April 07, 2020

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.


March 24, 2020

Coro NO a

I tried to go for a pun in the title. I guess it’s time to address the elephant in the room. Corona or as it is officially known, Covid-19. I have to admit, it’s been in the back of my mind since the first cases arrived in the UK but I never once believed it would get to the stage it has today. It’s affected people everywhere and posed a particular problem to medical students.

We turned up to our placement on Monday. I’ve officially moved hospitals and I am now at George Eliot (fondly known as Geliot), a small local hospital and a million miles away from what I have known at UHCW. We can get a cup of coffee for a £1 here for starters. We were issued our passes and then went out to explore the hospital before our welcome lecture from Dr Nair at 12:30pm. My clinical partner and I decided to hunt down one of our consultants who is a Respiratory consultant to say hello and get to know her timetable. We eventually found the ward and waited for her to arrive. It was weird, a new hospital, new wards, new staff. My brain was struggling to keep up. The side room behind us was being treated by nurses in full PPE. Our doctor arrived and as we said hello, we knew were not going to be there long. She explained how she didn’t want medical students on the ward because of the extra workload they were facing, however, she did provide us with a timetable of her work life which was brilliant.

We ended up wandering the hospital unsure of what to do next when we bumped into the F3 who was on the ward who offered to take us to the morgue. We accepted but I was a bit hesitant about what we were going to see. We stepped in and watched the doctor checking for pacemakers. It was profound to see those who had passed on, and coming out of the room, my brain was still trying to process everything I had seen.

We went to grab a cup of tea after to sit down and mull over everything when we found out others had been removed from the wards and were upstairs. We ended up all sitting in the canteen, delving into Geliot's well-talked about ice cream bar, waiting for 12:30pm to arrive. However, word began to leak through that all first-year teaching had been cancelled. I was pretty sure what that meant for us then. Then the email came through to say we were off placement for two weeks. It felt odd. On one hand we were happy, we wouldn’t be posing an infection risk anymore and it meant we had a bit of a break after our first 10 weeks of placement. On the other hand, we were disappointed as it meant two weeks of nothing but theory and no clinical time, especially when we had only been at our new hospital for four hours.

We met Dr Nair for a hello and goodbye session before making our way back home. Luckily for me, it meant I could have the afternoon sleeping off my newly developed cold (not covid, runny nose, no cough, no high temp) and not have to miss placement.

The next few weeks will be interesting and worrying. A lot of my year have gone home to help the NHS in their old roles of HCA/nursing/ODP and many more. I just hope they stay safe. For me, I’m trying to see if I can get a job as a HCA or help out at local GPs. I can take bloods, insert a cannula, do obs, and now ABGs. I want to help out but if helping out means staying away, then I guess it’s the presentation list for me! There’s schemes being set up across the country by med students offering child/pet care for health professionals who are caught on the Covid front line which I think is brilliant. We are all DBS checked, and have a lot of time on our hands!

How this is going to affect the future of my degree is unknown, how it’s going to affect the NHS is unknown. The next few weeks will bring change but by sticking together (figuratively), following guidelines and keeping safe, that’s the best we can do for now.


March 23, 2020

Resuscitation and COVID–19

It’s only been 2 weeks since my last blog, but it feels like a lifetime in so many ways! Coronavirus has gone from a distant virus circulating in China to the main news story every day and a major concern for everyone.

Starting with last week, I had a shift at the UHCW A&E Resuscitation department on Saturday night. This is where the really sick patients come in to be stabilised before they move on to other areas of the hospital. These patients have a variety of serious conditions including sepsis, major pneumonias, major trauma, major bleeds, heart attacks etc. I really enjoyed this shift and how fast paced the work was. The patients are “big sick” and the job of resus is to treat them as quickly as possible, stabilise them and send them to the wards/theatre etc. The doctor who was supervising me was great and encouraged me to go and talk to patients, put in cannulas and take bloods, all of which I managed to do! It really built my confidence to be able to actually be useful and help the team, rather than the ever-present feeling of just being a burden as a medical student. I also got a chance to practice and perfect some airway manoeuvres, which are skills that are difficult to practice apart from in a Resuscitation environment. One of these is called the jaw thrust and involves pushing the jaw forward to keep the airway open while holding an oxygen mask over the patient’s face. You then have to monitor the oxygen and carbon dioxide in their blood to make sure you are oxygenating them successfully. Although this was daunting, I had lots of support, teaching and supervision from the very talented staff in Resus and managed to do this successfully.

