All 9 entries tagged John

Clinical Skills and T–DOCS

As medical students, we obviously spend a great deal of time learning how to be competent and effective clinicians. A lot of this involves learning about the human body, what can go wrong with it and how to treat that. We learn this, initially, through lectures and case-based learning, and then later during placements on the wards. But the development of another essential skillset, the hands-on, practical techniques that we actually use with patients – comes from more tactile and interactive forms of instruction.

In the first year, we were drilled on our “clinical skills”; this is the battery of basic examinations that every doctor knows by heart. They could be major-system based (abdominal, cardiac, respiratory), neurological or musculoskeletal – we had to know them all, and testing us on them formed a major part of our end-of-year-one summative OSCE exams. And a large part of our clinical days in the first year (and beyond) involved practicing our exams on very patient and willing patients, most of whom were resident on wards and had provided consent to letting us try our skills on them. These people, the uncountable thousands across the country, are absolutely invaluable resources to the NHS.

In the second year, our clinical skills (now renamed TDOCs) have taken on a very focused, very clinical approach. We have focused much more on basic tasks that doctors, especially junior doctors, are expected to carry out on a daily basis. We learn in great detail procedures such as cannulation, venepuncture (drawing blood from veins for laboratory tests, etc.), drawing arterial blood, inserting nasogastric tubes and so on. The list is long, and the instruction is very complete – we don’t just learn the basics of how to insert needles into veins, for instance. We also learn about the indications, contraindications, complications and risks of each of these procedures – all of these are extremely important, and I’m glad that the medical school goes to great lengths to ensure patient safety. For instance, I wouldn’t want someone to poke my arm or a relative's arm with a needle unless they’ve had this training, and I’m glad that we go through this process.

Once we have been assessed as competent by our clinical-skills instructor, then we are given permission to put our skills to use on our assigned wards – under supervision by qualified doctors, of course. And it is with practice that our competence and confidence grows. Not every encounter is perfect of course, because human bodies are complex, but this is the reality of medicine. Gaining experience is the best part of our education. By the time we qualify, we will have had a great deal of practice with all of our TDOC skills, and hopefully, at least in this aspect, transitioning to being junior doctors should not be so challenging. I’m sure it will be challenging in many other ways, though!

John

Catrin Davies : 02 Jun 2016 09:27 |  Tags: John Mbchb Patients Skills Student Warwick Wms |  Comments (0) |  Close comments |  Report a problem

Orthopaedics

At the beginning of each CCE block we are assigned to a new consultant, whose job it is to teach us about their speciality and assess our competence in particular areas. The theme for CCE1 was “history and examination”, and the theme for CCE2 is “investigations and diagnosis”. My trust has assigned me to an orthopaedic surgeon for this block, so I’m seeing lots of bone and joint conditions – a lot more than I ever expected to!

Block 4 in the first year was called “Locomotion”, and it was a very anatomy-heavy block. We learned all about the muscles and bones that help humans move, the blood vessels that supply and drain them, and the nerves that control them. It was a very intense five weeks, but since I love anatomy, it was by far my favourite block. Being with an orthopaedic surgeon (or orthopod, as they are commonly known) has brought all of that knowledge back to the fore. My consultant loves to quiz me on random musculature and arteries. Lumbricals? The posterior interosseous nerve? The attachment point of fibularis brevis? It’s all fair game, and my powers of recall have been put under serious stress – but I suppose I had better get used to it.

We see patients in many different scenarios, depending on the nature of their visit. Some patients turn up in the fracture clinic (which actually has little to do with fractures, and apparently more to do with either re-assessment of injuries after surgery or ongoing assessment of chronic conditions). These fracture clinics have themes as well: some are focused on foot-and-ankle injuries, some appear to be more focused on hip-and-knee complaints, and so on. It’s been a really good way to practice hands-on the musculoskeletal examinations that we learned during the first year on real live patients.

