All 52 entries tagged Joanne

The End of The Block…

After what feels like the longest year that most of us can remember, we are finally done with our last block of the Specialist Clinical Placements. It’s hard to believe that from now on, it’s all going to be revision and clinical apprenticeships (presuming finals success…). I’m glad that we ended with the Psychiatry block, however, as it allowed us to focus on an area of medicine that we don’t see very much of outside of psychiatry, and hopefully having this block so late will keep the information fresh for our upcoming exams.

Our last week of Psychiatry involved more time spent in an acute-ward setting, and enabled us to see far more presentations of common psychiatric conditions, including Emotionally Unstable Personality Disorder, severe Generalised Anxiety Disorder and many other fascinating presentations. We were also able to see another assessment under the Mental Health Act, something which is taken very seriously (for obvious reasons) and is very thorough and complete. I’m glad that so much effort is put in place to safeguard patients who might not be in a safe mental state to manage their own mental-health conditions, and it’s good that the process is so robust and observed so closely. There really is a lot of legal scrutiny for the process of detaining patients in hospital, and every professional I have worked with has agreed that this is entirely appropriate.

Looking back on 2017, it’s really amazing to think of how much ground we have actually covered; there is so much that I didn’t know at the start of the year but have picked up throughout the course of the year through many different means: we’ve had large-group teaching, small-group teaching, one-on-one teaching, ward-based exposure and of course loads of self-study. My notes, however, are a complete horror show and I could easily spend the majority of the next two months just reorganising and getting everything into shape! But of course we don’t have time for that right now. It’s all about accessing, revising and hopefully committing to memory all of the information that we’ve learned over the past three-and-a-half years. The task is daunting, but I think we’ve climbed steeper hills (first year, I’m looking at you). My main goal for the first day of revision is to at least get everything on one disk drive!

Now that we are done with our last Specialist Clinical Placement, most of our cohort are now off on Christmas break – which will be nice, but of course we will have the additional spectre of upcoming final exams looming over our heads. I’m looking forward to leaving the UK for a couple of weeks – Coventry is lovely, but I think I need a change of scenery to keep from going mad – and hopefully some slightly warmer weather and creature comforts will be the perfect environment to start my revision.

John

Joshua Galvin : 03 Jan 2018 09:12 |  Tags: Joanne Mbchb Student Warwick Wms |  Comments (0) |  Close comments |  Report a problem

Buzzwords…

In my last blog I spoke about the change of pace when I started the Psychiatry block. There is certainly less urgency about the psychiatry block but the days are no less intense and most days at the end of placement I’m just as exhausted as any of the shifts I worked in A&E.

My clinical partner and I are currently assigned to a male adult inpatient psychiatric ward. Like any other ward most days there is a ward round, however instead of a group of people peering at a patient from the end of the bed, there is a ward round room where patients come to speak to the team about their care. Sometimes the doctors or nurses may request to see someone, other times there are prescheduled appointments. Some of these meetings can be brief, patients who have improved a lot who are discussing spending more time at home and are nearly ready for discharge. In contrast, some of the patients may be seen for over an hour, taking a complex history from a newly admitted patient, as well as a collateral history from family, followed by time to discuss the plan among the clinical team. In other areas of medicine while patient centred care and involvement of family and friends is preached, it isn’t always practiced. However, in psychiatry every consultation starts with the same, important question: how are you feeling? Often patients don’t know how to answer this, but their response is key. Key to knowing if they are ready for discharge, if their home leave was a success, or if their new medication is having side effects or if their symptoms have improved. The involvement of family and friends is strongly encouraged and where these are lacking other means of social support are utilised in the form of community psychiatric teams and social services as well as other members of the MDT or multidisciplinary team (a key buzzword for exam purposes!).

