All 49 entries tagged John

Assistantship – Learning how to be a Foundation Doctor

The logical progression for medical students who graduate from the MB ChB programme at Warwick is to move into the foundation programme. This is a nationwide, structured programme that cycles all recent med-school grads through six four-month rotations over two years within a particular deanery (or region of the country, of which there are currently twenty). Every deanery is different: some will rotate you between hospitals or trusts depending on the job you do, and some will let you stay at the same hospital for the full two years. It all depends on the deanery you end up in and the jobs that are available. I have been allocated to one of my top choices: a large district general hospital in the southwest of England, where I plan to be for the full two years.

The Foundation Programme is relatively uniform across the country, in that F1s (those of us in our first year of the programme) and F2s (doctors in their second year) are expected to complete more or less the same things and cover the same ground over the course of their years. For instance, I believe that all F1s are required to have a surgical rotation, and all F2s are required to have either an A&E, GP or GUM rotation. And all foundation doctors round the country all rotate jobs on the same days throughout the year – it’s kind of scary yet oddly comforting that our careers are planned out for us until August 2020! That will be six years since the beginning of medical school, but at the same time as least there shouldn’t be too many unpleasant surprises in our broad timetable and we can plan accordingly.

By definition, when the current F2 doctors leave their posts, the current F1s become F2s and we medical students become F1s, the collective experience level across foundation doctors drops by a year overnight. I gather that this might have had serious impact in the past on learning curves, efficiency of work, etc. However, in order to minimise the impact of this effect, the GMC, and by extension the various trusts and medical schools, take great pains to ensure that incoming F1s are adequately equipped to step into their roles. Foundation Trusts do this through inductions and shadowing at the beginning of our F1 year, and medical schools do this through including an Assistantship phase after finals.

As we are done with finals and our electives, we are now in that Assistantship phase. This is where we really ensure that we have the skills needed to be competent and functional F1 doctors. Our Assistantship placements are carried out in local hospitals, an arrangement with its plusses and minuses. On the plus side, we are all very familiar with the hospitals, their layouts, their wards and many of the doctors. However, many of our cohort will not be working in this deanery in the autumn, and so we will have to adjust our working practices to those of our base hospitals when the time comes. This might seem a minor point, but so many of the little things that F1s need to know about (how the imaging/patient-data systems work, how the stores cupboards are stocked, how procedures are requested) are completely different. It will require some adjustment. But at the same time, it appears to be a very well-run and well-thought-out block. Most importantly, we can learn on the wards without the threat of exams hanging over our head – always a bonus!

John

Joshua Galvin : 14 May 2018 09:23 |  Tags: John Mbchb Student Warwick Wms |  Comments (0) |  Close comments |  Report a problem

Nearing the End of our Elective Period

We’re nearing the end of our elective and it’s been a fantastic opportunity to explore a different aspect of medicine to the typical hospital- and community-based experiences that we have had so far. Whilst I like being in hospital or in a surgery, a lot of patient contact happens in the field and it’s great to get an experience of this in a supportive and structured setting – especially without the pressure of looming exams. I think I’ve had enough of that pressure for a little while!

I spent the first half of my elective in the Emergency Department of a local hospital in Greater London, which was interesting if not quite similar in nature to the acute block, part of our Phase III Specialist Clinical Placements. I loved it, and felt that I was able to integrate in the team quite quickly, but the format and scenario was not a million miles away from what I have been doing throughout medical school so far.

For the second half of my elective, I’ve done something completely different and am removed from the usual clinical setting. I’m using this opportunity to broaden my horizons and get exposure to a new medium in which medicine is practiced – and that’s what elective is about after all, isn’t it? I’m working with a company which does outsourced work by police constabularies around the country. I am shadowing healthcare professionals (known as FMEs, or forensic medical examiners), who are all either trained nurses, paramedics or doctors and all of whom have loads of healthcare experience. FMEs assess people who are detained by police officers and brought into custody to be held before either being released or brought to court, and the job of the FME is more or less to determine whether the detainee is fit to detain and fit to interview by police, based on either any self-declared health condition or anything brought to their attention by the custody officer.