Of course, since my consultant is a surgeon, he spends a fair amount of his time in operating theatre as well. I have also been lucky enough to accompany him on a few occasions. He does all sorts of things, from joint replacement to bone revisions to trauma and accident repair. I have seen a few different procedures (mainly joint replacements) and it is amazing – it’s like an anatomy lesson come to life! The knee in real life actually looks like how it does in the diagrams and flashcards. I don’t know why this surprises me, but it’s been fascinating all the same. My consultant also seems to do a lot of x-ray-guided joint injection of steroids – this is because the synovial space for some large joints can be difficult to reach with a needle in the absence of some guidance, hence the x-ray to help show the way.

It’s been a very interesting rotation and I’ve been enjoying myself. I’m not sure I’m cut out to be an orthopaedic surgeon – it seems to take a very specific skillset – but I’m still willing to remain open-minded. In any event, I’m glad to have the chance to see something entirely new.

Megan Earle : 16 May 2016 10:03 |  Tags: John Mbchb Orthopaedics Student Warwick Wms |  Comments (0) |  Close comments |  Report a problem

Visiting a Hospice

Warwick Medical School put a lot of effort into ensuring that we students spend a significant amount of time out in the community, so that we are exposed to methods of providing health care other than just what goes on in the hospital ward or the GP surgery. One of the very useful exercises we recently completed was visiting a hospice and chatting with one of the patients in its care.

Like most people, the word ‘hospice’ to me has always conjured up images of a slightly macabre place where patients come to live out their days, perhaps somewhat morose but doubtless very serious and sombre. The hospice we visited, however, was entirely different from what I expected. It was an extremely comforting, welcoming and supportive environment. There were inpatients who were looked after by the staff, but there were also groups who attended the ‘day hospice’ (including the patient whom we interviewed). The day hospice is a programme which hosts individuals from the community who are facing terminal diagnoses, and helps them participate in workshops, games, crafts and other therapeutic and palliative activities one day per week. It gives individuals far more support than they would have on their own, and helps them manage their end-of-life care with dignity and compassion.

This hospice also put a lot of emphasis on patient wellbeing and peace of mind – and for that of family members, too. There was a wellness room, several alternative-therapy practitioners generously volunteered their time to assisting patients (there were Reiki healers, acupuncturists and many others), and there was even a handful of occupational and physiotherapists to provide help and assistance to patients in need. For the handful of inpatients, the hospice also provides separate relatives’ accommodation so that they can focus their thoughts elsewhere. The most humbling thing about this hospice was not even the fact that it depended on donations for 80% of its operating budget – it was that across its network, it relied on the kindness of over 2,000 volunteers to help with the day-to-day running (in addition to the paid staff, of course).

Visits like these help me to get a huge amount from the community-day exercises and are helping me to become a much more well-rounded doctor. It was really important and valuable to see care managed outside of a hospital setting; it became very clear to my clinical partner and me that having a hospice environment which people attend voluntarily enabled them to manage their life course in the way best suitable for them – which is really the essence of patient-centred care. Hospital wards are great places in many ways, but I wouldn’t think that most are very relaxing or stress-free, and thus appreciating the hospice as a useful recourse to patients who are in need of them is a key component of our medical-school education.

Megan Earle : 06 May 2016 07:52 |  Tags: Hospice John Mbchb Student Warwick Wms |  Comments (0) |  Close comments |  Report a problem

Community Midwives out in the Field

We recently started a new block of Core Clinical Education, the second of three blocks for all second-year students. And with the shift to a new hospital comes a whole new set of speciality-introductions and mini-rotations through various wards and services. Over the past couple of weeks, we have been lucky enough to spend a few days shadowing community midwives to get a very clear idea of the challenges that they face and the responsibilities that they bear – it is a lot more than I ever imagined.

Although we spent an entire block in the first year studying reproduction and child-development, we have not had much of an opportunity so far in the second year to apply much of what we’ve learnt within clinical practice. The majority of the patients whom we’ve seen so far in hospital have been elderly with complex health needs and have usually required lengthy stays, discharge planning and that sort of thing. Understandably, my clinical partner and I were very excited to spend a few days with community midwives outside of hospital as the type of medicine that they are involved with is entirely different from what we’ve been used to.

