All entries for Friday 30 June 2017

Starting the Care of the Medical Patient Block

We have just started our fifth specialist clinical rotation of Phase III and it’s really hard to believe that the time is flying by so quickly (this seems to be a recurring theme). This block is called Care of the Medical Patient (CMP for short) and I think we’re lucky to be doing it at a very big and busy hospital with lots of learning opportunities. Whereas most of our blocks have focused on more focused topics (paediatrics, musculoskeletal health, and obstetrics and gynaecology), the flavour of this block is more on general medical topics than many other blocks. This means that we see lots of traditionally core-medicine topics in quick succession and have many varied learning opportunities.

In Phase II (the latter two-thirds of our second year), our curriculum introduced us to “Core Clinical Education”, the purpose of which, I gather, was to give us a grounding in core medicine and help us students become proto-clinicians without getting carried away by too-detailed topics. At this point, it seems like the CMP block is expanding on these themes. We are getting a lot of teaching on core topics and talking about conditions – their diagnosis and treatment – in far more detail than we ever did in the second year. We seem to be focusing a lot of dermatology, neurology, renal medicine (I actually love kidneys), cardiology, gastrointestinal medicine and respiratory medicine than we have so far in any other block, and I’m really enjoying it. I have always had a great time with the core-medicine subjects and could possibly see my career developing in this direction.

In addition to being assigned to a base ward for the block (my clinical partner and I are on an endocrinology ward, so we see lots of diabetes and thyroid problems), we are also expected to attend lots of clinics of all sorts of flavours and also rotate through other wards for exposure. It’s pretty full-on. So far, I have attending two renal-medicine clinics (did I mention I love kidneys? I love kidneys!), a lymphoma clinic and a diabetes clinic – and we’re just a week into the block. It has been absolutely fascinating to see physiology come to life: when we first learned about the structure and function of the kidneys in October 2014 (Block 1 of year 1), I found it really overwhelming. But I committed myself to learning more about them, and I’ve slowly developed a begrudging yet abiding love for all things renal. Needless to say, the clinics have been great.

In addition to wards and clinics, we also get a fair amount of teaching from consultants and registrars. This is usually very useful. Today we got the first haematology teaching since second year, and I found it fascinating. I think my coursemates all think I’m mad, but I love talking about things like Tissue Factor and the Extrinsic and Intrinsic Pathways. I am really looking forward to the rest of this block and seeing more of what CMP has to offer. Maybe I’ll see if there are any extra kidney clinics as well!

John

Luke Pemberton : 30 Jun 2017 10:26 |  Tags: John Mbchb Student Warwick Wms |  Comments (0) |  Close comments |  Report a problem

Learning outcome number 1: Learn all of medicine!

My task this year, to learn medicine, all of it. The medical school would say I am exaggerating but this is what it feels like to be a medical student. It’s so difficult to know how much we need to know and in what detail, learning outcomes are supposed to be a guide and can therefore seem vague and textbooks vary so wildly that you start to believe that maybe Wikipedia does have all the answers (note to self, it doesn’t!). This is a universal problem for medical students but it’s especially true of the Care of the Medical patient block which I am just finishing.

In third year, our speciality placement blocks are just 6 weeks long. I’m sure I’m not alone when I say medical students are often quite organised people and are good at compartmentalising their learning. So far this has worked in my favour, Paediatric block, focus on children’s health, then for Obstetrics and Gynaecology focus on women’s health. This theory doesn’t work in Care of the medical patient…which bits of medicine, or just all of it in just 6 weeks? I started the block wanting to see and learn everything medicine had to offer but after trying to sort out a timetable and plan of action going forward quickly realised this was unrealistic and impossible!

Thankfully at UHCW our block lead had taken the time to give us a timetable to guide our learning with some gaps in that we could choose to fill (or not!). Every week we are assigned to clinics from different specialities to give us a flavour of the sort of patients those doctors see. I particularly enjoyed a haematology clinic where I learnt lots about haematological disorders (such as blood cancer) as well as loads about interpreting blood tests. I also got the opportunity to attend a Fast track clinic for suspected Lung cancer, this clinic has patients referred from GP with symptoms that could be indicative of lung cancer. Attending this clinic reinforced the symptoms and signs all doctors should be aware of to identify a lung malignancy and how you would investigate it. One day a week we are also assigned to a different speciality ward. Tied in joint first are my days on the Gastro ward and on the Stroke ward. The Gastro day saw us attend an epic 5 hour long ward round seeing patients with liver and pancreatic disease all over the hospital. On the stroke ward we got to take some interesting histories from some of the patients recovering from severe strokes which really helped me understand more about potential risk factors and warning signs for stroke, we also got the opportunity to examine patients and see neurological signs first hand.

As well as days and clinics in different medical specialities we are assigned to a care of the elderly (or geriatric) ward. Geriatric wards have bad reputation among medical students. Common beliefs are that all the patients have dementia or are confused so no one can give a good history, or that patients aren’t medically unwell so there’s no point in examining them. Having spent 6 weeks on the geriatric ward there is some truth to these beliefs but it doesn’t mean there is nothing to learn as a medical student. On the geriatric ward you learn more about co-morbid disease than anywhere else in the hospital, you learn how a person’s psychological state and their social situation impacts on their health and how this needs to managed by a whole team of people and not just a doctor with prescription pad.

So, I haven’t learnt the whole of medicine in 6 weeks but I’ve learnt a lot about being a doctor that can’t be specified in any learning outcome.

Joanne

Luke Pemberton : 30 Jun 2017 10:22 |  Tags: Joanne Mbchb Student Warwick Wms |  Comments (0) |  Close comments |  Report a problem