December 2020 before revision and then finals in Feb 2021). There is a lot of uncertainty at the moment which is causing a lot of anxiety for everyone, and this is worst for the current third years who are the most senior medical students and so have the least time to make up any lost learning before graduating.

All of this anxiety about the future has been affecting me personally and my course-mates – we have joined the course to become doctors, but not just doctors for the sake of it. We want to be good doctors, who are able and good at doing the job of looking after people. For me personally, I don’t want to qualify and then feel like we aren’t as good as the years that have gone before us and those that come after us. Thus, it seems like a steep climb to the end – we will be out of practice with everything having had a 4 month gap, with less time to get to the same standard as our forebears in a changed NHS which may be unable to give us the same education as previously. I think this mountain must be surmountable – but at what cost? Added to that is the generally gloomy news; of economic uncertainty, of social isolation, of deaths in the news daily. The mental health impact on the UK mustn’t be discounted and I think will haunt us for years to come. As a former historian, I feel as though we are watching history unfurl before us – a turning point as real as the world wars, the nuclear age, the bubonic plague. As before, the solution is courage in the face of adversity – believe in better times and look after each other and we may yet see an end to this nightmare.

Megan Earle : 11 May 2020 08:58 |  Tags: Covid19 Jordan Mbchb Student Warwick Wms |  Comments (0) |  Close comments |  Report a problem

The Frontline

The last two weeks since my last blog have been…well, strange, as I am sure you are aware.

I have now been employed as “Medical Student Clinical Support”, and have been placed at University Hospital Coventry and Warwickshire (UHCW), which is the largest partner NHS trust affiliated to the Medical School. My ward is normally used for care of the elderly but it is looking after patients with suspected or confirmed COVID-19 at the moment. I am essentially working as a Healthcare Assistant, which involves duties such as bathing and moving patients, cleaning and general support. In addition, however, we are allowed to practise the clinical skills we have been signed off for in line with how competent we are. For example, this includes things such as venepuncture (taking blood), cannulation, setting up oxygen, doing Electrocardiograms etc. This has prompted me to think about my competencies – how confident/competent am I at performing these skills in the real world?

As a medical student, and indeed as a doctor, the phrase “act within your competencies” is used quite a lot to determine what you are able to do. But what does this mean practically? In years gone by, doctors operated by the adage “see one, do one, teach one”. For example, if a student/junior doctor had seen a certain operation (let’s say a hip replacement), then they would progress to doing one, before then teaching this skill to others. This would be how doctors would learn pretty much everything, but of course this method has its drawbacks – primarily that this isn’t an effective way to learn how to do something safely. I could watch someone lay a road, but that doesn’t mean that I would be happy to then “have a go” and I’m sure the results would be terrible!

What has happened then, in recent years is that things have moved towards competencies and a more holistic way of teaching and learning skills. So at medical school, we have to learn certain skills that all doctors must be able to do – for example inserting a venous cannula or administering oxygen therapy. We receive formal teaching on how to perform these skills which are called T-DOCs, and at the end we are assessed by the tutors as being signed off, meaning that we can practice these skills as long as we are supervised by more senior colleagues. You can then practise (of course with appropriate consent) and with supervision until you build up confidence and ability to perform these skills. You do the training for most of these skills in Year 2 of the course and they include lots of different skills. I have only had the chance to practice a couple of them so far on real patients – I have done about 20 cannulas, taken blood about 20 times, set up oxygen a couple of times, and have a reasonable rate of success.

We had a general induction and also some basic Healthcare Assistant training on the first few days. We were told how to clean effectively and how to bathe and feed patients etc, which are skills we don’t regularly get taught how to do during medical school. After this we started shifts on the wards. On my ward, everyone is really friendly and approachable and keen to teach and show you how to do things, which makes the whole thing of being a new member of staff so much easier. We have also been given uniforms which we have to change out of at the end of every shift and also been given appropriate PPE. At all times on our ward, because there are suspected and confirmed COVID-19 patients, you have to wear a surgical mask (which is fine for half an hour, but when worn for the whole of an 8-hour shift, your mouth dries out and cracks). When approaching and caring for patients, we then have to put on an apron, gloves and a plastic visor. Wearing all of this makes looking after patients so much more difficult and a lot warmer too, which isn’t great when its 25 degrees+ outside. So far, I have helped with general patient care including repositioning, feeding and cleaning and it’s amazing to feel like part of the team and like I am helping, if only a bit! Sometimes it can be really sad, especially because visitors aren’t allowed except in exceptional circumstances, which means that the only human the patient sees is you. I have been trying really hard to chat to the patients when I can and make sure they have everything they need to be as comfortable as possible in the circumstances. It has certainly been a different challenge to what I normally experience whilst on the ward, but rewarding and important nonetheless. Stay safe!

Hattie Trigg : 29 Apr 2020 10:31 |  Tags: Hospital Jordan Mbchb Patients Student Wards Warwick Wms |  Comments (1) |  Close comments |  Report a problem

Abbie down the Rabbit Hole

It feels like I’ve stepped into a weird alternate dimension of planet earth. Queues to get into Tesco, petrol nearly down to the pound and campus the quietest I have ever seen it. It’s like a ghost town here!

We’ve been off placement for four weeks now and I have lost all definition of time. It’s even harder as I live on my own, so the social distancing basically means social isolation for me. It’s been hard, getting up with not much to do and losing any sort of normality. However, I know it’s a very small on the bigger scale of things.

