All entries for January 2019

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!

Jordan

Charlie Gallan : 29 Jan 2019 15:57 |  Tags: Jordan Mbchb Student Warwick Wms |  Comments (0) |  Close comments |  Report a problem

Let loose on the wards

So, it finally happened! We have had our first bedside teaching and it definitely lived up to my expectations. I am at UHCW for my first year and have my bedside teaching on Tuesday afternoons, which is a slight pain in the ass for parking at UHCW in the afternoon. However, Matt and I managed by sheer luck to grab a space within 40 minutes of getting there. We headed in and made it with 5 minutes to spare before the lecture welcoming us into the trust. We were told about what is expected of us, how to sign in and general admin before we were introduced to our consultants.

My consultant is lovely and approachable which is something I had been worried about as you hear a lot about the nature of consultants to hide away from medical students. So, I was happy to have an approachable teacher who was keen to get us straight on the wards. We went to the Medical Decisions Unit where patients are transferred from A&E and within 10 minutes, I was meeting my first patient.

I was nervous because this was all new and I did feel a bit sorry for the patient who suddenly had 4 medical students descend on them, plus a clinical fellow who was supervising us, so it got cramped in the cubicle but we got through. We carried out a history and some clinical examinations under the supervision of the clinical fellow who was writing down our findings into the patient’s actual notes! I carried out an abdominal and respiratory exam and it really hit home why we learn clinical skills every Friday. It is easy for it to become out of context but putting these skills into use allowed me to put Friday lectures into context.

After we finished, we were sent away to discuss treatment plans and differential diagnoses amongst ourselves and it really hit home why we are doing what we are doing. I’ve said it before, it's easy to get lost amongst the hours of lectures, workshops and self-study but when we get to put our knowledge into a clinical setting when there is a real life involved, it makes it all seem worthwhile.

I had a bit of an idiot moment at the end of the day as I spent 20 minutes trying to get into a locker that wasn’t mine. I mistakenly had written my name on the wrong locker and only by curiosity I had discovered my mistake – I think I need more caffeine in my life!

Coming back round to the academic life, we have started block three and it is as interesting and brilliant to learn as I thought it would be. I come from a neuroscience background so I had been virtually pining for some brains. It’s not easy and there is a lot to learn but it’s nice to hear familiar words again and I feel a bit more at home on my turf now. We are seeing brain MRI scans virtually every day and I am taking the opportunity to transfer my new knowledge onto my own brain MRI scan that I had done a couple of years ago.

My favourite lecture so far must be the one we had on consciousness. I was expecting the philosophical approach that I had sat through in my undergraduate degree. I was so wrong. We had a consultant neurosurgeon from UHCW (so I was in slight awe to begin with) and he approached it from the GSC score (how we assess how “awake” someone is). He was funny and gave a lot of insight into the scale so I took a lot away from the lecture. Neurosurgery is a career I am determined to pursue having completed two weeks as part of my pre-med work experience. I find the brain fascinating and to see it for the first time after the dura (a covering of the brain) was pulled back is an experience I will never forget. As you can imagine, I was inspired just by having a neurosurgeon in the room.

So far Term 2 has been intense but I have enjoyed it and I am on top of my work for once! I know these 5 weeks will give me the confidence boost I need with the exams drawing slowly nearer. On Sunday, we went as a flat to the local watering hole where I watched three of my flatmates devour 50 chicken wings between them before playing the QI board game. Well… there are worse ways to spend a Sunday evening.

Did you know that Scotland won the first ever elephant polo championships? Neither did I until 10pm on Sunday …!

Abbie

Charlie Gallan : 21 Jan 2019 14:17 |  Tags: Abbie Mbchb Student Warwick Wms |  Comments (0) |  Close comments |  Report a problem

Core Clinical Education begins…

Our first clinical block began bright and early on a Wednesday in early January with a block called Core Clinical Education 1 (CCE 1 for short). CCE 1 is our first proper block where the majority of our time is spent in hospital on placement. The basic structure of the block for me is that we have a community day/GP placement on most Tuesdays every week. Every other Friday we have "academic days”, where we have CBL (Cased Based Learning) and lectures at university, and every other day of the week, we are at hospital on placement, where we have a variety of different activities. These include “T-DOCs” (practical skill teaching), workshops (clinical teaching), and the rest of our time we are shadowing our consultants and their juniors on the wards and in outpatient clinics.

Thursday started with our first “T-DOC” of this block. A T-DOC is a name for a practical skill which we must learn before we graduate as doctors – named after the GMC document “Tomorrow’s Doctors”, which outlines the basic procedures doctors should be proficient in. Our first T-DOC of this block was our cannulation T-DOC. A cannula is a plastic tube which fluids and medications can be given into the venous system, and for ill patients, they are one of the main ways of giving medications to the patient. The session is structured so that we are shown the procedure and then given time to practice on plastic mannequins, who, surprisingly, have veins and blood and everything you would expect in a real patient!

We have already done our venepuncture/phlebotomy T-DOC, so I was vaguely familiar with finding a vein and applying the tourniquet. The main difference is that cannulation is done by an aseptic technique, which means that you have to be very careful with what parts of the sterile field and equipment you touch. Happily, I passed the assessment at the end, meaning that I have been marked as suitable to practice with real patients, under the supervision of someone who is qualified. No doubt my first actual time inserting a cannula in a real patient would be slightly terrifying, but at least we have the reassuring back up of someone supervising us who can make sure we are doing each stage of the procedure correctly.

