All 39 entries tagged John

Getting Stuck into the Acute Block

We’re in the middle of the acute block and it is really living up to its vaunted reputation. I am having a great time and learning a lot, and it seems like everyone in my rotation is having similar experiences. My clinical partner and I are lucky because most of our teaching and shadowing sessions are at a very large regional hospital; this appears to mean that we see lots of injuries and presentations that wouldn’t normally go to a regional hospital. There is a lot of trauma and some fairly serious acute medical presentations, and we get to see a lot of very interesting and cool things.

I’ve found that we are really encouraged to get involved once we tell the A&E staff that we are students, and this is a huge advantage of the acute block and being so far advanced in our careers as students. When we’ve been observing/helping out in A&E, most of our time is split between A&E minors (where people present with not-very-acute conditions) A&E majors (where people come for acute and serious but not life-threatening presentations) and A&E resus, which is geared toward stabilising patients, saving their lives and initiating immediate management before passing them along to more appropriate parts of the hospital.

Each area has its positives: the minors area is the least hectic and stressful of the three, which means that when we see patients here, we can spend more time focusing on their presenting complaint without the added pressure of it becoming urgent very quickly. In the majors area, the energy level is really high, and there are loads of doctors around, so as students we get support as soon as we need it and clinical contact all the time. And the resus area gives us the opportunity to see the bare face of medicine, where people’s lives need to be saved immediately. Both my clinical partner and I have seen some really eye-opening trauma in resus – let’s just say that I am absolutely never, ever getting on a motorbike in my life.

I feel that we’re lucky because our acute block is coming rather late in Phase III (much luckier than had it been our first rotation, for instance). It being so late has equipped us to consolidate a lot of the medical knowledge that we’ve built over the phase and indeed over the preceding years, and we also have a lot more confidence speaking to patients and getting straight to the point about what information needs to be uncovered. Unlike lots of other degrees, basically everything that we’ve learned throughout our time in medical school (especially a lot of the anatomy and physiology from Phase I) is relevant at all parts. The vocational nature of the degree means that everything is applicable at all times – we were quizzed the other day on the mechanism of action of bronchodilators, which we learned in November of our first year! In any event, the acute block has exceeded my expectations, and I am seriously considering a career in emergency medicine because of it

Joshua Galvin : 22 Dec 2017 10:09 |  Tags: John Mbchb Student Warwick Wms |  Comments (0) |  Close comments |  Report a problem

Psychiatry and Beyond

As 2017 draws to a close, it’s amazing to think of how much ground we have covered and how much we have learned since the start. We are now coming to the end of our eighth Specialist Clinical Placement this year, and once again it’s been a fascinating tour through a part of medicine that we’ve not had much exposure to up till now.

After spending the first three weeks of the block on a community psychiatric placement, we have spent the past two weeks learning about old age and acute psychiatry. Most of the care that we have had in these two sections has been ward-based, and we have had the opportunity to see some very interesting presentations of a more acute nature. These tend to be patients who have been asked to remain confined to a ward for their own good, as they pose a danger to themselves or other people and are in clear need of treatment. The legal process that doctors are required to go through in order to detain someone are very robust, and I think that this process is crucial to a beneficial and defensible medical service.

It’s easy to think of medicine in discrete blocks: a patient with a heart problem is only a heart problem, a patient with bipolar disorder is only bipolar disorder, etc. But what we have seen a lot of in this block is patients with multiple mental-health and physical-health comorbidities presenting at the same time. We have been able to see why psychiatry requires a strong foundation in physical medicine – doctors need an in-depth knowledge of physiology in order to understand side-effects of drugs and physical causes of mental ill-health, among many other things. Although my stethoscope isn’t getting much exposure during this block, the potential to use it is always there. Next week is our final week on psychiatry (and actually on Specialist Clinical Placements altogether!) and I’m really looking forward to what it will bring.

Along with several thousand other hopeful final-year medical students around the country, we sat our Situational Judgement Test exams last Friday. This is a relatively new assessment (in the past five or so years), which plays a large role in determining where we will go for our foundation-programme placements. We were presented with dozens of ethical scenarios and asked to respond to each, and even though Warwick Medical School do a really good job of preparing us for the exam (as much as they can), I think it’s fair to say that there’s no more preparation I could have done to have performed better or worse. It’s just so tough to prepare for this exam – I guess that’s the point, though! We’re expected to react instinctively and be evaluated based on this judgement. We won’t know the outcome until early March when we are given our foundation-programme placements.

