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March 08, 2019
The end of CCE 1 is upon the second years and I for one cannot believe it. It seems like 5 minutes ago I was writing my blog at Christmas talking about starting CCE and how different my life was going to be as a clinical phase medical student. For that reason, I think this is quite a good juncture to pause and take stock of how CCE 1 has been for me!
First of all, the final weeks of CCE 1 (weeks 9 & 10). As mentioned in the previous blog, we have spent these final weeks doing our audit in George Eliot Hospital into surgical complications. Basically, the audit involves finding out the operation lists for each day and then finding the patient after surgery and going through the notes, looking for complications and consequences of surgery. We have been incredibly busy doing the audit over the last few weeks – staying in hospital until 10:30pm one evening going through hundreds of pages of medical notes and making sure our data collection was accurate. I won’t say it hasn’t been challenging, because it has been extremely exhausting! At the same time though, having done the audit is great experience and has taught us lots about abdominal surgeries and types of surgical incisions (interesting, if not immediately useful!). This week I also had to apply to do my research project for next year. I will (hopefully!) be doing something to do with bereavement care in the UK – watch this space!
Coming to the end of CCE 1 means we are a third of the way through our Core Clinical Education, so it is also a good time to stop and think and take stock of what I’ve learned about both medicine and myself this block at George Eliot Hospital. My statistics for CCE 1:
- 10 weeks (January to March)
- 4 supervising consultants (2 cardiologists, 1 respiratory doctor and 1 anaesthetist)
- 9-10 bloods taken
- 4 clinical skills labs (acute assessment, blood gases, oxygen masks, cannulation)
- 7 days spent with our GP practice
- 9 workshops (on topics ranging from fever to weight loss)
- 5 academic days
- 1 clinical partner – Cliona
- Lots of awkwardly standing on the wards trying to make eye contact!
Coming to the end of my placement at George Eliot Hospital is bittersweet. We did our very first clinical experiences in first year at this hospital and has been here ever since (about 16 months – our entire medical degree until this point). All of my stream really have started our medical careers here at George Eliot and created great relationships with the undergraduate staff and education team alike. I think they’ve seen us grow from nervous first year students into slightly less nervous, and slightly more competent second year medical students! George Eliot is a smallish hospital, but it will be the first of many hospitals in my medical career, and I think for that reason, I’ll always be a little bit fond of it. Next week I’m off to University Hospital Coventry, which is the main teaching hospital for the University of Warwick, and this will bring different challenges, but is also really exciting in the wider range of specialities we will get a chance to see there. Until next time!
February 18, 2019
The week started on Monday with me teaching my BLS (Basic Life Support) to first year medical students. This was my last session as a trainee BLS instructor (like a probationary period), and after completing it, I am now qualified as a fully-fledged BLS Instructor! We will hopefully be teaching some of the first-year medical students here at Warwick Medical School very soon, providing high quality BLS training. Watch this space!
Tuesday is GP day, which has quickly become one of my favourite days of the week. In GP we get to lead several consultations per day each, which is very fun, and a little bit of lucky dip, because you aren’t sure who will walk through the door! The GP supervising us is very supportive, and tries to encourage us to take the consultation, even when the medical issue the patient has isn’t straight forward. This is great because it gives us a chance to deal with conditions and issues that we might not be totally confident with but means that we get to push ourselves and try and learn as much as we can. The great thing is that if we do get stuck or go off topic, our GP is observing and jumps in to help out. Overall, it’s a great chance to practice our skills, to try and develop, but is in a safe environment with us being watched by experienced hands.
Today we spent our first proper day with the Respiratory department at George Eliot hospital. For each CCE block we have to get specific activities signed off, including examinations, histories and procedures and also what is called a Case Based Discussion. We do these with the education doctors (Clinical Education Fellows - CEFs), who then give us feedback on our skills. We wanted to get our Case Based Discussion done today (roughly by the middle of the block) so we booked a session with one of the CEFs to try and get this signed off.