As I understand it, there are various types of midwife. Community midwives are usually associated with GP practices or other non-hospital care services and are normally out “in the field”, meeting with pregnant women (and their partners/family who are usually present to provide support) in surgeries at several points throughout the pregnancy. These meetings tend to be fairly routine, and involve things such as assessing maternal and foetal health, advising the mother on the best practices to promote health for her baby, and detecting and acting on any early-warning signs.

My days shadowing the community midwives were a very interesting and eye-opening experience. Whereas our GP surgery had been based in a very affluent and comfortable part of Warwickshire with a very specific demographic, the community midwives whom I shadowed covered a less-well-off area. This presented a very different set of issues for the midwives to confront. Their attitudes were unfailingly supportive, and they were adept at dealing with many varied social circumstances – sometimes in languages other than English, reflecting the national diversity of the areas they covered.

What struck me most, other than the fact that they all work so hard! – was feeling absolutely honoured to be working with individuals in a health service who are so clearly committed to ensuring that every child really does get the best start in life. These midwives made countless home visits, they squeezed patients into appointments even though they were really busy, they helped patients find the right resources to solve housing and schooling issues and conducted myriad other, immensely helpful small acts that hopefully make each mother’s life just a little bit less stressful. Getting out of our small bubble and seeing the true diversity of our society, the challenges that everybody faces and using our tools to hopefully make their health even a tiny bit better is such an important part of our education, and I am so glad to have had the chance to see it on this level.

John

Megan Earle : 12 Apr 2016 15:10 |  Tags: John Mbchb Midwives Student Warwick Wms |  Comments (0) |  Close comments |  Report a problem

Two Weeks on a Surgical Ward

As part of the Core Clinical Education block during the second half of our second year, each student is assigned to spend two weeks on a surgical ward. The purpose of this rotation is to see how the ward operates, speak with and examine pre- and post-operative patients, and hopefully to observe some procedures in progress. My clinical partner and I just completed our two-week rotation and it was extremely useful.

The surgical ward at our hospital was an interesting place ­ and entirely different to the respiratory ward where we'd spent most other days since the beginning of this year. For one thing, most patients in the surgical ward are more acutely unwell than those of most other wards ­ this is logical, as they've either just been operated on and are not well enough to go home, or they are in a state in which they require an operation. This presented its own challenges when finding patients who were willing to speak with us and to let us examine them, but after some investigation and detective work (and handy tip-offs from helpful doctors) we found several willing patients over the course of the two weeks.

The variation in age was also far greater on the surgical ward than the respiratory ward. Perhaps it has to do with the fact that most people with significant respiratory ailments are elderly (and many of them have a decades-long history of smoking) and that surgical candidates can be of any age. There were far more middle-aged patients to speak with (and even a few under the age of 30, which was a novelty!).

My clinical partner and I had the wonderful opportunity to observe a few different surgical procedures over the course of several days as well. Once again, I was humbled and impressed by the utter professionalism on show at all times by the staff. The surgeons, the nurses, the anaesthetists and the rest of the team all worked seamlessly together as a matter of course to ensure the very best outcomes for the patient.

On one afternoon, I was asked to help assist by manoeuvring the little camera for a routine laparoscopic abdominal procedure (this is the one where a few small holes are cut in order to minimise tissue trauma to the patient and everything is conducted using apparatuses at the end of long, thin rods). It was absolutely excellent. Not only was the surgery like an anatomy lesson come to life, but it took a while to get my head round the fact that I was actually looking in someone's living abdomen ­ I was honoured and grateful to have been given that chance. But the most rewarding part of all was speaking with the patient the next day (who was very well recovered and well enough to go home). The patient was immensely grateful for the care delivered and for having met all of the surgical staff before the procedure, and thus couldn't have been more gracious. Moments like these reminded me that sometimes the best lessons are taught outside of the lecture theatre.

John

Megan Earle : 22 Feb 2016 09:49 |  Tags: John Mbchb Student Surgical Wards Warwick Wms |  Comments (1) |  Close comments |  Report a problem