All 34 entries tagged John

Spending time in clinics!

Well, the pace of the fourth year hasn’t slackened at all, and things have picked right back up after our summer break. I’m still really enjoying the Care of the Surgical Patient block and am learning loads at the same time. I’m not only spending time in the theatres and on ward rounds, but also attend my fair share of clinics. A clinic is (usually) a half-day session where the doctor has appointments to meet patients alone in a treatment room and discuss their condition. Clinic appointments can be either new referrals or follow-ups; the nature of the follow-up appointments varies depending on the discipline. Some people with lifelong chronic conditions will check in with their doctor every six months or every year or something. But others, for instance after surgery or a broken bone, will come in for a meeting just to make sure that everything is OK before being discharged.

I like the nature of clinics and find them very useful to attend. It’s much easier for me to remember details of a condition when I can attach a person’s name and face to it. I can almost walk through the consultation in my head after the fact, which helps me remember investigations and management. You’re not guaranteed to see everything in a clinic, but you’ll definitely see more by attending than if you don’t go at all, and that’s what I like about them. In this block, we have the opportunity to attend a great deal of post-surgery clinics and some pre-surgery clinics as well – including vascular clinics (lots of foot ulcers and artery blockage), colorectal clinics, ENT (ear, nose and throat) clinics, breast clinics, urology clinics and more. It’s great that the organisers of the block are giving us so much of an opportunity to take advantage of what our huge hospital has to offer.

In addition to a main surgical consultant, we are also assigned to an anaesthetist (or two…) for the block and are given a lot of anaesthetics training and tutorials. I have had the privilege of spending some time in theatre with my assigned anaesthetist and have learned a great deal about the science of anaesthetics and how a lot of our physiology needs to be taken into account when anaesthetists do their jobs. It’s not all about making people unconscious and then waking them back up – so many things need to be monitored and kept within safe ranges whilst a patient is being operated on. The list of things to monitor and that can go wrong is really endless.

I recently saw an operation on a patient who was having an adrenal tumour removed; an excess level of adrenaline and related hormones were being released by the adrenal gland directly into the patient’s bloodstream. So before the gland was removed, the anaesthetist had to administer drugs to counteract the effects of the adrenaline: the patient’s heart rate and blood pressure had to be brought down and kept within safe ranges to avoid the effects of high blood pressure. But – and this is where teamwork with the surgeons comes in – as soon as the gland was removed (and ideally a few minutes before), supplementary adrenaline had to be given for a while to counteract for the sudden deficit that the patient’s body was now experiencing. Watching the physiology literally in action was absolutely fascinating and an extremely worthwhile use of my time. I cannot wait to see more!

Joshua Galvin : 21 Sep 2017 12:12 |  Tags: John Patients Student Warwick |  Comments (0) |  Close comments |  Report a problem

Care of the Surgical Patient – and the Beginning of Year Four

When I first became a medical student, being a fourth-year student seemed such a distant place to be. Before getting there, we had lectures to sit through, ward rounds to attend, and – who can forget? – exams to pass. I used to look in awe at the fourth-years I knew and think, “Wow – they must know so much. I wonder how I’ll ever learn enough to make it into the fourth year.” Well, odd as it may seem, last week we started our fourth year – it’s a bit anti-climactic, however, as it’s really a continuation of what we’ve been doing in the third year. Nevertheless, it’s hard to believe that I’m in that position now. I certainly don’t feel as confident and knowledgeable as those fourth-years seemed to me, way back when. But maybe I just don’t realise how much I’ve actually learned in the intervening three years. I’ll have to wait and see how I do on finals!

Along with our fourth year of medical school, we have also just started our sixth Specialist Clinical Placement block – this one is the CSP block (Care of the Surgical Patient). I’m thrilled about it for a couple of reasons. First, my clinical partner and I are at the largest of our teaching hospitals. I am taking full advantage of the huge variety of cases and the opportunities for teaching that are sometimes present at smaller hospitals but are definitely routinely present at ours. There’s just so much going on here. Second, I’m teamed up with a vascular-surgery team for most of this block. In previous blocks, I’ve spent time in orthopaedic surgery, colorectal surgery, urological surgery, gynaelogical surgery and loads of other disciplines, but I’ve never actually spent time watching operations on blood vessels, so this is an area entirely new to me.

