All entries for April 2020

The Frontline

The last two weeks since my last blog have been…well, strange, as I am sure you are aware.

I have now been employed as “Medical Student Clinical Support”, and have been placed at University Hospital Coventry and Warwickshire (UHCW), which is the largest partner NHS trust affiliated to the Medical School. My ward is normally used for care of the elderly but it is looking after patients with suspected or confirmed COVID-19 at the moment. I am essentially working as a Healthcare Assistant, which involves duties such as bathing and moving patients, cleaning and general support. In addition, however, we are allowed to practise the clinical skills we have been signed off for in line with how competent we are. For example, this includes things such as venepuncture (taking blood), cannulation, setting up oxygen, doing Electrocardiograms etc. This has prompted me to think about my competencies – how confident/competent am I at performing these skills in the real world?

As a medical student, and indeed as a doctor, the phrase “act within your competencies” is used quite a lot to determine what you are able to do. But what does this mean practically? In years gone by, doctors operated by the adage “see one, do one, teach one”. For example, if a student/junior doctor had seen a certain operation (let’s say a hip replacement), then they would progress to doing one, before then teaching this skill to others. This would be how doctors would learn pretty much everything, but of course this method has its drawbacks – primarily that this isn’t an effective way to learn how to do something safely. I could watch someone lay a road, but that doesn’t mean that I would be happy to then “have a go” and I’m sure the results would be terrible!

What has happened then, in recent years is that things have moved towards competencies and a more holistic way of teaching and learning skills. So at medical school, we have to learn certain skills that all doctors must be able to do – for example inserting a venous cannula or administering oxygen therapy. We receive formal teaching on how to perform these skills which are called T-DOCs, and at the end we are assessed by the tutors as being signed off, meaning that we can practice these skills as long as we are supervised by more senior colleagues. You can then practise (of course with appropriate consent) and with supervision until you build up confidence and ability to perform these skills. You do the training for most of these skills in Year 2 of the course and they include lots of different skills. I have only had the chance to practice a couple of them so far on real patients – I have done about 20 cannulas, taken blood about 20 times, set up oxygen a couple of times, and have a reasonable rate of success.

We had a general induction and also some basic Healthcare Assistant training on the first few days. We were told how to clean effectively and how to bathe and feed patients etc, which are skills we don’t regularly get taught how to do during medical school. After this we started shifts on the wards. On my ward, everyone is really friendly and approachable and keen to teach and show you how to do things, which makes the whole thing of being a new member of staff so much easier. We have also been given uniforms which we have to change out of at the end of every shift and also been given appropriate PPE. At all times on our ward, because there are suspected and confirmed COVID-19 patients, you have to wear a surgical mask (which is fine for half an hour, but when worn for the whole of an 8-hour shift, your mouth dries out and cracks). When approaching and caring for patients, we then have to put on an apron, gloves and a plastic visor. Wearing all of this makes looking after patients so much more difficult and a lot warmer too, which isn’t great when its 25 degrees+ outside. So far, I have helped with general patient care including repositioning, feeding and cleaning and it’s amazing to feel like part of the team and like I am helping, if only a bit! Sometimes it can be really sad, especially because visitors aren’t allowed except in exceptional circumstances, which means that the only human the patient sees is you. I have been trying really hard to chat to the patients when I can and make sure they have everything they need to be as comfortable as possible in the circumstances. It has certainly been a different challenge to what I normally experience whilst on the ward, but rewarding and important nonetheless. Stay safe!

Hattie Trigg : 29 Apr 2020 10:31 |  Tags: Hospital Jordan Mbchb Patients Student Wards Warwick Wms |  Comments (1) |  Close comments |  Report a problem

Abbie down the Rabbit Hole

It feels like I’ve stepped into a weird alternate dimension of planet earth. Queues to get into Tesco, petrol nearly down to the pound and campus the quietest I have ever seen it. It’s like a ghost town here!

We’ve been off placement for four weeks now and I have lost all definition of time. It’s even harder as I live on my own, so the social distancing basically means social isolation for me. It’s been hard, getting up with not much to do and losing any sort of normality. However, I know it’s a very small on the bigger scale of things.

We’ve also had changes to the order of our degree. We normally do our SSC2 project after second year exams in third year. I had self-proposed my own SSC2 project and I was really excited to get on with it. However, due to Covid-19, that was all about to change. Instead of CCE2/3 which we would have normally been doing up until the end of July, we have essentially swapped them for the SSC2 project, and our exams will be pushed back. That was ok until I read the second part of the swap. We would all now be doing a systematic review. I was gutted. I thought my project would be ok as I didn’t need to use any patient data or go anywhere near a hospital. However, due to many of the staff going back into their NHS roles, ethical clearance wouldn’t have been able to take place. Again, not the biggest injustice in this crisis but I was gutted and the thought of doing a systematic review instead of my own project was underwhelming. However, I am still hoping to keep a similar topic to the one I originally planned so hopefully, not all is lost.

