All 13 entries tagged Hospital
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November 12, 2020
The last 2 weeks have been very busy for me. The time has come for us to apply to the Foundation Programme. I have spoken about the Foundation Programme in my blog before, but just for a brief recap, the Foundation Programme is a 2-year programme which new doctors complete. It is, as the name suggests, a Foundation – a 2-year programme where you are a qualified doctor but work in specific roles where there is plenty of support and training to allow you to build your confidence and abilities as a new doctor. The application process is relatively straightforward and pretty much nothing like a normal job interview. Your medical school ‘nominates’ you, and then there is a brief online form, and then you rank geographical areas where you want to work. There is no nerve-wracking job interview, just a ranking process based on your performance at Medical School and in an exam called the Situational Judgement Test (SJT). The SJT asks you certain dilemmas and asks you how you would respond, and you get points for the most correct answer. We have to sit the SJT in December or January.
In addition to preparing for the future I am also in the middle of the Paediatric and Child Health block. Last week we had Paediatric Basic Life Support training. We have had training in Adult Basic Life Support before on the course, but Paediatric life support is actually quite a bit different. In adults, you approach an unconscious causality and presume that they have had some sort of heart issue, whereas in children the most common cause of a collapse is a breathing problem such as choking. We had to practice on model babies which is an unsettling experience, even though it is only a doll. I really hope that during my time on Paediatric block I don’t need these skills, and luckily it is very rare for a child to be that poorly!
This week I have been placed on the Special Care Baby Unit (SCBU) at the George Eliot Hospital. This unit looks after babies in the first few weeks and months of life who have developed medical issues or are struggling to grow, feed or develop. We have also had online lectures about common issues that affect babies such as jaundice (yellowing of the skin) and various heart murmurs (some of which can be normal). I have also spent time this week observing the new-born baby checks. These are done by a trained midwife or one of the doctors and all babies have a check within 72 hours of birth which is done by the hospital. Another check is then done by the family doctor/GP at 6 weeks of age. These checks aim to identify any problems present from birth, for example birth defects or any issues which may impact on the baby and its ability to grow and live. It has been really interesting to observe these checks, and, of course, there is the added bonus of getting to see some very cute babies! All of the babies I observed were okay but watching the checks has opened my eyes to the many issues which can affect babies and their families – birth is just the beginning!
October 07, 2020
This week I had three shifts on labour ward at Warwick Hospital. Each one started at 7:30am sharp with the midwife handover, and then I was assigned a midwife to help/shadow for the day. On my first shift I stayed with the same patient all day and things ended with a birth which was amazing to see. It does sound cheesy, but welcoming new life into the world is one of the highest privileges there is. And the babies are very cute!
On Saturday I received some great news – one of the block coordinators forwarded me some feedback sent into the ward by one of the families that I had worked with this week which mentioned me by name! Studying medicine is sometimes a process of continual confidence building, followed by realising how little you do know. A lot of the feedback we receive is about how to improve, which does sometimes feel like negative feedback as it concentrates naturally on what you didn’t do but should have done. This is of course all in the interest of patient safety – one must continually improve to ensure one reaches the competence expected of a doctor. It honestly makes such a difference to receive some positive feedback and after a long and tiring week makes it all feel worth it.
The positive impact this had on me reminds me of something I think I’ve spoken about before in this blog – Learning from Excellence (LFE). LFE is an initiative which was started by one of the consultants I worked with before medicine but is an idea which is gaining considerable traction. LFE focuses on inverting the traditional “Incident reporting” which operates in hospitals – i.e. where an incident occurs, and it is reported so that measures can be taken to prevent it happening again. LFE instead focuses on reporting excellent practice so that we can make sure it does happen again. Of course, both of these approaches have their place and really work in tandem – but LFE focuses on raising morale and also ensuring excellent care. Positive feedback about what went well is just as important as what didn’t go well.
Something else I think is very important is showing kindness and humanity to others in healthcare. When stressed it is so easy to get offended or start on a poor tone, but kindness and positivity has such an important impact. I believe it is key to try our best to be kind to everyone we meet – staff members and patients alike. One of the consultants at University Hospital Coventry actually gave an excellent TED talk which I would recommend – “When rudeness in teams turns deadly”, which talks about the direct consequences of being rude, or of being unkind and inversely the importance of being civil and being kind.
The lesson to take away is that kindness costs nothing apart from your time, and whether it takes the form of positive feedback or just being nice to someone - it can make all the difference. It could make someone’s week – it made mine this week!