One of the things I really like about Psychiatry is that it takes a truly holistic approach to patient care. While a patient’s main reason for being in hospital may be their psychiatric condition the doctors know that treatment of this alone won’t solve the issue. Another key buzzword for medical school exams is treating patients using the “bio-psych-social model”. You need all three to treat any condition effectively, this applies to any medical condition but it is particularly pertinent in psychiatry. A psychiatric illness may require medication or even ECT treatment (the biological approach), but a patient may also benefit enormously from psychological support. The social approach can be very complex in psychiatric patients, patients may need help with housing if they are homeless or may not know how to claim all the benefits they are entitled too. They may need help finding a job or gaining work experience. These are things the doctors and nurses discuss at ward round with the patients, finding out what their hopes and ambitions are for when they are discharged.

Mental health services may be severely under pressure and underfunded, but it’s great to see the psychiatric team help a patient with every aspect of their lives to achieve the best management of their psychiatric illness. Perhaps psychiatry is where all the MDT and Bio-psycho-social magic really does happen!

Joshua Galvin : 22 Dec 2017 10:14 |  Tags: Joanne Mbchb Warwick Wms |  Comments (0) |  Close comments |  Report a problem

Fingers and toes crossed…

Well that’s it, I have officially completed my final specialist clinical placement as a final year medical student. I will be back in hospital in January for my revision block and then next stop finals!

I cannot believe how fast this year has gone, it feels like only yesterday I was checking my emails as a 3^rd year student to see where my first specialist placement would be and it doesn’t seem that long ago I was in the lecture theatres in first year. The amount I have learnt in such a short space of time is quite staggering, however it is equally alarming how much I need to learn and remember over the next 8 weeks!

The last two weeks of my musculoskeletal block have mostly been focused on rheumatology and our end of block assessments. I presented a patient case about Psoriatic arthritis (a condition that affects the skin and joints) to our consultant and was then quizzed about my knowledge of the case and of the disease, which was quite nerve wracking but good practice for our clinical exams. We also had our end of block clinical exam which is run exactly like our finals will be. Mine was in fracture clinic with a patient presenting with hip pain. He was such a lovely person and he was still in very good spirits when I saw him despite him already seeing another medical student due to a lack of patients. He was less impressed with my examination technique which involved making him manoeuvre quite awkwardly around the couch which would have been tricky even if his hip didn’t hurt! I certainly still have some way to go before my examinations are slick enough for finals!

In our last week my clinical partner and I were invited by our rheumatology consultant to attend a special clinic conducted by a Professor visiting from London. This professor specialises in a rare disease called scleroderma, a disease where the body’s immune system attacks different tissues in the body resulting in skin disease and various problems with other organs which can be life threatening. This is an incurable condition and it can be very difficult to treat, many of the patients in the area with this condition travel to London for treatment but once a year this professor visits Coventry to see particularly difficult cases and offer advice to the rheumatology team at UHCW. It was interesting to observe the UHCW consultants presenting cases (getting tips for my own exams!) and see how this world-famous Professor was still so down to earth and friendly with the patients. While medical students are often told not to worry too much about rare diseases, when you are in final year and preparing for clinical exams you start to believe all the rumours about some of the tougher clinical cases, with scleroderma rumoured to be one of them I wasn’t going to miss the opportunity to attend this specialist clinic!

Keep your fingers and toes crossed me and hopefully the next time I’m writing my blog it will be on the right side of finals!

Joshua Galvin : 18 Dec 2017 09:43 |  Tags: Joanne Mbchb Student Warwick Wms |  Comments (0) |  Close comments |  Report a problem

One exam down…only a gazillion more to go

First exam done! All Warwick students sat the national Situational Judgement Test (SJT) last week. This is an exam that makes up 50% of our total score for our Foundation job applications so while it doesn’t test your medical knowledge it’s still very important! The SJT focuses more on the qualities expected of a doctor and how you handle difficult situations that we will be faced with such as confidentiality issues, explaining mistakes to patients and prioritising our workload. It’s a tricky test to prepare for so I’m glad it’s out of the way.

