All entries for Thursday 17 December 2020
December 17, 2020
The last two weeks have been…very busy! I have been continuing my Care of the Medical Patient (CMP) block, which covers most of general and internal medicine. Because it covers so much of medicine, it has been very busy because there is simply a lot of content to cover. However, I do think that this block has been one of the best learning experiences. One of the most useful things that I have been able to do this block is attend bedside teaching sessions. One of the original proponents of bedside teaching was the great physician William Osler (after whom several clinical signs are named), who believed that medics learned best at the bedside, by doing. This seems odd to us today, where we would expect trainee doctors to come into contact with patients but 100 years ago this wasn’t necessarily the case. Derived from the practices of William Osler, our bedside teaching in my CMP block is where two medical students are joined by a doctor and they go and see a patient. One medical students usually take a history (i.e. ask the patient what brought them into hospital) and the other student often does a physical examination of the patient. The doctor observes and teaches and gives us students feedback on our history and examination skills. Because of COVID, we have had less opportunities than normal to be able to see patients, so getting this practice under supervision has been really useful. Having an experienced doctor observing and providing feedback allows us to identify our strengths and also areas where we may improve.
Last week I also had an exciting opportunity to attend a Diabetes outpatient clinic with one of the Professors from the Medical School. We have known this professor since first year so it was interesting to observe them doing consultations and experiencing their reputation for amazing teaching first-hand. Diabetes is a really common condition and often comes up in medical final exams – so much so that if I was a betting man, I would say it will definitely come up somewhere. It was really good preparation to go over the basic management of Diabetes.
And here we are, Merry Christmas! Or…not quite! We break up next week, but first there is one last hurdle before that long-awaited break. The Situational Judgment Test (SJT) is an exam that has featured in my blog previously, and I think that pays tribute to just how important it is. The SJT is an exam which is based around what you would do in certain ethical and workplace dilemmas. My result in the SJT will be an important factor in what doctor jobs I will get when I graduate, and even decides the area you are placed. Thus, the result is really important, and it is a very high stakes exam – if you get below a certain mark, you are removed from the job application process and may not get offered a job as a doctor. I’m told this is very unusual, but that doesn’t stop the worry that I could be one of the only ones…So over the last few weeks I have been doing practice questions and reading ethical guidance to hopefully get me over that line, get a good result and hopefully get the chance to be a doctor next year. I can’t wait for Christmas to just relax after a stressful year, and I’m sure many of you reading this will feel the same. Wish me luck in my SJT exam and I hope you all have a great Christmas!
My current placement is Care of the Medical Patient, which is an overarching block which touches on many different areas. Medical patients include cardiology patients, respiratory patients, gastroenterology patients and many others. One area which comes under the umbrella is neurology and stroke care and for this block I have been attached to a stroke ward at George Eliot Hospital. Initially, I was apprehensive about being on a stroke ward because of how poorly stroke patients can be. In addition to this, I would say that personally neurology and stroke is one of my weakest areas academically. I think the anatomy of the brain and spinal cord is so complicated, I struggle to get my head around it. I suppose it’s good that I will get some practice in this area and hopefully become more comfortable with this area. Last week we attended a ward round on the stroke ward with one of the stroke consultants during which the consultant did some teaching about the management of various types of stroke. It was a really useful experience and we even got the chance to do some examinations as part of the round which was a good recap of the neurological examination (one of the hardest ones!)
Then, last Friday I attended an outpatient clinic looking after Parkinson’s Disease patients. Parkinson’s is a disease where one of the chemicals in our brain (dopamine) becomes depleted and this leads to issues with movement, including tremor amongst other issues. Having never seen a patient with Parkinson’s disease before I hadn’t appreciated the fact that there are many different types of the disease and that the course of the disease is so individual. Some patients progress quickly and some people remain stable and do not get any worse for years and decades. I also hadn’t realised how multi-disciplinary the management is. For example, Parkinson’s patients often have help not only from doctors, but specialist nurses, speech and language therapists, physiotherapists and dieticians.
This week I had been booked on to attend an ILS course (Immediate Life Support). All medical students have to have this course to be able to graduate as doctors and it teaches resuscitation in a hospital setting – including skills such as managing an airway, doing CPR and using a defibrillator. I really enjoyed the course and it sort of drew together and consolidated several sessions we have had before. None of the information or skills were new to us, but the application and practice using simulated sessions really refreshed that knowledge and I’m sure will be really useful revision for finals.
The week ended with Friday afternoon which was small group teaching on ECGs and heart problems. Being able to interpret ECGs (electric scans of the heart) is one of the most difficult skills expected of junior doctors, so having some recap and revision of some of the most common rhythms was useful. I haven’t seen an ECG in a long time as I have been doing Paediatrics, Obstetrics and Orthopaedics, so I had completely forgotten everything! Luckily, I quickly clicked back in with looking at ECGs and feel much more confident having a go now! Next week will be a busy one, with a few teaching sessions and hopefully some clinical skills practice. It should be a good one!