This is a very niche area of medicine, and one that I have never had anything to do with before – and I’m seeing a whole new side of our society. Aside from having my mobile phone stolen over ten years ago, I can’t remember the last time I spoke to a police officer. It’s been very interesting so far – the hours are tough (twelve-hour shifts, and I’ve had a few overnights) but of course crime can happen at any time. The teams of officers in the custody are very tight, with good reason, and all members are always scrupulously professional in their interactions with the public and each other. It’s very nice to see.

The area of the country that I’m based in isn’t known for its high levels of violent crime, which is just as well, although of course people can be detained for all sorts of reasons. A lot – but by no means all – of the offences seem to involve people taking various intoxicants usually combined with either driving or hurting other people. It’s a very interesting view into a part of our society that I never see, and I’m glad that I’m using this opportunity to broaden my horizons just that little bit more.

John

Joshua Galvin : 24 Apr 2018 10:27 |  Tags: John Mbchb Student Warwick Wms |  Comments (0) |  Close comments |  Report a problem

Halfway through the Elective Period

Our post-finals elective period is six weeks long, and we’re right in the middle of it. It’s going well – I’m seeing loads of notifications from social media about my coursemates in all sorts of exotic places around the world and I have no doubt that lots of medical experience is being gained regardless of location. After the stress of finals, it’s been a wonderful opportunity for us to experience clinical care in a new surrounding.

We have the option to spend all six weeks in one placement, or we can split it into two – application-approval dependent, of course! Submitting the different forms was a module in and of itself! I have elected to split my elective, and have just finished the first half, which was three weeks in an A&E department in outer London. It’s been really interesting and eye-opening. Our acute block gives us some exposure to A&E (majors, minors and resuscitation) but we only have five or six shifts over six weeks. The great thing about the elective was that it allowed me to spend time doing exactly what I liked and doing it every day.

The doctors – and all of the healthcare professionals, for that matter – in the A&E department were all very helpful and lovely and were keen for me to learn. A typical day involved me turning up in mid-morning and finding a doctor to shadow for the day – usually an F2 or a reg. I would choose a patient from the list of new arrivals, take a history and do an exam, present back to the doctor and then we would see the patient together to talk about investigations and management. It was very similar to the acute block, but as I became more stuck in with the team I found that I was taken under the wings of the doctors and taken very seriously. It was a nice feeling of semi-autonomy. Occasionally I would spend the days in the resus department helping the nurses and stationary paramedics (qualified paramedics who spend time stabilising patients in hospital instead of driving around in ambulances), and it was very good to help with the most acute cases. I really loved A&E and am looking forward to my placement there in the Foundation Programme.

One thing stuck in my mind from this placement: a young patient presented with complications from a serious and notifiable disease, for which his mother chose not to get him vaccinated when he was a young child because of unfounded risks which have since been widely debunked. I found it very unfortunate that diseases, which we think of as relegated to our grandparents’ generation, are still affecting people in our very rich society. Although parents have the choice as to whether or not to have their children vaccinated, if they choose not to then they have to accept that their children very well might contract life-threatening diseases later in life and live with the complications. I had never seen this particular disease in a person before, but I don’t think I’ll forget it anytime soon.

Joshua Galvin : 09 Apr 2018 09:14 |  Tags: John Mbchb Student Warwick Wms |  Comments (0) |  Close comments |  Report a problem

Post–Finals and Medical Electives

After a seemingly unending course of exams – clinicals, writtens, and then practicals – we finally got our results from our finals last week. After having been through this process a couple of times (both Phase I and Phase II results periods were similar), we were pretty used to the drill. Still, this didn’t reduce the anxiety and uncertainty in the buildup to results day. It’s like this big clock constantly ticking in the background and you barely notice it getting louder and louder until eventually you can’t ignore it any longer. Knowing the exact date and time that results will be released – whilst appreciated and necessary – doesn’t make the anxiety any easier! I don’t know a single person who was entirely certain that they’d made it through. Everybody was on edge. And just like Phase II results, we didn’t have much of a buffer zone between results day and getting ready to go off on the next stage: this time, it was our elective – we found out the news on Thursday and our elective period started four days later on the following Monday. Those who were successful on their finals were permitted to proceed to their elective.

