All 9 entries tagged Hospital

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

Coro NO a

I tried to go for a pun in the title. I guess it’s time to address the elephant in the room. Corona or as it is officially known, Covid-19. I have to admit, it’s been in the back of my mind since the first cases arrived in the UK but I never once believed it would get to the stage it has today. It’s affected people everywhere and posed a particular problem to medical students.

We turned up to our placement on Monday. I’ve officially moved hospitals and I am now at George Eliot (fondly known as Geliot), a small local hospital and a million miles away from what I have known at UHCW. We can get a cup of coffee for a £1 here for starters. We were issued our passes and then went out to explore the hospital before our welcome lecture from Dr Nair at 12:30pm. My clinical partner and I decided to hunt down one of our consultants who is a Respiratory consultant to say hello and get to know her timetable. We eventually found the ward and waited for her to arrive. It was weird, a new hospital, new wards, new staff. My brain was struggling to keep up. The side room behind us was being treated by nurses in full PPE. Our doctor arrived and as we said hello, we knew were not going to be there long. She explained how she didn’t want medical students on the ward because of the extra workload they were facing, however, she did provide us with a timetable of her work life which was brilliant.

We ended up wandering the hospital unsure of what to do next when we bumped into the F3 who was on the ward who offered to take us to the morgue. We accepted but I was a bit hesitant about what we were going to see. We stepped in and watched the doctor checking for pacemakers. It was profound to see those who had passed on, and coming out of the room, my brain was still trying to process everything I had seen.

We went to grab a cup of tea after to sit down and mull over everything when we found out others had been removed from the wards and were upstairs. We ended up all sitting in the canteen, delving into Geliot's well-talked about ice cream bar, waiting for 12:30pm to arrive. However, word began to leak through that all first-year teaching had been cancelled. I was pretty sure what that meant for us then. Then the email came through to say we were off placement for two weeks. It felt odd. On one hand we were happy, we wouldn’t be posing an infection risk anymore and it meant we had a bit of a break after our first 10 weeks of placement. On the other hand, we were disappointed as it meant two weeks of nothing but theory and no clinical time, especially when we had only been at our new hospital for four hours.

We met Dr Nair for a hello and goodbye session before making our way back home. Luckily for me, it meant I could have the afternoon sleeping off my newly developed cold (not covid, runny nose, no cough, no high temp) and not have to miss placement.

The next few weeks will be interesting and worrying. A lot of my year have gone home to help the NHS in their old roles of HCA/nursing/ODP and many more. I just hope they stay safe. For me, I’m trying to see if I can get a job as a HCA or help out at local GPs. I can take bloods, insert a cannula, do obs, and now ABGs. I want to help out but if helping out means staying away, then I guess it’s the presentation list for me! There’s schemes being set up across the country by med students offering child/pet care for health professionals who are caught on the Covid front line which I think is brilliant. We are all DBS checked, and have a lot of time on our hands!

How this is going to affect the future of my degree is unknown, how it’s going to affect the NHS is unknown. The next few weeks will bring change but by sticking together (figuratively), following guidelines and keeping safe, that’s the best we can do for now.

Hattie Trigg : 24 Mar 2020 08:00 |  Tags: Abbie Hospital Mbchb Patients Student Warwick Wms |  Comments (0) |  Close comments |  Report a problem

Core Clinical Education Begins

I wrote my last blog at the start of the Christmas holidays as I eagerly awaited the start of Core clinical education (or CCE). As usual I had grand plans for work and preparation over the Christmas holiday and as usual they never materialized. Getting ready for hospital on the first Monday back I was starting to worry about my chilled out holiday but after two weeks in hospital I’m glad I took the time to relax and recuperate before clinical life hit me! These past few weeks have been intense to say the least but definitely worth the wait.

CCE is the first fully clinical phase of the course here at Warwick, the next 30 weeks are split into 10 week blocks, each at a different hospital. I’m starting at Warwick Hospital which is a small district hospital. My base ward is a Respiratory Ward but in my timetable I also have time on the surgery, paediatrics and special baby care wards. Each hospital organizes tutorials on specific topics and we have lots more clinical skills to learn. In my first block I’m going to learn how to insert cannulas and perform Arterial blood gas measurements. It may seem scary to be learning all these clinical skills but once we can do them we can help out on the wards and get lots of practice in a safe environment. Much better than waiting till exam time!

I’ve been spending a lot of time with the junior doctors, some of which are only in their first year. Despite how busy they are they always have time to teach. After taking a history and examining a patient they are happy to sit down and talk through the case, show me the imaging results and teach on tricky topics. I’ve learnt so much from just these short sessions. I suppose that shows you that no number of lectures on lung function and pathology will help you understand unless you see it for yourself with the patient in front of you.

We’ve also had our first day with our community practice. We will be spending 3 days of every block in the community, learning about chronic illness management and how healthcare interventions are implemented in primary care. These community days complement our time in GP which I am really looking forward to. Some of us have also attended our psychiatry placement induction. Later in the year we will all have a 4 day placement in psychiatry and to prepare us for this we had a clinical skills day in psychiatry where we got to practice history taking with actors in a number of scenarios which ranged from an acute psychotic episode to chronic fatigue syndrome. I found this session really helpful as a psychiatry history is a very different skill, one which I’m looking forward to putting into practice.