There was only one thing missing – a patient! A CBD is where we see a patient on our own (doing a history and examination), and then meet up with the CEF afterwards and discuss the case, including how the diagnosis was made and what management we would provide for the patient. Our CEF session was booked for 9am, and we needed to have seen a patient before then, so my clinical partner and I went in for an early start at 8:10 and went straight to the ward. We ended up finding a lovely patient and doing our history and examination and also having a nice chat – bonus! All in all, it went well and our history and exam definitely went more smoothly than it was at the start of this block (only in January, 5 weeks ago). It’s a nice feeling when it comes together, and you feel like you’ve done a really comprehensive history and good exam. In CCE we do history and examinations pretty much every day (and multiple times a day on GP days), so we have plenty of time to really improve our skills.
After doing our Case Based Discussion, we headed to the ward to find someone to shadow and just get settled in, including just introducing ourselves to everyone. The ward was very busy so it took us a little while to find someone who was free to talk, but in the end we found a lovely registrar (the level in between foundation doctor and consultant) who let us follow while they saw some of the sickest patients on the ward. They asked us to read an ECG and work out the diagnosis which is never, but between the two of us we seemed to work out that the ECG was normal, and the registrar confirmed that it was. I think it was beginners’ luck! The registrar also ended up seeing a sick patient and having a very difficult conversation with a relative about the prognosis of the patient, which was extremely difficult to witness, but unfortunately an important part of the work of a junior doctor. The registrar did a very good job, and I took notes as to good practice and an example of how to do it well. It is important while on the wards and clinics to find doctors who can act as good role models of how to be a compassionate and competent medic and I learned a lot today about how to have a sensitive conversation.
All in all, it has been a busy and challenging week. Despite this, there is definitely a feeling of growth – I don’t feel nearly as out of place as I did at the beginning of this block and have sort of worked out who we need to speak to on the wards to find the best learning opportunities. It’s weeks like this that remind you how amazing it is to be a doctor – to be with people in the best and worst times of their lives. Hopefully you can make them feel better too!
January 29, 2019
How time flies – its Week 3 of CCE already! CCE (Core Clinical Education) is 30 weeks long, and to think that it is already one tenth completed is quite a daunting thought to say the least. The transition to clinical medicine that CCE represents has definitely brought both opportunity and challenge in equal measure. For example, the majority of our time is self-directed now – the only “sign-in” sessions, so to speak, are workshops (1 hour a week) and academic days (1 day a fortnight). For the rest of our time, we are expected to decide on which clinical activities are most useful for our learning, whether that be outpatient clinics, inpatient ward rounds, theatres, etc. This is great as we can go to the activities that we have found most useful. So far, my clinical partner and I have mostly attended outpatient clinics, as these are the activities which our assigned consultants mostly conduct. These have been great for practicing our history and examinations on patients under the experienced eye of a consultant. It also means that we have the chance to listen to real pathologies. For example, so far most of our patients in OSCEs have been healthy, which is great when learning the basic steps in an examination, but means that we haven’t heard many heart murmurs for real. We identified that we wanted to hear some real heart conditions, so we went to a cardiology clinic and had the chance to listen to actual patients with heart murmurs. Listening to YouTube videos of murmurs can be useful, but listening for real is the only way to gain experience in what the various murmurs sound like and (hopefully!) remember these for exams.
One downside to the self-directed nature of being a clinical medical student is that it can be hard to know where to go sometimes to use your time most effectively, and even when you decide you want to i.e. attend a certain ward round, it doesn’t always go to plan. We have attended hospital twice over the last few weeks and found that it wasn’t possible to attend the activity we intended to go to. This happens because sometimes the ward doesn’t have capacity to have us because they are busy, or that other medical students have got to the ward first. This means we have found ourselves at a loss of what to do, and have ended up wondering hospital wards asking if there are any patients we could see or anything we could attend. Last Monday this happened to us and we couldn’t go on ward round with our consultant because they weren’t around, so we ended up going around surgical wards asking the nurses whether there were any patients who it would be good to talk to. We ended up on a gastrointestinal surgery ward, with patients recovering from abdominal surgery or waiting for surgery.