Both of our named consultants for this block are still away on annual leave until next week, so my clinical partner and I were discussing the best way to use the couple of days we have in hospital this week. We decided that it was about time to get some real-life experience with one of our core practical skills – phlebotomy (i.e. taking blood!). We had our official training (our “T-DOC”), which was the theory and practice on rubber arms last term, but we hadn’t found time to actually practice supervised on our first real patients yet. Phlebotomy is one of the most fundamental practical skills that doctors need to be able to undertake, and also something which has the potential to appear in our practical exams – so no time like the present! It was very nerve-wracking doing my first couple, but the phlebotomists who were supervising us were very patient and good at explaining the correct technique to reinforce our previous training. As experts who undertake the procedure all day every day, they were definitely thebestpeople to teach us. It was only one morning of practice, and I wasn’t successful every time, but even so, I feel as though my confidence has massively increased. I would feel much less daunted when it comes to doing it again. All of the patients who agreed to let me try were very kind and patient – thank you!

I then had my first workshop in hospital – based around acute abdominal pain. The way that CCE works is that we get given a list of ‘presentations’ – i.e. the symptoms with which patients may come to us. We then have to come up with our differential diagnoses and management of each presentation. This core list forms the large part of the content for ourYear 2exams. We do however have taught workshops every week which aim to help us to cover the important aspects. The workshop was run by a surgeon who deals with acute abdominal issues every day and also one of our Clinical Education Fellows. I found the workshop really useful in knowing which aspects were the most important to cover, and ultimately, revise.

That brings us to the end of week 1 of this block! Next week, I am going to try and find our consultants and go on some ward rounds and maybe attend some outpatient clinics. So far, this block seems really interesting and I can’t wait for more next week

Jordan

Charlie Gallan : 15 Jan 2019 09:17 |  Tags: Jordan Mbchb Student Warwick Wms |  Comments (0) |  Close comments |  Report a problem

Interviews, Christmas and New Year!

It only feels like 5 seconds ago we were back on the 24^thof September nervously walking up the hill to our first day of lectures. I now think reality has hit us all. After the MOSCES most of us went home but I stuck around on campus to help with the medical school interviews. It was weird walking around with no one around on campus but it’s nice not having High School Musical songs sung outside your window at 12 in the morning because the undergrads have finished for Christmas!

The interview days felt a bit surreal. It had only been 11 months since our own and now we were on the other side calming the candidates in the very same room we had all be nervously sat in this January. We know a little more about the interview process and I know it was the common joke amongst us during the day trying to figure out how we ever got in ourselves! My main advice to candidates on the day was to breathe and be a nice person before the interviews, to forget about the interviews afterwards and to stay off The Student Room! It’s a great place if you want to see what is happening with regards to what’s being sent out, but it can easily spark a frenzy of panicked students so it’s best to keep off it!

It was an incredible thing to be allowed to help on the day and I like the fact Warwick does it. You get to talk to actual students before your interview and it gives you a better gauge of what it is like here. It also shows how we are valued at the med school as students and how our perspectives do matter. I also think we are better at calming everyone down because we only went through it 11 months before!

I eventually got back for Christmas and even though I had planned to do work up to the 24^th, I can safely say that did not happen! I managed to complete the final lecture notes I had hanging off the back of the last term and sort out all the paperwork I had acquired over the term, but I had originally planned to get more done. However, I needed the break and I now feel like a different person compared to the stress head I was before Christmas.

It’s currently the 30^thof December and I’ve been doing a couple of hours of work here and there. However, if there is something I want to do, I will just go out and enjoy myself as I won’t be able to drop everything as easily back on campus. Currently, I am working on my pharmacology notes and amusing myself by writing questions with case studies using characters such as “Albus Dumbledore” who has stomach problems and “Sherlock Holmes” who has heart problems. It’s the little things in life that keep me going!

I am really looking forward to getting back in January as I miss having my own space and weirdly the lectures. I think it’s the routine that I miss, and I am looking forward to clinical skills this term. Having the OSCES before Christmas puts into context why we are learning these exams every week and I know how to better structure learning in the sessions. I also got my results back from the MOSCES and I passed 3 out of the 4 stations only missing out on ONE mark. ONE MARK. I was honestly surprised at my scores and I was happy for the rest of the day! I’m not too fussed about failing the fourth station (one mark!) as I know what you need to look for. I think my problem was the timing and nerves. I kept pausing for 10 seconds trying to remember what came next despite having practised it up to 10 times. We get written feedback in January which I am looking forward to as it provides us with more details than just the marks alone (that one mark will haunt me forever).

I am also looking forward to getting into the hospitals and having our first bedside teaching sessions! It is going to be incredible to finally meet patients and apply our knowledge in a clinical setting rather than just cramming it into our heads for the summer exam. I am hoping it will help me to remember the material as I can apply it to real patients with real problems. I am also thankful for the fact I am in the afternoons for my sessions as it means I only have to get the 6:20am bus once a week instead of twice.

Bring on 2019!

Happy new year

Abbie

Charlie Gallan : 03 Jan 2019 13:40 |  Tags: Abbie Mbchb Student Warwick Wms |  Comments (0) |  Close comments |  Report a problem