I really wanted to avoid talking about coronavirus/COVID-19, but it’s impossible to do when it has had such a big impact on everything, so I thought I would update you from a medical student’s perspective. What is happening depends on which medical school you are at, but for third years at Warwick (i.e. me!), there has been little change. Overall, from this week the first years are being taught online/via lecture recordings, the second years are off placement and we are continuing until we finish this block in one week’s time. I think the thinking behind this is that our specialist placements are very time limited because they run until December and then we have finals, so there isn’t much time to make up for any lost teaching. Completing this block means that if there is any future disruption, at least we have this block completed and banked. I am glad we are still on Acute block as I have enjoyed it so far and it is an important one overall.

I think the next few months will be very challenging based on the news, but I also think it’s important to make sure that we look after one another and reach out to any members of our community that are vulnerable and may need extra support. There has been talk in the news of medical students supporting the NHS, but I think that is more the current final years as they are more useful clinically and can help with some basic jobs. What about us? Well, there has been some talk online about junior medical students maybe helping with babysitting NHS staff member’s children and odd jobs to help out but I haven’t heard anything officially. I will keep you posted!


March 19, 2020

Yes I cannula

We are coming up to the final weeks of our block and getting ready to move on to our next placements. I am moving to George Elliot which is a general district hospital which will be a million miles away from UHCW, but a welcome change.

However, before we get there, we still have three more weeks left of our speciality block to get through. We started out with peri-op. This is basically everything that happens just before and after you have an operation. It was nice to be away in theatres for a change and I have fully decided that I want to live in scrubs for the rest of my life. It was also an opportunity to find out more about anaesthetics which is a totally different speciality to what we have seen so far. I’ve encountered anaesthetists already on the labour ward but this was a chance to find out more about the speciality when it comes to operations.

We began watching general surgery which was a hernia repair. I was interested as to how they put the patient to sleep and what drugs were used. I was watching the cannula being inserted like a hawk as it’s a skill I’ve been nervous about due to the fiddly nature of it, but I’m keen to get one done this week. The anaesthetist took us aside in the theatre and talked us through methods of cannulation and egged us on to practise our one-handed technique. We spend the next 20 minutes inserting a cannula into the packaging it came it. It felt weird but was great practise. We had to go then for teaching on otoscopy which is looking into people’s ears. I seem to have a thing where I keep getting ear infections, so I am familiar with the tools of the trade. I think what I took away from this session most of all however was a little motivational talk I got from the doctor.

I mentioned how I had gone off surgery since I don’t feel like I can cope in a world where people are a vastly different personality type to me. I am a bit fluffy, and most surgeons are not. I said I would rather be happy in all the years of my career than happy just at the end. She told me off for thinking this way, that I should never give up just because I don’t fit in, and that I should make my career fit with me. She said we need more female surgical consultants. I admit I did feel a sense of comradery after this but I just think I have drifted away from the idea. I don’t mind, I have a deepening love of paediatrics and a goal of getting to GOSH that no one is going to stop me getting to.

Aside from the small uplifting talk, I also achieved another milestone this week. On Tuesday we had a couple of surgeries and a lovely anaesthetist who allowed me to practise my cannulation. On my third patient, I managed to completely insert the cannula, completely unaided from beginning to finish. Inside I was grinning ear to ear. My demon had been banished. I asked our lovely anaesthetist to sign my cannula off but she stated she wasn’t a doctor so couldn’t do it. I was so confused; she had run all the induction and was alone in the theatre running it. Turns out she was an anaesthetist associate. I had never heard of that role before, so it was nice to actually have a chat and find out more. We are encountering physicians associates at George Elliot (fondly known as Gelliot) so it was nice to have a chat with someone of a similar background.