So far, it’s been really interesting. I thought a lot of vascular surgery was occupied with conducting bypass operations, but there’s so much more to it than that! A lot of the patients we’re treating are elderly people who have diabetes and/or a smoking history, as these are two of the many risk factors for peripheral vascular disease. The issues that the surgery team deal with are much more varied than I expected: there are lots of bypass operations, some toe/limb amputations, a lot of wound debridement (removing dead tissue from wounds that have not healed fully) and lots of other things that you probably wouldn’t discuss over the dinner table with your mother – unless she is a vascular surgeon. Let’s just say there’s more gangrene than I expected.

And of course, although we’ve had our fair share of shadowing operations (I even got to make a stitch the other day!), there’s much more to the CSP block than just time spent in theatre. We have post-take ward rounds, clinics and lots and lots of teaching around surgery-related topics. We’ve had anaesthetics sessions, suturing workshops, teaching on wound dressing and care, and many other topics. I wasn’t too keen on a career in surgery before coming into this block, but who knows? There’s still time to change my mind!

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Luke Pemberton : 31 Aug 2017 15:44 |  Tags: John Mbchb Patients Student Wards Warwick Wms |  Comments (0) |  Close comments |  Report a problem

Time flies…

Now that we've finished the Care of the Medical Patient block, our fifth six-week block in a row in 2017, we finally have a couple of weeks off to relax and re-charge our batteries. This is our official Summer Vacation. I worked for many years in the private sector before coming to medical school, but this thirty-week stretch in Phase III with only (three) bank holidays off is the longest I have ever done without a break in my professional life. I really hope that it's worth it in the end! I'm relaxing and not doing much and in between the lie-ins and catching up with old friends, I'm taking my time filling in the gaps in my notes from some of the earlier blocks. I'd rather do it now than spending time panicking over Christmas.

Slightly more alarming is the fact that we're now the oldest cohort at Warwick Medical School. When did this happen? It feels like we had our induction week just last month, but now we're just weeks away from yet another cohort starting. And the people who have been just one year ahead of us the whole way through the course have now got their degrees and are now actual, real-life F1s in hospitals up and down the country. It's wonderful, inspiring and more than a little daunting that this will almost certainly be us in a year's time. I have faith that we'll be fine, though. The environment for junior doctors to learn is very supportive, and the medical school has trained us well in what to expect.

When we start back, we'll be on the Care of the Surgical Patient block, which is intended to teach us as medical students everything we need to know for a firm basis in surgery and anaesthetics. I'm actually really excited - it's not a part of medicine I know much about from a practical standpoint. We've observed lots of operations and procedures but our (minimal) involvement up to this point has been on an ad hoc basis from consultants who kindly ask us to scrub in; this is rare. I hope in this block we will get a much better, hands-on view of what surgery actually entails. I believe that every foundation doctor is required to do at least one surgical rotation (although don't quote me) so this will be excellent practical backing.

For the rest of my break, however, I'm going to concentrate a little more heavily on the 'life' part of my work-life balance. This will be the last time before final exams that I get to relax and have a lie-in occasionally (or frequently)! I'd be lying, however, if I said that I wasn't revising a little bit at times. There is so much information to learn, and I cannot afford to forget any of it. But maybe I'll think more about it after I wake up from my nap!

John

Luke Pemberton : 08 Aug 2017 10:05 |  Tags: John Mbchb Student Warwick Wms |  Comments (0) |  Close comments |  Report a problem

Coming to the End of Year Three

Starting the Care of the Medical Patient block felt like staring into the great unknown – how could we possibly cover all of this information in just six weeks?! – but it’s actually been great, if hard work. I’ve seen so much – it feels like all of medicine compressed into one six-week period and it’s hard to believe it’s almost over. It feels like a whirlwind tour!

Despite the time constraints of the block, however, our tutors have put a lot of thought into our timetable and, whilst it’s very broad in its focus, sometimes it feels like we’re jumping around a lot. I guess this is what being an F1 on A&E feels like! For instance, it’s not rare at all to spend the morning on an endocrine ward, have haematology teaching at lunchtime and then spend the afternoon in a neurology clinic! But thankfully we have developed a very strong base on core medicine in the second year – our hard work in Core Clinical Education is paying off – and so this block is allowing us to build on that.

