All entries for January 2017

Musculoskeletal Health Care…

Our cohort is a few weeks into the first of our eight Specialist Clinical Placements (SCPs) and 2017 is stretching out before us. Although it seems long, the time is actually going by quite quickly. I wouldn't say it's exactly fun, but I'm enjoying myself tremendously on this block and am learning a great deal.

My first rotation is the MSK block (musculoskeletal health), which is pretty self-explanatory. In this block, we become more familiar with problems of joints, muscles and bones (and nerves and connective tissue and some skin and so many other things as well...). Many people run a mile when they think of anatomy and memorising lists of muscles and bones, but block 4 in the first year (Locomotion) was actually my favourite block and I'm loving the MSK placement. We've seen so many things that I wasn't expecting and we're only just over three weeks in.

As is probably fairly obvious, a lot of the work revolves around bones and joints - so we see fractures and their treatment, joint replacements, and that sort of thing. But of course they don't exist in a bubble - for instance, fractures are often accompanied by soft-tissue injuries and we have to know all of the repairs that come along with them. Getting a new knee or a new hip is a major operation and can take weeks or months to recover from fully. A lot of the learning we've done in earlier years around the biological, psychological and social impact of health conditions has come in very handy in understanding the lives that our patients live and how injuries might change them. It's proven incredibly applicable now that we are seeing more patients in a clinical setting than we did in the first years of the course.

I was not expecting that we'd be taught rheumatology as much in this block as we have been. It's a very diverse field and there's so much going on! The more I see of it and the more I learn about the speciality, the more interested I become. The patients are very interesting and diverse, and being an effective rheumatologist requires extensive knowledge of many branches of medicine and the ability to pull them all together very quickly. Since rheumatological diseases can affect multiple body systems, specialists in this field need to be quite broad in their knowledge and approach. We have seen patients with rheumatoid arthritis (of course) but also psoriasis (and the multiple effects that it has), polymyalgia rheumatica, systemic lupus erythematosus and several other conditions that we've only seen in textbooks before now.

I'm enjoying the block so much, I'm really gutted that it is coming to an end so soon. But of course new adventures await in the next placement, too.

John

Luke Pemberton : 26 Jan 2017 14:46 |  Tags: John Mbchb Patients Student Wards Warwick Wms |  Comments (0) |  Close comments |  Report a problem

New Year's resolutions…

The start of a new year is always filled with hope and ambitious plans for the year ahead. For myself my new year’s resolutions were to continue to maintain a good work/life balance so I had time to exercise and look after myself and I also wanted to work consistently throughout the year so I could avoid the exam panic that I experienced in my second year. Two weeks in and my first specialist clinical placement (SCP) is creating problems for both my resolutions!

My first SCP is in General Practice. I was lucky to get my top choice of practice which means I can cycle or walk to my placement, this helps with my new years resolution to keep active, however the days in GP are very long so the work/life balance is a bit skewed at the moment. I really enjoyed our GP placements in second year, so was looking forward to it this year. Now that we are 3^rdyear students we are expected to be able to complete the whole consultation (including management) for most cases. This was really scary at first, but even just two weeks in I can see how much I have improved. In my first week I wasn’t even sure of my examination findings and would let the GP take over for the management part of the consultation but now I am happy reporting my findings and saying what I think, safe in the knowledge that the GP will correct me if I’m completely wrong!

I’m also really enjoying the variety that comes with GP. Not only do you see medical conditions affecting all the different systems of the body but there is also a big range in terms of severity. It’s certainly not just coughs and colds! I also enjoy getting to know patients better, something we are encouraged to do in GP. The social aspects of the history are very important in GP, the job a person does may affect their illness or pain management and their situation at home may have a bigger impact on their mental health than any medication we can give. As a GP you need to understand the patient and their illness in the context of their life, something that is often forgotten in other specialities.

One skill in particular that is very important in GP which I still need to develop, is learning that it is ok to do nothing. It’s sometimes much harder to listen to a history from a patient who has been really unwell with a terrible cough and who is short of breath and tell them that they don’t have a chest infection and just need rest and paracetamol, than it is to hand out a prescription. During medical school I’ve been trained to recognise signs of illness and what to do when I find them, but saying to a patient that you don’t think anything is wrong and being confident in that decision is a skill in itself. Knowing when to do nothing and stopping unnecessary medications are a huge part of a GP’s workload. We have visited local care homes with our GP tutors and most of the visit has been crossing off unnecessary medications which might actually be doing more harm than good. All Doctors take the Hippocratic Oath which says “Do no harm”, I now understand that “Do no harm” isn’t just about treating disease, it’s knowing when not to treat, and that is actually much harder.

Joanne

Luke Pemberton : 16 Jan 2017 15:25 |  Tags: Joanne Mbchb Student Warwick Wms |  Comments (0) |  Close comments |  Report a problem

The Start of Specialist Clinical Placements

We third-year students have successfully navigated a lot in our medical career so far, but it looks like 2017 is going to be the busiest – but most exciting! – phase yet. We’ve had a year and a half of pre-clinical work, covering all major systems of the body and lots of multi-system disease presentations. We’ve had a long spell of core clinical education. We’ve all done our own research projects, complete with lengthy write-ups and, of course, reflection. We’ve been through two cycles of exams and have made it out the other side. And now we have just started the final push: earlier this week, we began the first of our Specialist Clinical Placement (SCP) blocks, where our education now focuses on particular areas of medicine in preparation for finals and practice beyond.

Our cohort is split into eight groups of roughly equal size, and these groups rotate through eight placements across our main hospital sites. My clinical partner and I are in the Musculoskeletal Healthcare (MSK) block, which is actually extremely interesting – much more interesting than I was expecting. The great thing about the Warwick curriculum is that it is spiral learning, which means that we are encountering topics and building upon knowledge that we’ve got several times throughout the course. For the MSK block, this means that a lot of knowledge we gained in Block 4 of the first year – the one called Locomotion – is really coming in handy now. Our knowledge of muscle and bone anatomy, innervation and blood supply is being called upon with alarming regularity!

Of the five blocks we had in the first year, my favourite was actually Block 4. I liked the tangibility and unchanging nature of human anatomy. There are some structures that are complex, but they just need to be learned. And once the difficult material has been learned, it really isn’t going to change. Now I’m most looking forward to seeing how specific pathologies present and how they are corrected, and spending some serious time in clinic with specialists. I’m also looking forward to surgery and watching some hands-on reconstruction work happening.

And even though I was expecting this SCP block to be heavily anatomy-based, there is a great deal of rheumatology taught as well. This is a topic area to which we aren’t exposed very much in Phase I and Phase II, but we are making up for it now in Phase III. We are scheduled to attend several rheumatology-teaching sessions and have already spent lots of time in rheumatology clinics and so on. It’s been really interesting and we’ve seen a wide variety of cases – obviously there is rheumatoid arthritis, but also polymyalgia rheumatica, psoriasis, osteoarthritis and lots of other conditions. Patients of course will also have several comorbidities as well. I know this sounds naïve, but I had no idea the field of rheumatology was so varied and interesting. I might have to look into it further for possible career options...!

John

Luke Pemberton : 06 Jan 2017 09:09 |  Tags: John Mbchb Student Warwick Wms |  Comments (0) |  Close comments |  Report a problem