A tenth of the way!
How time flies – its Week 3 of CCE already! CCE (Core Clinical Education) is 30 weeks long, and to think that it is already one tenth completed is quite a daunting thought to say the least. The transition to clinical medicine that CCE represents has definitely brought both opportunity and challenge in equal measure. For example, the majority of our time is self-directed now – the only “sign-in” sessions, so to speak, are workshops (1 hour a week) and academic days (1 day a fortnight). For the rest of our time, we are expected to decide on which clinical activities are most useful for our learning, whether that be outpatient clinics, inpatient ward rounds, theatres, etc. This is great as we can go to the activities that we have found most useful. So far, my clinical partner and I have mostly attended outpatient clinics, as these are the activities which our assigned consultants mostly conduct. These have been great for practicing our history and examinations on patients under the experienced eye of a consultant. It also means that we have the chance to listen to real pathologies. For example, so far most of our patients in OSCEs have been healthy, which is great when learning the basic steps in an examination, but means that we haven’t heard many heart murmurs for real. We identified that we wanted to hear some real heart conditions, so we went to a cardiology clinic and had the chance to listen to actual patients with heart murmurs. Listening to YouTube videos of murmurs can be useful, but listening for real is the only way to gain experience in what the various murmurs sound like and (hopefully!) remember these for exams.
One downside to the self-directed nature of being a clinical medical student is that it can be hard to know where to go sometimes to use your time most effectively, and even when you decide you want to i.e. attend a certain ward round, it doesn’t always go to plan. We have attended hospital twice over the last few weeks and found that it wasn’t possible to attend the activity we intended to go to. This happens because sometimes the ward doesn’t have capacity to have us because they are busy, or that other medical students have got to the ward first. This means we have found ourselves at a loss of what to do, and have ended up wondering hospital wards asking if there are any patients we could see or anything we could attend. Last Monday this happened to us and we couldn’t go on ward round with our consultant because they weren’t around, so we ended up going around surgical wards asking the nurses whether there were any patients who it would be good to talk to. We ended up on a gastrointestinal surgery ward, with patients recovering from abdominal surgery or waiting for surgery.
We had the chance to take some good histories on our own, with me and my clinical partner giving each other feedback on how to improve our histories and examinations. We were reading the patients notes when a very friendly FY1 (Foundation Year 1 doctor, which is the first year as a doctor after medical school) asked if we were medical students and whether we wanted some teaching – we said yes! The FY1 offered to watch us do a history and examination and then talk through our performance and the case with us. This was much useful than us just giving each other feedback and we received some good advice on how to approach exams as the FY1 was actually a Warwick graduate! This meant that they knew the level we were at and was able to give us some useful tips on how to approach exams. It can be difficult to find someone to teach you, but when you do, it is definitely worth it.
This Tuesday we had our GP (General Practice) placement. We had already had a taster GP session last term which gave us some idea about how our placement would work, and now we have 21 days of GP over CCE (so roughly 1 GP day a week, every Tuesday). Coming into medical school, I had already done one week of GP shadowing before applying and had already decided that GP was not for me. I couldn’t have been more wrong! The entire day was structured in that the GP we were assigned to would pre-screen each patient to see if the case could be suitable for us to see, and then took consent as well from the patient for them to see us.
We then took it in turns (my clinical partner and I) to take a history and examine the patient, under the watchful eye of the GP who would be observing. This was great as it was almost like being a doctor – seeing patients and conducting the consultation patients almost by ourselves. It was quite scary to do this at first, but we have been well prepared for this – we’ve taken histories from patients in hospital since halfway through first year, and the patient in GP generally have slightly less complicated histories and they tend to be less ill than hospitalised patients. In addition, patients in GP generally only come in with one presenting complaint, which means your history can be very focussed and can aim to address that complaint. GP is definitely back on my list of potential careers.
CCE so far is vastly different from first year and second year up until now – we are much more autonomous than previously and most of our learning is self-directed. This is scary, but I feel as though my clinical partner and I are getting the hang of finding our consultants in the hospital (the secretaries extremely knowledgeable and very friendly!) and deciding on the activities we want to attend to maximise our learning. We have 2 more weeks attached to our cardiology consultants and then we move on to Respiratory – how time flies!