All entries for June 2016

Communication

We had the last of our community-day exercises for the second year last week. These are non-hospital days, where my clinical partner and I meet with a patient to discuss how they are managing in the community with a specific condition, diagnosis, or care package (or all three). Usually our discussions are very focused – for instance, we once met with a patient who was making use of hospice services. We also once met the parents of a child who was living with Down Syndrome and discussed with them all of the services that they are provided and how they make use of them.

These sessions are really useful, as they open our eyes to the services that our government and communities provide and show us all of the support that families can use. As someone who has led a relatively health-filled life, I’ve never had to make much use of these services – apart from the odd visit to the GP – and thus it’s always very useful and educational to see what else is out there. Health Visitors, District Nurses, physiotherapists, occupational therapists – just to name a few – all play a very important role in managing patient health, especially out in the community. And it’s so important for us to talk with these professionals as well to get an idea on how they can help our patients.

On our “recap” day, we get together with a few other clinical-partner pairs to present our cases and discuss any common themes that might come up across some or all of them. It’s interesting for several reasons. First, the different patients’ conditions are, of course, interesting by themselves. After spending so long in lectures and discussing people on paper, it’s really interesting to see them in real life. But more importantly (and fulfilling the purpose of our exercise), we are there to see how their packages of care fit together. Sometimes this works really well, and other times it doesn’t fit quite so nicely.

Communication (or lack thereof) was the one common theme that came up across all clinical-partner groups in our most recent meeting. Most patients and their families could not fault the quality of service nor the professionalism they received from each of their caregivers. And none had a bad word to say about the facilities. But what came up time and time again was the fact that, at least for these people, it simply didn’t seem joined up. Every time some of them saw a new doctor, they had to start from the beginning and explain their cases again. It seemed that either the letters were getting lost (or never sent) or, somehow, the communication train was breaking down a little too often for them.

This gave me a lot to think about – whilst, even as a practicing doctor, I expect to be little more than one cog in an enormous wheel most of the time, at least I am better equipped to understand where my patients are coming from should they be frustrated at the “system”. This portion of our education is very valuable. It cannot be taught from PowerPoint, nor even told from a hospital bed. Seeing these first-hand encounters really brings home for me what the entire patient experience is all about.

John

Catrin Davies : 29 Jun 2016 15:11 |  Tags: Communication John Mbchb Student Warwick Wms |  Comments (0) |  Close comments |  Report a problem

10 fingers and 10 toes

Over the course of Core Clinical Education we have had several different themes running throughout. CCE1 was history and examination, CCE2 was investigations and CCE3 focused on basic management. Amongst all this we have also had several speciality areas which have been mixed in amongst all this; Obstetrics and Gynaecology, Orthopaedics, Psychiatry and Child Heath.

For Obstetrics and Gynaecology, we all had the chance to attend shifts on the Labour Ward and spend time with the community midwives. Everyone has an orthopaedics rotation at some point during CCE so we can learn about different types of fractures. For Psychiatry we all attended a Clinical case day with simulated patients to prepare us for our week long psychiatry placements. For child health we have covered a few different topics over the course of CCE which I have thoroughly enjoyed.

In CCE1 the focus was on the new-born assessment, screening programmes and baby checks. We had tutorials to take us through the theory and recap some material from Block 5 in Phase 1. We also spent a day split between the paediatric ward and the special care baby unit. Here we got the chance to see a baby check. The baby I observed in CCE1 was not impressed with us and the paediatrician moved at lightning speed so this week I arranged some time with one of the teaching fellows at George Eliot who specialises in paediatrics.

We found a very chilled out baby and she talked me through the baby check step by step and allowed me the chance to perform some of the examination. Listening to a new-born baby’s heart beating at 150 beats per minute is a bit alarming at first but for babies this is perfectly normal (compared to adults where our heart beat should be 60-90bpm). Getting some hands on experience is invaluable and I am so grateful for the parents who let me practice on their precious new-born.

In CCE2 the focus for child health was acute paediatric medicine. We had some lectures introducing us to history and examination in children. The questions in a paediatric history seem to be endless; you need to ask about the pregnancy, the birth, immunisations, what is their sleep schedule, what do they like to eat, do they have any friends? We spent a morning on the paediatric ward at UHCW speaking to patients and their parents. Some patients are more difficult than others but children are something else entirely, watching the paediatrician exam a wriggly child was as confusing as it was impressive!