I’m delighted to say that I passed. More than elation, I’m just relieved. Although it is a bit strange to know what to do with myself – I’m so used to being in the revision mindset that I am having a really difficult time just relaxing without the compulsion to be doing something exam-related. I’m really glad my passmedicine subscription expired the other day – otherwise I’d probably still be doing a few dozen questions a day!

Lots of people in my cohort elected to spend their elective overseas, so I’m already hearing stories of fabulous times in the most exotic locations. The purpose of the elective period is to experience medicine in a different surrounding, thereby allowing us to compare, contrast and grow as clinicians when we return to a more familiar surrounding. As you can imagine, after forty-three months of extremely hard and intense work with very few breaks, most people apply the ‘different setting’ rules rather liberally – and with good reason. It’s a great opportunity to travel somewhere exotic and new and experience some better weather than what we have in England – and why not? All electives require approval from the medical school, so it’s all perfectly legitimate, but once that approval is given then we’re good to go.

I spent a month for our SSC2 block (October 2016) in the Gambia, researching TB investigations. For this reason, I was less motivated to have another big overseas elective experience – also because I couldn’t have borne cancelling it had I not been successful in my finals. So instead of going somewhere like India, Sri Lanka, Colombia or New Zealand (all destinations of people in my cohort) I decided to return to my old home in Greater London. For the first three weeks of this six-week block I’m based in the A&E department of a medium-sized district general hospital in an affluent area of the capital, and am enjoying myself tremendously. The acute block in Phase III was my favourite block, and being able to relive these experiences in a different setting and get properly stuck in is so much fun, and really what I understand the elective period to be all about.

John

Joshua Galvin : 22 Mar 2018 11:01 |  Tags: John Mbchb Student Warwick Wms |  Comments (0) |  Close comments |  Report a problem

There’s Light at the End of the Tunnel – or is that the Approaching Train?

As we are now in our final year, we have been experiencing the joys of final exams over the past month or so. If the truth be told, the exam season actually kicked off at the beginning of December with the Situational Judgement Test, and we had the Warwick Safe Prescribing Assessment (SPA) exam at the beginning of January (plus the odd mock exam here and there) but it really got underway in earnest with OSCEs (structured clinical exams) on 12 February. With just a month separating the OSCEs and our last scheduled exam in the first sit (this is the national Prescribing Safety Assessment), it’s been a tough old run and most of us just want a few days to sleep and hibernate.

After the written component of our assessment (SAQs and MCQs), our cohort was assessed via the OSLER (Objective Structured Long Examination Record) method. There was a very famous Canadian physician called Dr William Osler (he of the eponymous nodes) and I have often wondered if there is a connection between him and the rather clunky acronym for our exams. Maybe I’ll make it my mission to find out when we’re all done – that is, if I still have the energy!

We haven’t got our results from any exam yet aside from the SPA, so these could be my famous last words, but all in all I found the OSLER process quite manageable. We each were assigned a full day and a half day of OSLERs. I was in a group of people who started our OSLERs very late in the week and thus most of my cohort had had their full day before I did. Of course nobody shared specifics of their cases with anyone else, but I was told that the time does pass quite quickly during the day when you’re actually doing it – and I found that to be the case as well. All of the patients whom I examined were really nice and friendly, and it seemed like they really wanted each student to pass and do well. I am always grateful to patients who give up their time to help us medical students learn and be assessed – they seem to enjoy themselves and it must be great fun to watch students come through all day. I might get tired of being examined repeatedly, but none of them seemed to mind that much. Maybe there was more variation in exam technique than I realised!

Recently our allocations to the Foundation Programme were released. This is the region of the country – known as the deanery – in which we will be doctors for the next two years. This was really exciting for everyone, as it’s a combination of a few things – both our educational performance ranking (for which we get 50 points out of 100) and the results of the SJT exam sat back in December (for which we get the remaining 50 points). Our combined score decides our ranking against all of the other 7,000-odd applicants from all over the country (and even the world, as there is a sizeable international component) and this in turn dictates which of the programmes we are allocated to. It’s very exciting to ponder the next step of our lives, and it’s really hard to believe that in a few short months, we will be sent to all corners of the country to start the next phase of our careers!

John

Joshua Galvin : 13 Mar 2018 10:24 |  Tags: John Mbchb Student Warwick Wms |  Comments (0) |  Close comments |  Report a problem