And very soon our Specialist Clinical Placement blocks will draw to an end entirely, leaving us in the run-up for finals. It’s been a long road and a very busy year, but I’m looking forward to seeing what the next chapter brings!

Joshua Galvin : 13 Dec 2017 16:53 |  Tags: John Mbchb Student Warwick Wms |  Comments (0) |  Close comments |  Report a problem

Community Psychiatry and the SJT

All of us Phase-III students are now in the third week of our final Specialist Clinical Placement rotation. It’s hard to believe but we’re almost at the end of this year’s formal medical instruction. We’ve all been working really hard and I hope something comes out of it. 2017 has just flown by

We’re about halfway done with our Psychiatry block, and it’s proven fascinating thus far. Of the six-week block, three weeks are meant to be spent in the community, one spent with an old-age consultant, and two on acute care. Our community placement has been in a lovely clinical practice in the community (i.e., not at a hospital) with several psychiatrists (including consultants and registrars), psychologists, and care coordinators all working together for each patient’s wellbeing. I gather that most patients won’t be seen by a psychiatrist unless they are referred by a medical professional or a police officer, depending on the circumstances. We’ve seen lots of varying presentations in the clinics, including severe depression, emotionally unstable personality disorder, paranoid schizophrenia and many other things. And we’ve seen patients at various stages of treatment as well, including new-onset, follow-ups after initial therapy, and some patients who’ve been under treatment for decades and have come in for medication reviews. It’s fascinating to see all of these presentations at once, after having read about them for so long.

Most patients have been really open with me and my clinical partner when we ask them questions about their conditions, including symptoms, duration and treatment of their condition – and it’s great when they are able to help us learn. Elements of the psychiatric history can be quite personal, as they involve intimate details about a patient’s upbringing and social life, and so sometimes it takes some effort to get comfortable posing them, but when you realise that you need to handle an intimate psychiatric exam the same way you’d handle an intimate physical exam – with sensitivity and professionalism at all times, focusing on the patient’s wellbeing – it becomes easier with practice.

Over the next few weeks, we have old-age and acute psychiatric placements. I’m really looking forward to them, especially the acute part. About a year and a half ago, we had an introductory week on a psychiatric intensive-care ward and it was absolutely brilliant. Now that we have gained a lot more medical knowledge, and in particular have spent the past few weeks bolstering our knowledge of psychiatric conditions and how to treat them, I hope it will be that much better and more useful.

Very shortly, members of our cohort will also be sitting the SJT, or the Situational Judgement Test. This is a test that all final-year medical students are required to take before entering the foundation programme, which is hopefully at the end of summer 2018 after graduation. The SJT is designed to assess students’ ethical judgement through asking us to respond to various realistic scenarios. One common scenario presents us with a fictional but realistic hospital situation and asks us to rank, in order of appropriateness, the options on how to proceed. Although you cannot officially revise for this exam, its administrators issue official practice tests, and there is no shortage of revision courses and materials to help us get through. WMS have even included sample SJT questions at the end of our CBL cases as well, which has been very helpful. I’m looking forward to seeing what the exam contains, but more importantly, I’m looking forward to it being behind me!

Joshua Galvin : 27 Nov 2017 16:49 |  Tags: John Mbchb Medicine Warwick Wms |  Comments (0) |  Close comments |  Report a problem

Psychiatry: the Last Frontier

Our cohort is in the first week of our last specialist clinical placement, and there is a certain feeling of conclusion in the air. For the vast majority of our group, this is the last medical rotation we will do at Warwick Medical School. It’s hard to believe that we’re so close to being done (well, there’s just that small matter of final exams…), but at the same time it feels like we’ve been learning for a very long time (actually, we have!) and so the fact that the end is in sight is a bit of a relief. We’re very much looking forward to progressing onto the next phase of our lives and careers.