My body hasn’t quite adjusted to the change in pace and finding time study in between all of our placements is tricky but it was all the clinical stuff that made me want to come back to study medicine so while I may be very tired I know it’s worth it!

Joanne

Megan Earle : 25 Jan 2016 15:08 |  Tags: Hospital Joanne Mbchb Student Warwick Wms |  Comments (0) |  Close comments |  Report a problem

The End of Pre–clinicals and the Start of Clinicals

For the past year and a half, we have spent a great deal of time in the lecture theatre and in other practical sessions getting to know the human body inside and out (literally). We have studied the structures of cells, tissues and organs, how they work together, what can go wrong and how to manage it. Most of the work we’ve done up till now has been very theoretical – although WMS does a good job of integrating (or at least introducing) clinical exposure into the curriculum, we have still had to endure more Power Point than any human should have to. This is understandable, of course, as the amount of information we must absorb is just huge and the pace is quick and we need to be able to access a lot of it in the future.

The end of the autumn term also marked the conclusion of the pre-clinical phase of our curriculum. Our weeks of lectures and intense group work have morphed into something much more hands-on and practical in its delivery –and most of us our going into this period with many different emotions swirling about. It’s exciting that we’re finally going to be on wards and working with teams like proper doctors do (which of course we are not, yet). It’s a little scary that our hands are no longer going to be held quite so tightly as before – a lot of our learning is self-directed and self-managed. But it’s also very encouraging to know that we are given responsibility by the medical school (and its overseers) to manage our own education to a high degree.

From what I have heard, Warwick are quite pro-active and advanced regarding clinical exposure as compared to other medical schools around. Although (of course) all students in the country complete the same amount of clinical exposure by graduation, and all must meet the same standard, WMS introduces the exposure far earlier in our medical-school careers than many other medical schools, thus making the process of speaking to patients far less daunting than it might otherwise be. We meet several patients during the first year through a variety of means: ‘community days’, in which we meet non-hospital patients in the community with medically complex conditions; brief hospital-ward introductions and examination practice; and various other opportunities.

But now, as of Monday 4 January, we will be joining the hospitals full-time and our focus will shift to learning in the clinical environment. It’s very exciting. We’re focusing on history-taking and examination of common diseases in our first ten-week block. Although my partner and I are based on a respiratory block, the focus is not on respiratory ailments as such, but rather the basics of patient interaction from the doctor’s perspective. All of our cohort are distributed throughout the three main hospitals in the Warwickshire area, across numerous wards, but all will be following the same basic curriculum. I am very much looking forward to the transition towards becoming a member of the hospital team and putting my efforts into learning in the clinical environment.

John

Megan Earle : 06 Jan 2016 11:51 |  Tags: History Hospital John Mbchb Patients Student Wards Warwick Wms |  Comments (0) |  Close comments |  Report a problem

Working in the hospital

As part of the introduction to Core Clinical Education that all second-years will be starting in the New Year, we have been spending each Monday at our respective hospitals completing several different orientation tasks. Students in our cohort are assigned to either UHCW (University Hospital of Coventry and Warwickshire), Warwick Hospital or to George Eliot Hospital in Nuneaton. It has been fascinating to see how hospitals work, and this extended orientation session has had the very welcome effect of showing us not just how doctors do their jobs, but how all teams work together to make the process of healing, treatment and management as therapeutic for each patient as possible, whilst working with finite and closely-managed resources.

Students at my hospital are given multiple different tasks to complete over the term; these include bedside-teaching sessions (practicing taking histories and performing examinations), mandatory orientation sessions (such as introduction to outpatient services) and some optional sessions that we chose before starting. The purpose of these tasks is to ensure that students develop respect and appreciation for all members of every team, and see how the many, varied cogs of each ward’s wheels fit so nicely together.

One of my morning placements was in the operating theatre, the purpose of which was to observe several operations and see how the team members’ tasks complemented one another. I had the privilege of witnessing three relatively routine procedures take place back-to-back and watch the progression of each from start-to-finish. Each of these procedures required the patients to be given general anaesthetic, and I was present for the entire process. I watched the anaesthetist and the ODP (Operating Department Practitioner) prepare the drugs, was present when the (conscious and alert) patient was wheeled in, and observed everything from that point forward.

I once watched a documentary about a Formula-1 pit-stop crew; the stops were so tightly choreographed that each team member had certain spots where they could place their feet so that they did not get in the way of anyone else. The amount of precision and professionalism in this operating-theatre team was not far off of that. Every task was completed efficiently and quickly, and with minimal disruption to the patient’s wellbeing. And this was the most impressive and best part of it all: the patients are so vulnerable and so trusting of their medical professionals. Each was literally unconscious, and yet no doubt entered anyone’s mind that each would be given anything but the most dignified and respectful treatment possible - and so they were. It made me proud to be part of a service which takes its duties so seriously, and in which the absolute highest standard of care is not merely something to be aspired to, it is something which is actively practiced and expected.

John

Megan Earle : 04 Dec 2015 09:02 |  Tags: Hospital John Mbchb Student Surgery Warwick Wms |  Comments (0) |  Close comments |  Report a problem