We’ve also had changes to the order of our degree. We normally do our SSC2 project after second year exams in third year. I had self-proposed my own SSC2 project and I was really excited to get on with it. However, due to Covid-19, that was all about to change. Instead of CCE2/3 which we would have normally been doing up until the end of July, we have essentially swapped them for the SSC2 project, and our exams will be pushed back. That was ok until I read the second part of the swap. We would all now be doing a systematic review. I was gutted. I thought my project would be ok as I didn’t need to use any patient data or go anywhere near a hospital. However, due to many of the staff going back into their NHS roles, ethical clearance wouldn’t have been able to take place. Again, not the biggest injustice in this crisis but I was gutted and the thought of doing a systematic review instead of my own project was underwhelming. However, I am still hoping to keep a similar topic to the one I originally planned so hopefully, not all is lost.

We have also been offered the opportunity to take up roles in the NHS like our fourth year counterparts. We are going in as a morph of HCA/medical student. Essentially, an extra pair of hands to help in this unprecedented time. I am working in the A&E department of George Elliot Hospital which I am looking forward to as it will enable me to spend time in a department that I have only been a patient in before. I had a bit of an introduction shift last week which felt odd as there were only four patients there the entire time I was on shift. However, it gave us time to get used to the place and even get some ECG teaching. Something I really did need; cardiology is not my strong point. I’m looking forward to being able to put my skill set to use and helping where I can. I know I can’t do a huge amount but every little helps right? I am grateful for the opportunity as I know not all medical schools have done this, so we are incredibly lucky to have this opportunity and I do hope other medical schools follow suit!

I don’t know when the lockdown is going to end. Everyone seems to have their own theory and I am just trying to avoid spending too much time on social media. I am hoping I can keep myself busy with SSC2 and shifts in A&E to try and stop myself becoming homesick during this time. I have an Easter egg from home waiting in my fridge for Sunday, I wish I could pop home for Easter roast but I’ll just have to wait until we are released back into the world. For now, I am waiting for the goslings and ducklings to make their appearance down at Tocil lake and making good friends with the local wildlife.

'Til next time!

Hattie Trigg : 14 Apr 2020 12:24 |  Tags: Abbie Easter Mbchb Patients Student Warwick Wms |  Comments (0) |  Close comments |  Report a problem

Changes

In my previous blog, I think I said nothing has changed. Well... I have been proven dead wrong in the last two weeks. Week 5 of Acute block was delivered normally, and we were told on Sunday evening that Week 6 (the final week) of Acute block would go ahead as much as possible. So we turned up for teaching on Monday morning and were told that everything had changed and sent straight home with all teaching and placement cancelled. We then had an online meeting from the Medical School saying that our next block (for me, Musculoskeletal care) had also been cancelled.

Usually in the last week of Acute block, you have lots of teaching sessions and then at the end you have a practical exam where you are observed performing an assessment of a patient and are then signed off for the block. However, considering the COVID-19 situation, this was cancelled and instead we were signed off by telephone by the block lead. I think mostly this was to make sure that were signed off for the block so we had it “banked” and wouldn’t have to re-sit it afterwards. For the rest of Week 6 of Acute block I mostly just did some book work and got on top of my notes to make sure I was using the time productively. To be honest, I was behind on my note-making so the week off was helpful.

The Medical School have been trying to update us as much as possible about what is happening, but of course its difficult as no-one really knows how things are going to go. For us third years it brings added uncertainty. Phase III (Years 3 & 4) are very tight for time. We have 8 specialist rotations January - December with only a two-week break in August. And then we have a revision block in January before sitting our final exams in February. In actual terms I have my 8 x rotations January 2020 - December 2020, and then January 2021 - February 2021 revision block and then final exams in February 2021. However, because of COVID, if we miss one 6 week block, we still have to do these hours somewhere else so we would lose revision period and/or exams would need to be moved to facilitate a revision period. So, by losing placement time now, it has potentially large repercussions for the course. The Medical School have been great in terms of working tirelessly to try and make sure missing things has the least impact possible, but of course it is hugely challenging for them to restructure the whole course for 4 years groups all of which have different requirements and challenges! I will keep you updated!

Another development in the last few days is the opportunity to work/volunteer in the NHS. The NHS is on the frontline of the epidemic and is struggling at the moment with staff illness and also an increase of demand, so they need more support than ever to deal with the consequences of the virus. To this end, they have asked medical students to help out within their competencies as far as possible. It's completely voluntary but we are going to get paid to help out with basic medical tasks. For us third years, this means that we are able to help with doing ECGs, cannulas, taking bloods and direct patient care (washing, dressing etc). I thought long and hard about whether to help and have decided that I will go for it, partly for myself in terms of keeping my clinical experience up to date and engaged, but also on a wider level to help out. COVID-19 is unprecedented and the event of a generation and anything that I can do to help, no matter how small, I feel duty bound to help, as (hopefully) a future doctor, a current medical student and also as a human being.

All of the blogs that follow will document this interesting journey until we get back to a “business as usual” medical school. Although formal medical education has been postponed for now, I think that education of a different type will happen whilst I’m working in this role and of course I still will have all of my book learning to do at home. I will keep you updated as always as we go through this challenging journey together, which I’m sure will be a steep learning curve for us all.

Hattie Trigg : 07 Apr 2020 13:32 |  Tags: Jordan Mbchb Patients Student Wards Warwick Wms |  Comments (0) |  Close comments |  Report a problem