We had the chance to take some good histories on our own, with me and my clinical partner giving each other feedback on how to improve our histories and examinations. We were reading the patients notes when a very friendly FY1 (Foundation Year 1 doctor, which is the first year as a doctor after medical school) asked if we were medical students and whether we wanted some teaching – we said yes! The FY1 offered to watch us do a history and examination and then talk through our performance and the case with us. This was much useful than us just giving each other feedback and we received some good advice on how to approach exams as the FY1 was actually a Warwick graduate! This meant that they knew the level we were at and was able to give us some useful tips on how to approach exams. It can be difficult to find someone to teach you, but when you do, it is definitely worth it.
This Tuesday we had our GP (General Practice) placement. We had already had a taster GP session last term which gave us some idea about how our placement would work, and now we have 21 days of GP over CCE (so roughly 1 GP day a week, every Tuesday). Coming into medical school, I had already done one week of GP shadowing before applying and had already decided that GP was not for me. I couldn’t have been more wrong! The entire day was structured in that the GP we were assigned to would pre-screen each patient to see if the case could be suitable for us to see, and then took consent as well from the patient for them to see us.
We then took it in turns (my clinical partner and I) to take a history and examine the patient, under the watchful eye of the GP who would be observing. This was great as it was almost like being a doctor – seeing patients and conducting the consultation patients almost by ourselves. It was quite scary to do this at first, but we have been well prepared for this – we’ve taken histories from patients in hospital since halfway through first year, and the patient in GP generally have slightly less complicated histories and they tend to be less ill than hospitalised patients. In addition, patients in GP generally only come in with one presenting complaint, which means your history can be very focussed and can aim to address that complaint. GP is definitely back on my list of potential careers.
CCE so far is vastly different from first year and second year up until now – we are much more autonomous than previously and most of our learning is self-directed. This is scary, but I feel as though my clinical partner and I are getting the hang of finding our consultants in the hospital (the secretaries extremely knowledgeable and very friendly!) and deciding on the activities we want to attend to maximise our learning. We have 2 more weeks attached to our cardiology consultants and then we move on to Respiratory – how time flies!
January 15, 2019
Our first clinical block began bright and early on a Wednesday in early January with a block called Core Clinical Education 1 (CCE 1 for short). CCE 1 is our first proper block where the majority of our time is spent in hospital on placement. The basic structure of the block for me is that we have a community day/GP placement on most Tuesdays every week. Every other Friday we have "academic days”, where we have CBL (Cased Based Learning) and lectures at university, and every other day of the week, we are at hospital on placement, where we have a variety of different activities. These include “T-DOCs” (practical skill teaching), workshops (clinical teaching), and the rest of our time we are shadowing our consultants and their juniors on the wards and in outpatient clinics.
Thursday started with our first “T-DOC” of this block. A T-DOC is a name for a practical skill which we must learn before we graduate as doctors – named after the GMC document “Tomorrow’s Doctors”, which outlines the basic procedures doctors should be proficient in. Our first T-DOC of this block was our cannulation T-DOC. A cannula is a plastic tube which fluids and medications can be given into the venous system, and for ill patients, they are one of the main ways of giving medications to the patient. The session is structured so that we are shown the procedure and then given time to practice on plastic mannequins, who, surprisingly, have veins and blood and everything you would expect in a real patient!
We have already done our venepuncture/phlebotomy T-DOC, so I was vaguely familiar with finding a vein and applying the tourniquet. The main difference is that cannulation is done by an aseptic technique, which means that you have to be very careful with what parts of the sterile field and equipment you touch. Happily, I passed the assessment at the end, meaning that I have been marked as suitable to practice with real patients, under the supervision of someone who is qualified. No doubt my first actual time inserting a cannula in a real patient would be slightly terrifying, but at least we have the reassuring back up of someone supervising us who can make sure we are doing each stage of the procedure correctly.