My clinical partner and I have Psychiatry as our last rotation, and it’s proving to be very interesting and eye-opening. This is a branch of medicine about which I know very little, and so seeing the different presentations and the sheer variety on offer is really interesting. It’s also the one rotation that’s probably got the least to do with any other speciality, and so we really have to concentrate if we want to follow everything. Back in Phase II, we had a week’s exposure to the psychiatry speciality via a placement on a secure ward: it was interesting, but that placement was slightly more intense as it was psychiatric intensive care, whereas our current placement is almost wholly community-based. In any event, we’re seeing loads of very interesting presentations and the staff we work with are all very supportive and friendly, and they want to make sure that we learn as much as we can.

We’ve had lectures at many points in our medical-school career about the various types of psychiatric presentations, and like most of medicine, most of them are little more than words on a page until we see them in the flesh. However, up till now we have tended not to focus on a patient’s psychiatric co-morbidities if he or she is on a regular medical ward with a more pressing physical problem. For that reason, we haven’t usually been focusing on many psychiatric presentations until now, when it is the specific focus of our block. That’s why this block is helping us to see lots of new and exciting cases of conditions we’ve read about – it’s been a long time since a new branch of medicine was opened up to us like this!

We’re only a few days into it, but so far we have seen patients with schizophrenia, emotionally unstable personality disorder, severe depression and many other conditions that we’ve only read about up to now. It’s really a different flavour of medicine entirely. There is a lot of pharmacology (and with this come LOADS of contraindications and side-effects to learn), a lot of psychological therapies (mainly CBT, or cognitive behavioural therapy, typically administered by psychologists) and plenty of other therapies that we don’t see much of outside of psychiatry. I’m really excited by the potential, and I’m sure this block will live up to the excitement.

Joshua Galvin : 10 Nov 2017 09:09 |  Tags: John Student Warwick Wms |  Comments (0) |  Close comments |  Report a problem

The End of the Surgical Block and the Passage of Time

Our sixth block, officially known as Care of the Surgical Patient, is coming to a close already. I swear it just started the other day, and yet it’s already almost over. Like lots of specialist-placement blocks, it’s been a very self-motivated learning experience. This is something I wasn’t quite expecting about the course: as a student, we are given a framework of learning opportunities and then, depending on the block, we are expected to fill in some portion of our timetables by ourselves. This requires a very proactive student who isn’t afraid to get stuck in and talk to the right people, but can also take some getting used to as well.

I spent the first few weeks of the surgery block really enjoying vascular surgery (really, it’s very cool!) but then branched out to learning about other forms of surgery in the last couple of weeks. You really have to do this in the trust where we did our surgery block. I spent some time with colorectal teams and going to lots of follow-up clinics in other areas – breast surgery, urology, even the ENT (ear, nose and throat) clinic for an afternoon. It was absolutely fascinating to spend time in underexposed parts of medicine and surgery, and I’m acutely aware that these might be the last opportunities for a long time that any of us students get to see such a wide variety of disciplines.

One big surprise of this block was that, interestingly, it contains a lot less exposure to actual operations than I initially expected. This kind of makes sense, however. I guess that a lot of what we as students and foundation doctors have to know has far less to do with actual surgery and far more with knowing about conditions that would cause an operation to be necessary (and there are plenty), how to assess a patient immediately before an operation, how to treat them afterwards, and of course the anaesthesia care before, during and after as well. I don’t think foundation-year doctors even make it into theatre for operations, so that realm is basically reserved for registrars and consultants. Even though I found surgery really interesting to watch, I’m glad to have had the opportunity to gain knowledge in other related areas too as it feels much more relevant to our education at this level.

Soon we will be starting the acute block, which means that our seventh – and penultimate – block will begin. A new cohort of medical students (I remember when we were that young and excited!) will be starting and we’ll now be top of the heap. I’ve been interested in emergency medicine for a while, so this block is really exciting to me. Although we have our fair share of overnight and odd-hours shifts, I think it will be really accurate and a good opportunity for us to understand what emergency medicine is like – plus I want to see if it really is like 24 Hours in A&E! I am very excited about this next block and anticipate a lot of excitement.

Joshua Galvin : 27 Sep 2017 12:18 |  Tags: John Patients Student Surgical Warwick Wms |  Comments (0) |  Close comments |  Report a problem