I can’t wait to move on. My next post will be coming from after I start at Gelliot but reflecting on block one, I have three memorable moments:

  1. Helping to deliver a baby
  2. Meeting my first paeds patient in GP and getting two hugs as a thank you and finally...
  3. Having a neonate baby hold my little finger whilst they were having a cannula inserted.

It’s been a eye-opening 10 weeks and I’m looking forward to the next 10, even if it is partly because I’m looking forward to my week off in May!


March 13, 2020

Accidents and Emergencies

For the last two weeks, I have been on placement as part of the ‘Acute Block’. I have been excited to experience as much as possible during this block as I’ve always considered ‘Acute Medicine’ as a potential career path after graduation. The block includes a variety of placements including A+E, the Intensive Care Unit, Anaesthetics, etc. There’s something I find exciting about the challenge of not knowing what’s going to come through the door and having to work quickly to make the patient better. (This may just be because I’ve got a short attention span, but I’ll let you decide!)

Last week I had two shifts in Warwick Hospital’s A+E department. One shift was in ‘See and Treat’ from 1.00pm - 9.00pm and another in ‘A+E Majors’. ‘See and Treat’ is where patients have problems that can be treated on the spot without need for lengthy hospital admission. I thought that I would be shadowing at first and then may be able to see some patients later, however I was immediately told to go and see patients. Having just come out of the 6 week ‘Psychiatry Block’ I was quite apprehensive as it had been some time since I’d put my knowledge of physical medicine into practice. Quickly enough, though, I was able to remember how to examine a suspected broken foot and I knew what questions to ask to rule out a bleed on the brain after a head injury. Most of the patients had suspected fractures, so I also got a fair helping of X-ray interpretation. One of the Advanced Nurse Practitioners was keen on teaching and went through some good radiology revision with me, as well as the criteria for a head scan after trauma.

This week I have also had shifts on ‘A+E Majors’ at UHCW, our main teaching hospital, and also a regional Major Trauma Centre (MTC). I didn’t really know what a MTC was before this block, but it basically means that it is a centre of excellence for dealing with major traumas such as car crashes, stabbings, shootings etc. Not all hospitals are MTCs, so it’s sort of neat that our main hospital is. It also means that patients are brought in from all over – so if you had a car accident outside for example Warwick Hospital, even though there is an emergency department at that hospital, the ambulance service would drive you all the way to UHCW. The theory is that because UHCW is used to dealing with these major traumas, the survival rate is better. I think I saw a research paper that showed that structuring services like this does save lives every year, so it does work. Because of this, during my time in A+E Majors, I have seen several traumas, along with heart attacks, pneumonias, sepsis and many other things.

During my second shift, Majors was busy, so I went over to the “Rapid Assessment and Treatment” unit, where they assess patients and decide where they need to go next. Up until now I had only done 3 cannulas and failed 2 of them so I was feeling less than confident. However, in the Rapid Assessment unit, almost all of the patients need cannulas – so this was my chance to get some practice in. I managed to try and do 3 more and managed to get all of them, massively improving my overall success rate. Towards the end of this shift I went back over to Majors and was told that there was a patient having a heart attack. I was able to go over and see the patient and observe while they got their treatment. In the media, you only ever see negative stories about our NHS – for example how the targets aren’t being met, or when it failed to give good care. Today, however, I saw how the NHS does work when it matters – for example, someone can have a heart attack, have the paramedics turn up, be taken to a specialist hospital with a specialist cardiac unit, be seen in A+E, and then be taken to the catheter lab to have the clot removed within an hour and a half. This saves their life. The NHS isn’t perfect by any means, and there are lots of inefficiencies. However, when someone is really sick and in need, the NHS delivers, and it delivers the best standard of care imaginable. To make it even sweeter, it costs patients nothing at the point of care.


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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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