Both of our named consultants for this block are still away on annual leave until next week, so my clinical partner and I were discussing the best way to use the couple of days we have in hospital this week. We decided that it was about time to get some real-life experience with one of our core practical skills – phlebotomy (i.e. taking blood!). We had our official training (our “T-DOC”), which was the theory and practice on rubber arms last term, but we hadn’t found time to actually practice supervised on our first real patients yet. Phlebotomy is one of the most fundamental practical skills that doctors need to be able to undertake, and also something which has the potential to appear in our practical exams – so no time like the present! It was very nerve-wracking doing my first couple, but the phlebotomists who were supervising us were very patient and good at explaining the correct technique to reinforce our previous training. As experts who undertake the procedure all day every day, they were definitely thebestpeople to teach us. It was only one morning of practice, and I wasn’t successful every time, but even so, I feel as though my confidence has massively increased. I would feel much less daunted when it comes to doing it again. All of the patients who agreed to let me try were very kind and patient – thank you!
I then had my first workshop in hospital – based around acute abdominal pain. The way that CCE works is that we get given a list of ‘presentations’ – i.e. the symptoms with which patients may come to us. We then have to come up with our differential diagnoses and management of each presentation. This core list forms the large part of the content for ourYear 2exams. We do however have taught workshops every week which aim to help us to cover the important aspects. The workshop was run by a surgeon who deals with acute abdominal issues every day and also one of our Clinical Education Fellows. I found the workshop really useful in knowing which aspects were the most important to cover, and ultimately, revise.
That brings us to the end of week 1 of this block! Next week, I am going to try and find our consultants and go on some ward rounds and maybe attend some outpatient clinics. So far, this block seems really interesting and I can’t wait for more next week
December 18, 2018
After the end of transition week, November ended, and so did our term. We now have a good month off, from the end of November to the 2nd of January. I have to say, the break is very much needed! This term, we have done a 12 week stretch with no breaks at all and combined with the very full weeks that we have, means that most people are tired out! Medical school can be very busy and challenging, so you soon learn that taking proper time off to recharge is vital to your own wellbeing. I certainly needed a break!
Although term has ended, this doesn’t mean I will be doing nothing. For the previous two Mondays I have also been continuing my BLS teaching. Basic Life Support (BLS) teaches students the skills to possibly be able to save a life if they come across a seriously ill casualty in the community. Getting involved in teaching these skills is something I have been passionate about pursuing for a couple of years, so this year I decided to train to become a BLS instructor.
The overall idea is that senior medical students teach BLS to first year medical students, giving them the skills to assess a seriously ill casualty and intervene to perhaps save a life. This Monday was the last session before the exam and started with practice for the students before their assessment. I was nervous for them, having gotten to know my group over a number of teaching sessions, but am pleased to report that their skills were all very good. The ability to assess a seriously ill casualty and provide chest compressions and other interventions are key skills that all medical students must master, and as a teacher, it is very rewarding to see their skills improve over the length of the course.
On Tuesday I also taught my Student Seminar group at the Medical School. The other two teachers for my group were away this week, so it was just me teaching our group of first years, which was quite daunting! Usually we all support each other whilst teaching, so teaching alone was quite daunting. I taught a session on ECG interpretation, which is a key skill for the first-year students to learn at this stage of their training (at least to a basic level). I covered heart anatomy and physiology, before proceeding to the more clinical aspects, including interpreting an ECG. As well as hopefully being useful for the first years, teaching ECG also served as revision for me, which I’m sure will be useful as my first full-time clinical placement in the New Year is in cardiology and ECGs are like the bread and butter for this speciality.
Have a lovely Christmas!