Apart from SJT practice I’ve still been enjoying my musculoskeletal block, we’ve been in the plaster room practicing putting casts on each other and I’ve also been in the trauma theatres. A day with the trauma team starts early with the 7.30am trauma meeting where all the traumas that came in the previous day are discussed and operations planned and prioritised. The team on call then head off to fracture clinic and the junior doctors respond to any trauma bleeps from A&E. The following day the same team then is in the trauma operating theatre doing any operations that are required on trauma patients that have come in over the previous few days. The day that I was in theatres we had a huge variety of different hip fractures, an unusual fracture in a teenager and then more common types of hip fractures that occur in the elderly. When we first learnt about falls in the elderly and hip fractures in second year I could not believe how much they cost the NHS with some studies suggesting they cost £1 billion per year, they are also a significant cause of mortality with a significant proportion of elderly patients not surviving even just 1 month after a hip fracture. All the studies show that if you treat a hip fracture quickly the mortality goes down no matter what the age of the patient is. For that reason, we had patients in their 90s on the trauma list to fix their hip fracture to preserve their mobility so they don’t become unwell and suffer any further complications.

Operations to fix hip fractures aren’t the most pleasant to watch and there is an awful lot of hammering and banging that makes you appreciate why people are so sore after their operation. I don’t have the best track record when it comes to fainting in theatres so I was slightly apprehensive about attending trauma theatres. So far during medical school I’ve hit the deck on a ward during a chest drain insertion as well as in theatre during a C-section, both times staff were lovely and understanding but both times I was completely mortified so I ate the biggest breakfast I could manage before heading into theatres. I must admit then when I was scrubbed up and quite close to the action I did feel quite queasy but I managed to stay standing! Hopefully I’ll have plenty of opportunities to further desensitise myself during our assistantship so I don’t continue to be a falls risk!

Joshua Galvin : 04 Dec 2017 09:57 |  Tags: Joanne Mbchb Student Warwick Wms |  Comments (0) |  Close comments |  Report a problem

To study or not to study…

Two weeks into my final block and my fellow students and I are counting the days, not until Christmas, but to our exams! I’m already a week behind on my revision timetable and I seem to spend more time thinking about all the time I’ve wasted rather than getting on with my revision!

My last block is the musculoskeletal block. Our year group is split into 7 groups and each one has done the blocks in a slightly different order, so everyone is finishing on something different. Some students are happy they are finishing on General Practice so they can practice and revise almost every subject, other people are glad they are doing Paediatrics or Obstetrics and Gynaecology so that all the information covered in those blocks stays fresh in their mind for exams. Musculoskeletal isn’t a bad block to finish on, this block covers rheumatological conditions which are a favourite of medical school clinical exams and covers orthopaedic surgery so we are seeing lots of patients with osteoarthritis and painful joints, which also come up a lot in our exams. Many rheumatological conditions don’t just affect the joints but have effects on other areas of the body so it’s actually very good revision for other organ systems as well as ensuring my anatomy hasn’t been completely forgotten.

One of our teaching sessions can be slightly nerve-wracking with a consultant who likes to sit in the middle of a circle of nervous students and swivel on his chair and directing questions at us about almost any subject in medicine and surgery! Trying to think of another side effect of steroids when all the ones I remember have been said already or been asked to name 4 causes of clubbing (a clinical sign of disease in the nails) is quite exhausting but it’s also helpful! Our consultant helps us if we are struggling with a range of comedic actions and facial expressions and we all leave with a smile on our face knowing that while we got some answers right, it didn’t matter which ones we got wrong as now we know which areas of medicine we need to work on!

We are also spending time with the orthopaedic team in fracture clinic, seeing new patients as they are sent round from A&E with a variety of injuries. We are getting lots of practice with our history and examination as well as getting the chance to look at some painful looking X rays!

Aside from our MSK block and revision I am also trying to fit in some revision time for the Situational Judgement test, a national exam that will determine 50% of the score I get for job application to the foundation programme. Fingers crossed for the start of exam season!

Joshua Galvin : 21 Nov 2017 09:21 |  Tags: Joanne Mbchb Student Warwick Wms |  Comments (0) |  Close comments |  Report a problem