In CCE3 the focus has turned to child development. We need to understand how to assess child development and common problems that can cause abnormal development. A full developmental assessment can take up to half an hour and is usually performed by a paediatric registrar. However, we still need to know what the developed milestones are and how we would assess them. We might come across problems in development in GP and we need to be able to assess them competently enough so we can be confident in either providing reassurance or deciding that further investigation and referral is needed.

I have really enjoyed all aspects of the child health theme. Learning the theory is fascinating as the physiology of children is actually very different compared to adults. This year we have had limited practical experience with children in hospital but I have come across plenty in GP. Working with children is hugely rewarding and fun, definitely something to think about when considering future career options!

Joanne

Catrin Davies : 27 Jun 2016 15:22 |  Tags: Children Joanne Mbchb Medicine Paediatrics Warwick Wms |  Comments (0) |  Close comments |  Report a problem

Core Clinical Education 3, is it all in the mind?

As the first year students sit their end of year exams the second years have been getting to grips with the start of our next 10-week block. For me that means starting at George Elliot Hospital in Nuneaton.

George Elliot is a small district hospital, so compared to UHCW it feels quite small but I've still managed to take a few wrong turns. George Elliot organise Core Clinical Education (CCE) a bit differently in that we have a medical consultant and ward for the first 5 weeks, then we swap to surgery for the rest of the placement. I've started off on Cardiology and will move to Urology. So far I'm enjoying cardiology, on ward rounds we are shown the ECG of every patient and asked to interpret it. This is as terrifying as it is useful! It's great practice as interpreting ECGs is very likely to come up in both written and clinical exams. Many of the patients are attached to a heart monitor that can be seen at the nurses’ station, alerting staff quickly to any changes and providing a reassuring beep to those sat working.

I'm really enjoying our clinical placements and one of my best experiences so far has been my psychiatry placement. Psychiatry isn't everyone's favourite specialty but I'm really interested so I might be a bit biased! I had my placement during CCE2 and was based at the Caludon Centre right next to UHCW.

The Caludon provides most of the inpatient psychiatric facilities for Coventry and the surrounding area. I was based on an inpatient female ward. Ward rounds on a psychiatric ward are unusual as the doctors and nurse in charge usually sit in a lounge and the patients come to them at allocated times. It can get a bit crowded, often family members or carers also attend as well as social workers and allocated case workers who work with patients in the community. It was really interesting to hear all the different views from various people involved in a patients care and seeing everyone work together in a way that is rare in other areas of medicine. Many of the patients also lacked insight into their condition and did not believe they were unwell or needed treatment so it was interesting to see how the law impacts on medical care in these cases.

In the last few weeks I've also started my SSC2 project: this is the research project that takes place in the first 2 months of third year. As I had decided not to propose my own project, I ranked my top choices from a list provided by the med school. I was lucky to get my top choice, a questionnaire-based project designed to investigate career aspirations of medical students at Warwick with a particular focus on academic medicine and gender imbalances. I chose this project as I have never done qualitative research before and, as a female medical student interested in academic medicine, I want to help find out how we can address the huge gender imbalance in this area. At the moment we just have to write a project plan and ethics approvals but I can't wait to get started in September. However, before that there is the small matter of exams but I'll pretend I didn't just say that!

Joanne

Catrin Davies : 13 Jun 2016 11:00 |  Tags: Cardiology Joanne Mbchb Psychiatry Student Urology Warwick Wms |  Comments (0) |  Close comments |  Report a problem

A New Block and a New Hospital

We’ve just started the final block of our Core Clinical Education module. It’s hard to believe that the second year is almost over – this officially marks the halfway point in our journey through med school. As with most students in our cohort, my clinical partner and I are at a new hospital for the final ten weeks of the year. With this comes an entirely new set of corridors to memorise, IT systems to navigate and ward-round schedules to memories. I think this is what it’s going to be like for a very long time if we continue pursuing our careers in the NHS! The rotations throughout the rest of med school and beyond – into the foundation programme and even specialist training – will see us rotated about like this as well.

