All entries for March 2016

Cradle to Grave…

Writing about web page http://www2.warwick.ac.uk/fac/med/study/ugr/

In medicine we are privileged to witness both the birth of new life and the end of life. During Core Clinical Education (CCE) 1 there were times when I started on the ward and enquired about a patient only to learn they had passed away; other students have been present for a patient's last moments and others have been present when families have been informed. All of these situations present unique challenges to doctors and to us as medical students. I still feel like an unwelcome intruder in these situations but the only way we will learn how to cope with these difficult times is by observing others. We have excellent teaching from doctors and nurses who work in palliative care in the local hospice, teaching us about care at the end of a person’s life. I’m grateful of any extra knowledge in the hope that it will help me when it’s my turn to cope with these difficult situations, although I'm prepared to feel like I said all the wrong things the first time knowing that after reflecting I will be better next time.

An equally pivotal moment in a patient’s life that we get to witness is their birth. In my first couple of weeks of CCE2 at University Hopsital Coventry and Warwickshire I have had shifts on the Labour ward (both day and night!) and have also spent time in the community with the midwives. These have been amazing experiences and have made me think a lot about what specialty I see myself in. Working with the team of midwives and Obstetrics and Gynaecology doctors was great, I got to spend lots of time with the patients and was able to provide a lot of practical help to the midwives as well as be a much needed distraction for some of the women whose contractions were pushing them over the edge! I was able to observe both natural deliveries as well as some emergency Caesareans.Seeing the team come together to ensure that it is no longer than 30 minutes from the time of the call to when the baby comes out was incredible. Seeing the midwives, anaesthetists, theatre staff and obstetricians all working as one to ensure both Mum and Baby are safe was incredible and I had tears in my eyes on several occasions. As a second year medical student we are limited in what we can do and therefore how helpful we can be, but we can talk to patients and reassure them, and nowhere is this needed more than on the Labour ward. Leaving my 13 hour shift and saying bye to a patient I had worked with for the last six hours I was really touched to be hugged by both the patient and the midwife who said I was a pleasure to work with, hearing this was so rewarding and makes you realise that no matter what stage of your medical career you can make a difference. I’ve learnt that One Born Every Minute is not entirely accurate but the Labour Ward is certainly filled with some very special moments that are great to be part of.

In our first year we learnt a lot about health inequalities and the effects of social deprivation on the health of both mothers and children. Nowhere is this highlighted more than when working with the community midwives. The community midwives spend a lot of time educating patients about their health and wellbeing and also take part in multi-agency schemes designed to support families in a variety of ways. Seeing pregnant mothers living in damp, overcrowded housing makes you realise just how important health professionals are in tackling poverty and social isolation. Working with the community midwives we spent a lot of time trying to find a good place to listen to a heartbeat in the antenatal clinic in cases where a baby was especially active (apparently a sign it’s a boy!) as well as spending time on postnatal visits ensuring families were coping and checking for signs of postnatal depression. What I really liked about Obstetrics and Gynaecology is that it is a specialty that takes a holistic approach, the whole family and social circumstances around a patient are relevant and can have a huge impact on outcomes.

As well as cooing over newborn babies I presented my summer project at the Warwick Academic Medicine Society’s annual conference, an amazing day filled with excellent talks from both staff and students and tonight I start my first week of the optional Student Selected Component (SSC) in Medical Education. There is definitely never a dull week as a medical student!

Joanne

Sarah Hill : 30 Mar 2016 09:58 |  Tags: Birth Caesareans Care Joanne Labour Mbchb Medicine Midwife Midwives Palliative Patient Student Ward Wards Warwick Wms |  Comments (0) |  Close comments |  Report a problem

Extra Extra…

From bedside teaching in first year, through advanced cases 1 in second year, and now as a fully-fledged clinical medical student I have always been based at Warwick Hospital. Warwick is a small hospital with a small A&E department. You start to recognize familiar faces in the corridor and bump into other students regularly.

With our first 10 week block coming to an end that’s all about to change as myself and my fellow students at Warwick prepare for Core clinical education 2 at UHCW. UHCW is a major trauma centre and a much bigger hospital, the chances of me getting lost are very high! Students at UHCW and George Elliot will all be moving onto their next placement too and I don’t think I’m the only one feeling a bit nervous having got used to how one hospital works.

Having survived CCE1 my history taking and examination skills have greatly improved and I’m starting to think more like a doctor. Formulating a differential diagnosis and thinking about investigations in a systematic way. I can take blood, insert cannulas and take arterial blood gases (which helps the junior doctors greatly so they have more time to teach!). I’ve got used to just going up to people, introducing myself and asking what they do and if I can come with them-being a bit pushy as a medical student seems to be a skill in itself.