September 18, 2020
I have now started my Obstetrics and Gynaecology block, for which I am based at Warwick Hospital. Warwick Hospital is one of the smaller hospitals for our medical school but one of the best in terms of the experience that you get. I have only been at Warwick before for a day here or there and never for a long time, so I was excited to start a 5-week block based at Warwick. Obstetrics and Gynaecology covers pregnancy, childbirth and women’s health, and for the block we have two midwives supervising, teaching and organising us. For our first week we had mostly lectures covering some of the basics of this speciality, some of which is revision and some of which was new information. The lecturer midwives who were teaching us did a fantastic job of breaking these topics down and giving just the right amount of information to make it digestible. We also had sessions on obstetric palpation (feeling babies in pregnant tummies), which I have always found tricky. The only way of describing what it is like is having an action man in a inflated balloon and then trying to feel what clothes action man is wearing. It can be tricky so I’m glad we got some more supervised practice!
This week we also had Genito-Urinary Medicine (GUM) day, which is a whole day in this block which covers sexual health and medicine. We don’t get much exposure to this speciality as a medical student, but I actually find it really interesting and varied. The day involved some lectures on HIV and different sexually transmitted infections (STIs), as well as some interactive sessions. This included practice conducting intimate examinations of male and female genitals, and then we also had some practice taking sexual histories. As I said, we don’t get much exposure so having some interactive practice makes tackling these sometimes-difficult areas a bit easier.
Today we had some bedside teaching. At Warwick Hospital we are very lucky to have booked sessions with doctors and midwives where they take us onto the wards, we find a patient and then see the patient under supervision to practice our history taking and examination practice. In the morning we were doing Gynaecological histories with one of the education doctors and in the afternoon, we were taking pregnancy histories and feeling tummies under the supervision of the midwives. Overall, the day was tiring but also really useful and we managed to get some hands-on practice, which is definitely needed at this stage!
I started my Obstetrics and Gynaecology block feeling as though it wasn’t really for me. I’m not really sure why – I think I find it difficult and so don’t enjoy it for that reason. However, after 2 weeks I feel as though it has been demystified a little bit and I definitely feel more comfortable already, with still 3 weeks to go. Im excited to see what the rest of the block brings!
June 01, 2020
For the last two weeks, I’ve been continuing with my work on the Gerontology ward at University Hospital Coventry. Gerontology is care of the elderly and the ward deals with general medical problems in this patient population. Many of the patients have a condition called delirium which means they are acutely confused (i.e. the confusion is new and has a rapid onset). Delirium can be caused by infections or even just by being admitted to hospital, but it is often reversible and the confusion gets better when the patient's medical condition improves. In addition to this confusion, many of the patients have existing dementia, where their confusion and cognitive abilities are impaired due to this long-term condition. This has made it very challenging at times when trying to encourage these patients to eat and whilst tending to their personal needs as they are often confused when and do not understand what you are doing or why.
I’ve worked on the ward for two months now and I think while I haven’t done much actual medicine in this time, I have developed what people call the “soft” skills which I think make the difference between a good doctor and a great doctor. It is not just about being able to recognise a cancer, for example, but being able to communicate with the patient about what their wishes and needs are. Communication is the most important skill a doctor has to have and is the cornerstone of what doctors call the ‘therapeutic relationship’ – a partnership between doctor and patient. When trying to communicate with confused patients, it is crucial to speak very clearly (which can be difficult wearing a mask), and I definitely think my own communication style has changed. Since I was a child, I have always spoken very quickly in general, to the extent that I used to get told off as a child because no-one could understand me! I also had a stutter for certain periods of my childhood, and I think working with these patients where communication is absolutely fundamental has led to lasting changes in the way I verbally communicate. I would say the speed of my speech when talking to patients has slowed down and I use clearer phraseology. I also have learned that if someone doesn’t understand, that is it essential to check if they usually wear a hearing aid and, indeed, if it is turned on!
I have really started to miss studying. It sounds strange when most people hate studying, but I find learning and working towards the goal of finally qualifying one of the most satisfying things in my life. There is a strange sense of dislocation when a goal you have worked towards for 3+ years suddenly seems further away and the goalposts shifted. I think the sense of dislocation comes from the questions and uncertainty due to COVID. Will we restart placement in July as the Medical School has planned? When will our final exams be? Will we have an elective period? Will we be as well equipped to pass finals as the students who have gone before us with potentially less time on placement? Healthcare students around the world face the same dilemmas and uncertainties and I hope things go back to normal soon for all of our sakes.
One flash of light in all of this uncertainty has been a revival of peer support. Warwick is known for being very strong when it comes to peer support, which is when the years above run sessions and teach to help the younger years. Our fantastic finalists have been true to that tradition and have been running online sessions to help us with some of the questions we have. They have done sessions on our final exams and what helped them, as well as practical tips for getting through this period. I think having this support run online at this time has certainly given me hope that we will come through this and be able to rise to the challenge of finishing the course successfully. It’s comforting to have support from those who have been through it and come out the other side.
April 29, 2020
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!