As the first core-clinical education block focused on history-taking and examination, and the second block focused on investigations and diagnosis, this final block will focus on management of conditions, diseases and illnesses. And of course “management” is more than just giving someone some pills or scheduling a date for them to turn up to operating theatre. We are highly encouraged to take a wide approach to condition management, considering all aspects of a patient’s health. We adhere to the bio-psycho-social model, examining the biological component of condition management alongside any impact that a patient’s condition may have upon the psychological and social aspects of their lives. It’s fascinating to see how this plays out in practice.

My assigned consultant for the first section of this block is a gastroenterologist, and my clinical partner has been given a cardiologist. Since our assigned consultants are employed in this aspect to support, teach and evaluate us, this means that we will spend a lot of time focusing on real core medicine with these doctors – the stuff we learned in the first term of the first year, and among my favourite part of the curriculum. It’s time to brush up on interpreting ECG tracings, hepatic metabolism of drugs and the mechanism of action for lots of different diuretics (among many other things)! This makes a major change from the previous block, where we were both linked with orthopaedic surgeons, and brings us back to some of the stuff we learned about quite early on.

Earlier this week we were lucky enough to see a few minor operations pertaining to cardiac abnormalities. First, we saw the placement of a pacemaker. The consultant cardiologist who performed the procedure was actually the same gentleman who lectured us about it back in Advanced Cases 1. Like most of these experiences, it was like an anatomy lesson come to life – in this case, he pointed out to us the patient’s cephalic vein, which he was going to use to access the heart (how he was able to find that vein and know that it was the right one, I will never know). The patient was conscious the entire time, and the entire procedure was conducted under local anaesthetic! We also saw the insertion of a few devices into other patients that function very similar to memory sticks – they collect information about a patient’s heart function over the course of months and even years. They are indicated in many situations, including strokes and various forms of arrhythmia. I look forward to seeing many more sorts of these procedures and many more over the coming weeks and months.

John

Catrin Davies : 09 Jun 2016 09:15 |  Tags: Cardiology Gastroenterology John Mbchb Medicine Student Warwick Wms |  Comments (0) |  Close comments |  Report a problem

Clinical Skills and T–DOCS

As medical students, we obviously spend a great deal of time learning how to be competent and effective clinicians. A lot of this involves learning about the human body, what can go wrong with it and how to treat that. We learn this, initially, through lectures and case-based learning, and then later during placements on the wards. But the development of another essential skillset, the hands-on, practical techniques that we actually use with patients – comes from more tactile and interactive forms of instruction.

In the first year, we were drilled on our “clinical skills”; this is the battery of basic examinations that every doctor knows by heart. They could be major-system based (abdominal, cardiac, respiratory), neurological or musculoskeletal – we had to know them all, and testing us on them formed a major part of our end-of-year-one summative OSCE exams. And a large part of our clinical days in the first year (and beyond) involved practicing our exams on very patient and willing patients, most of whom were resident on wards and had provided consent to letting us try our skills on them. These people, the uncountable thousands across the country, are absolutely invaluable resources to the NHS.

In the second year, our clinical skills (now renamed TDOCs) have taken on a very focused, very clinical approach. We have focused much more on basic tasks that doctors, especially junior doctors, are expected to carry out on a daily basis. We learn in great detail procedures such as cannulation, venepuncture (drawing blood from veins for laboratory tests, etc.), drawing arterial blood, inserting nasogastric tubes and so on. The list is long, and the instruction is very complete – we don’t just learn the basics of how to insert needles into veins, for instance. We also learn about the indications, contraindications, complications and risks of each of these procedures – all of these are extremely important, and I’m glad that the medical school goes to great lengths to ensure patient safety. For instance, I wouldn’t want someone to poke my arm or a relative's arm with a needle unless they’ve had this training, and I’m glad that we go through this process.

Once we have been assessed as competent by our clinical-skills instructor, then we are given permission to put our skills to use on our assigned wards – under supervision by qualified doctors, of course. And it is with practice that our competence and confidence grows. Not every encounter is perfect of course, because human bodies are complex, but this is the reality of medicine. Gaining experience is the best part of our education. By the time we qualify, we will have had a great deal of practice with all of our TDOC skills, and hopefully, at least in this aspect, transitioning to being junior doctors should not be so challenging. I’m sure it will be challenging in many other ways, though!

John

Catrin Davies : 02 Jun 2016 09:27 |  Tags: John Mbchb Patients Skills Student Warwick Wms |  Comments (0) |  Close comments |  Report a problem