Apart from more practice in different clinical specialties I have a few start of block resolutions. One is to teach in Peer support. I benefitted greatly as a first year student so really want to be able to give back and help out the current first years. The other resolution is slightly contradictory but it is to do LESS!

There is so much extra teaching and events on at Medical school it’s easy to get a bit carried away. In the last few weeks I have attended a suturing workshop run by the Surgical Society. This was a great event, we were taught using pig skin in the Surgical Training Centre at UHCW by current surgical trainees. Getting the chance to learn different types of suturing techniques was really fun and learning in such a small group meant you had lots of time to practice.

I also attended an Airway Management session run by the Trauma and Emergency Medicine Society. As a medical student you might think we won’t be managing airways but you would be wrong. My first day in theatre with an anesthetist and I found myself managing an airway and administering oxygen at the same time!

Another interesting evening was spent watching 3^rd year students studying an optional SSC in Medical Education give presentations on various medical topics. Seeing the different teaching styles was very interesting and was a great opportunity to learn more about the medical education course that I would really like to take part in next year.

A slightly more nerve wracking evening was at an event that I had organised with the Psychiatry Society. I organised for the President of the Royal College to come to Warwick as part of his tour of UK Medical Schools. The event was a great success, we had a really interesting talk accompanied by delicious M&S snacks and we had a good turn out from our members.

Despite really enjoying all these events I definitely need to find a better balance between extra things, study and time to relax! So this is something I’m going to work on going forward into CCE2.

Joanne

Megan Earle : 21 Mar 2016 09:24 |  Tags: Joanne Mbchb Student Warwick Wms |  Comments (0) |  Close comments |  Report a problem

Organised chaos…

No two weeks in hospital are the same, just as no two patients are the same. Routine is a word I am not familiar with at the moment. This isn’t necessarily a bad thing but it does mean I feel very busy and a little bewildered most of the time! These last few weeks I’ve spent time with a variety of different clinical teams. I’ve been in the TB clinic meeting a variety of patients with both latent and active TB which I really enjoyed. Rates of TB are increasing and it’s interesting to see the different groups of patients this can be a problem for, from healthcare workers exposed at work to homeless people living in damp conditions, and how the consultants and specialist TB nurses work with all these patients to help them.

I also really enjoyed my Child Health day which I spent in Paediatrics and in the Special Care Baby Unit (or SCBU!). I went on the Paediatric Ward round, meeting children and babies with their devoted parents who had slept with them in hospital overnight and then met the team who look after premature babies. In SCBU it was a quiet day on the ward with only two babies, the maximum capacity is up to 13 so the staff had lots of time to explain their work to me and the various complications that can occur in premature babies. I was just about to leave when a newborn baby was referred form the postnatal ward who was not able to feed and needed additional support. Seeing the team in action carrying out all the necessary checks highlighted to me that it’s never a quiet day in hospital and it’s is a real skill to be able to switch into action. Years of training prepare you for this and it is something which I’m only just beginning to appreciate.

In contrast to the quick action of the hospital GP seems relatively slow until you realise just how many patients are seen and how many problems each patient brings with them, all of which need addressing. Working efficiently to try and stick to 10 minute appointments is a skill in itself and many patients come in with multiple things they want to discuss which isn’t always possible. I am filled with so much respect with GPs with their ability to switch from one subject to another, even within one consultation. GPs are constantly making judgement calls about how ill a patient is, do they need a referral? Is it bacterial or viral? They make these calls in every consultation and in contrast to hospital doctors who have blood tests and imaging at their finger tips they have to do this based on their history taking skills and their in knowledge of the patient. Something that I’ve struggled to adapt to in second year is thinking about medicine in a multisystem way rather than compartmentalising things into separate body systems. When I’m on the respiratory ward I know I need to ask my respiratory questions and be thinking of respiratory disease but in GP a patient could walk through the door with anything. The breadth of knowledge that GPs have is something I’m severely lacking, but as with everything in medical school it will develop over time!

Developing our skills and gaining feedback is the main goal as a medical student in CCE and GP is great opportunity to conduct lots of histories and examinations in front of a senior doctor. Getting feedback from my first OSLER, an observed history and examination followed by questions about my differential diagnosis was terrifying but also really helpful. I now know which areas I need to improve but I also got a massive confidence boost when told about all the good things I already do. Proof that I have actually learnt something and that my quest to become a doctor is not the lost cause it sometimes feels when I’ve read the same paragraph about diabetes 20 times and are still none the wiser!

Joanne

Megan Earle : 10 Mar 2016 10:10 |  Tags: Joanne Mbchb Student Warwick Wms |  Comments (0) |  Close comments |  Report a problem