February 18, 2019

Difficult Conversations

The week started on Monday with me teaching my BLS (Basic Life Support) to first year medical students. This was my last session as a trainee BLS instructor (like a probationary period), and after completing it, I am now qualified as a fully-fledged BLS Instructor! We will hopefully be teaching some of the first-year medical students here at Warwick Medical School very soon, providing high quality BLS training. Watch this space!

Tuesday is GP day, which has quickly become one of my favourite days of the week. In GP we get to lead several consultations per day each, which is very fun, and a little bit of lucky dip, because you aren’t sure who will walk through the door! The GP supervising us is very supportive, and tries to encourage us to take the consultation, even when the medical issue the patient has isn’t straight forward. This is great because it gives us a chance to deal with conditions and issues that we might not be totally confident with but means that we get to push ourselves and try and learn as much as we can. The great thing is that if we do get stuck or go off topic, our GP is observing and jumps in to help out. Overall, it’s a great chance to practice our skills, to try and develop, but is in a safe environment with us being watched by experienced hands.

Today we spent our first proper day with the Respiratory department at George Eliot hospital. For each CCE block we have to get specific activities signed off, including examinations, histories and procedures and also what is called a Case Based Discussion. We do these with the education doctors (Clinical Education Fellows - CEFs), who then give us feedback on our skills. We wanted to get our Case Based Discussion done today (roughly by the middle of the block) so we booked a session with one of the CEFs to try and get this signed off.

There was only one thing missing – a patient! A CBD is where we see a patient on our own (doing a history and examination), and then meet up with the CEF afterwards and discuss the case, including how the diagnosis was made and what management we would provide for the patient. Our CEF session was booked for 9am, and we needed to have seen a patient before then, so my clinical partner and I went in for an early start at 8:10 and went straight to the ward. We ended up finding a lovely patient and doing our history and examination and also having a nice chat – bonus! All in all, it went well and our history and exam definitely went more smoothly than it was at the start of this block (only in January, 5 weeks ago). It’s a nice feeling when it comes together, and you feel like you’ve done a really comprehensive history and good exam. In CCE we do history and examinations pretty much every day (and multiple times a day on GP days), so we have plenty of time to really improve our skills.

After doing our Case Based Discussion, we headed to the ward to find someone to shadow and just get settled in, including just introducing ourselves to everyone. The ward was very busy so it took us a little while to find someone who was free to talk, but in the end we found a lovely registrar (the level in between foundation doctor and consultant) who let us follow while they saw some of the sickest patients on the ward. They asked us to read an ECG and work out the diagnosis which is never, but between the two of us we seemed to work out that the ECG was normal, and the registrar confirmed that it was. I think it was beginners’ luck! The registrar also ended up seeing a sick patient and having a very difficult conversation with a relative about the prognosis of the patient, which was extremely difficult to witness, but unfortunately an important part of the work of a junior doctor. The registrar did a very good job, and I took notes as to good practice and an example of how to do it well. It is important while on the wards and clinics to find doctors who can act as good role models of how to be a compassionate and competent medic and I learned a lot today about how to have a sensitive conversation.

All in all, it has been a busy and challenging week. Despite this, there is definitely a feeling of growth – I don’t feel nearly as out of place as I did at the beginning of this block and have sort of worked out who we need to speak to on the wards to find the best learning opportunities. It’s weeks like this that remind you how amazing it is to be a doctor – to be with people in the best and worst times of their lives. Hopefully you can make them feel better too!


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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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