We have also been offered the opportunity to take up roles in the NHS like our fourth year counterparts. We are going in as a morph of HCA/medical student. Essentially, an extra pair of hands to help in this unprecedented time. I am working in the A&E department of George Elliot Hospital which I am looking forward to as it will enable me to spend time in a department that I have only been a patient in before. I had a bit of an introduction shift last week which felt odd as there were only four patients there the entire time I was on shift. However, it gave us time to get used to the place and even get some ECG teaching. Something I really did need; cardiology is not my strong point. I’m looking forward to being able to put my skill set to use and helping where I can. I know I can’t do a huge amount but every little helps right? I am grateful for the opportunity as I know not all medical schools have done this, so we are incredibly lucky to have this opportunity and I do hope other medical schools follow suit!

I don’t know when the lockdown is going to end. Everyone seems to have their own theory and I am just trying to avoid spending too much time on social media. I am hoping I can keep myself busy with SSC2 and shifts in A&E to try and stop myself becoming homesick during this time. I have an Easter egg from home waiting in my fridge for Sunday, I wish I could pop home for Easter roast but I’ll just have to wait until we are released back into the world. For now, I am waiting for the goslings and ducklings to make their appearance down at Tocil lake and making good friends with the local wildlife.

'Til next time!

Hattie Trigg : 14 Apr 2020 12:24 |  Tags: Abbie Easter Mbchb Patients Student Warwick Wms |  Comments (0) |  Close comments |  Report a problem

Changes

In my previous blog, I think I said nothing has changed. Well... I have been proven dead wrong in the last two weeks. Week 5 of Acute block was delivered normally, and we were told on Sunday evening that Week 6 (the final week) of Acute block would go ahead as much as possible. So we turned up for teaching on Monday morning and were told that everything had changed and sent straight home with all teaching and placement cancelled. We then had an online meeting from the Medical School saying that our next block (for me, Musculoskeletal care) had also been cancelled.

Usually in the last week of Acute block, you have lots of teaching sessions and then at the end you have a practical exam where you are observed performing an assessment of a patient and are then signed off for the block. However, considering the COVID-19 situation, this was cancelled and instead we were signed off by telephone by the block lead. I think mostly this was to make sure that were signed off for the block so we had it “banked” and wouldn’t have to re-sit it afterwards. For the rest of Week 6 of Acute block I mostly just did some book work and got on top of my notes to make sure I was using the time productively. To be honest, I was behind on my note-making so the week off was helpful.

The Medical School have been trying to update us as much as possible about what is happening, but of course its difficult as no-one really knows how things are going to go. For us third years it brings added uncertainty. Phase III (Years 3 & 4) are very tight for time. We have 8 specialist rotations January - December with only a two-week break in August. And then we have a revision block in January before sitting our final exams in February. In actual terms I have my 8 x rotations January 2020 - December 2020, and then January 2021 - February 2021 revision block and then final exams in February 2021. However, because of COVID, if we miss one 6 week block, we still have to do these hours somewhere else so we would lose revision period and/or exams would need to be moved to facilitate a revision period. So, by losing placement time now, it has potentially large repercussions for the course. The Medical School have been great in terms of working tirelessly to try and make sure missing things has the least impact possible, but of course it is hugely challenging for them to restructure the whole course for 4 years groups all of which have different requirements and challenges! I will keep you updated!

Another development in the last few days is the opportunity to work/volunteer in the NHS. The NHS is on the frontline of the epidemic and is struggling at the moment with staff illness and also an increase of demand, so they need more support than ever to deal with the consequences of the virus. To this end, they have asked medical students to help out within their competencies as far as possible. It's completely voluntary but we are going to get paid to help out with basic medical tasks. For us third years, this means that we are able to help with doing ECGs, cannulas, taking bloods and direct patient care (washing, dressing etc). I thought long and hard about whether to help and have decided that I will go for it, partly for myself in terms of keeping my clinical experience up to date and engaged, but also on a wider level to help out. COVID-19 is unprecedented and the event of a generation and anything that I can do to help, no matter how small, I feel duty bound to help, as (hopefully) a future doctor, a current medical student and also as a human being.

All of the blogs that follow will document this interesting journey until we get back to a “business as usual” medical school. Although formal medical education has been postponed for now, I think that education of a different type will happen whilst I’m working in this role and of course I still will have all of my book learning to do at home. I will keep you updated as always as we go through this challenging journey together, which I’m sure will be a steep learning curve for us all.

Hattie Trigg : 07 Apr 2020 13:32 |  Tags: Jordan Mbchb Patients Student Wards Warwick Wms |  Comments (0) |  Close comments |  Report a problem