I spent some time last week in an oncology clinic. I’d somehow never been to one before and it was really interesting. All of the patients were follow-up patients, so I was not present for any new diagnosis or any situations in which bad news was broken – but of course that’s not all that medicine is about. We spoke a lot about follow-ups and ongoing treatment and how different upper-GI cancers can present. I got to hear about a really uncommon presentation over the phone (as my consultant was also on call) and we saw the patient’s scans on the internal imaging system. The patient’s superior vena cava had been almost completely occluded by an undetected growth just under the sternum, which was detected incidentally after imaging for a different problem – this is apparently very rare and everyone got very excited by this. How interesting to see!

One of the other timetabled sessions last week gave us the opportunity to follow the Diabetes Specialist Nurses around the hospital. As med students and future junior doctors we don’t interact much with Specialist Nurses on a day-to-day basis (at least at the hospital where I am, they tend to move between wards), so this was a great opportunity to see healthcare from the shoes of people whose roles were slightly different to ours. We went on a massive, great ward round around the entire hospital, seeing diabetic patients and making sure that they were all supported in their needs. Some were newly diagnosed and some had lived with the condition for years, but the Specialist Nurses gave them excellent support; I was really amazed how well-versed they were and the strength of the rapport they had built up with their patients across the entire hospital.

We’ve not got much time left but I feel like we’ve got loads out of this block. And even though we had CCE in the second half of year two, all of the knowledge from that 30-week chunk has created a very strong base for this block. I’m really glad we did it as we did. And when this block ends, so will our third year! I just cannot believe that we’re almost fourth-years. This sounds so terrifyingly old. In the meantime, I’ll just concentrate on enjoying my summer vacation.

John

Luke Pemberton : 27 Jul 2017 16:49 |  Tags: John Mbchb Patients Student Warwick Wms |  Comments (0) |  Close comments |  Report a problem

The Broad Church of the CMP Block

It’s hard to believe, but we have passed the halfway point in our Specialist Clinical Placement (SCP) blocks, although I wouldn’t yet say that the end is in sight yet! Our fifth, and current, block is called “Care of the Medical Patient” (CMP) and is the block with the broadest focus yet. The purpose of this block seems to be to cover the general-medicine topics that we don’t see in a lot of our other blocks. For instance, we’ve already had blocks covering musculoskeletal health, paediatrics and obstetrics & gynaecology, all of which are very focused in nature. This block is much broader in approach, and the hospital where we are working has done a very good job of distributing us very widely across multiple disciplines.

What I’m really liking about this block is that we are exposed to a lot of topics in more detail than we ever were in Core Clinical Education (the latter two-thirds of Phase II). It’s great, and I’m really glad that (finally) so much of my work in Phase II seems to be bearing fruit. For instance, we are getting focused haematology teaching for the first time – so we are learning about lymphomas and leukaemias, factor deficiencies and all sorts of stuff that we briefly skimmed over last year. And the best part is that now we get to go to clinics and see patients in the flesh who live with these conditions. I learn best when there is an actual human being with whom I can associate a particular condition. It just helps tremendously when I can picture a patient in my mind to recall presentation, examination and treatment. As a case in point, I feel much more comfortable with lymphomas and leukaemias than I did before starting this block.

For my first placement in the first CCE block of Phase II, I spent about ten weeks on a respiratory ward at a local hospital. At this point, I had been a medical student for about fifteen months. It seems so very long ago now! This was probably my favourite placement, and I really felt at home in this learning environment. I was lucky enough to spend another day in a respiratory ward again just this past week, and it reminded me of how much I liked it. The presentations were fairly common (exacerbations of COPD, advanced pneumonia, bronchial carcinoma, etc.) but it was great to come back to a respiratory setting with a lot more experience under my belt. I felt much more comfortable working with the doctors and nurses and also felt much more comfortable understanding which investigations were being done and way. I hope to see more respiratory medicine in the future.

I have also spent some time observing neurology clinics for the first time; this was another area in which I had read a great deal but had seen hardly any patients. Now I can confidently say that I have seen and can hopefully recognise cases of myasthenia gravis, epilepsy, early-stage Parkinson’s disease, multiple sclerosis and many other common neurological conditions. Attending neurology clinics definitely brought more than one flashback to Block 3 of Year 1 (Brain and Behaviour), especially the direct and indirect pathways for movement regulation and how they can become inhibited. Thankfully I didn’t have to worry much about the various tracts that go up and down the spinal cord – that’s a headache for another day!

John

Luke Pemberton : 21 Jul 2017 12:10 |  Tags: John Mbchb Student Warwick Wms |  Comments (0) |  Close comments |  Report a problem