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April 07, 2020
In my previous blog, I think I said nothing has changed. Well... I have been proven dead wrong in the last two weeks. Week 5 of Acute block was delivered normally, and we were told on Sunday evening that Week 6 (the final week) of Acute block would go ahead as much as possible. So we turned up for teaching on Monday morning and were told that everything had changed and sent straight home with all teaching and placement cancelled. We then had an online meeting from the Medical School saying that our next block (for me, Musculoskeletal care) had also been cancelled.
Usually in the last week of Acute block, you have lots of teaching sessions and then at the end you have a practical exam where you are observed performing an assessment of a patient and are then signed off for the block. However, considering the COVID-19 situation, this was cancelled and instead we were signed off by telephone by the block lead. I think mostly this was to make sure that were signed off for the block so we had it “banked” and wouldn’t have to re-sit it afterwards. For the rest of Week 6 of Acute block I mostly just did some book work and got on top of my notes to make sure I was using the time productively. To be honest, I was behind on my note-making so the week off was helpful.
The Medical School have been trying to update us as much as possible about what is happening, but of course its difficult as no-one really knows how things are going to go. For us third years it brings added uncertainty. Phase III (Years 3 & 4) are very tight for time. We have 8 specialist rotations January - December with only a two-week break in August. And then we have a revision block in January before sitting our final exams in February. In actual terms I have my 8 x rotations January 2020 - December 2020, and then January 2021 - February 2021 revision block and then final exams in February 2021. However, because of COVID, if we miss one 6 week block, we still have to do these hours somewhere else so we would lose revision period and/or exams would need to be moved to facilitate a revision period. So, by losing placement time now, it has potentially large repercussions for the course. The Medical School have been great in terms of working tirelessly to try and make sure missing things has the least impact possible, but of course it is hugely challenging for them to restructure the whole course for 4 years groups all of which have different requirements and challenges! I will keep you updated!
Another development in the last few days is the opportunity to work/volunteer in the NHS. The NHS is on the frontline of the epidemic and is struggling at the moment with staff illness and also an increase of demand, so they need more support than ever to deal with the consequences of the virus. To this end, they have asked medical students to help out within their competencies as far as possible. It's completely voluntary but we are going to get paid to help out with basic medical tasks. For us third years, this means that we are able to help with doing ECGs, cannulas, taking bloods and direct patient care (washing, dressing etc). I thought long and hard about whether to help and have decided that I will go for it, partly for myself in terms of keeping my clinical experience up to date and engaged, but also on a wider level to help out. COVID-19 is unprecedented and the event of a generation and anything that I can do to help, no matter how small, I feel duty bound to help, as (hopefully) a future doctor, a current medical student and also as a human being.
All of the blogs that follow will document this interesting journey until we get back to a “business as usual” medical school. Although formal medical education has been postponed for now, I think that education of a different type will happen whilst I’m working in this role and of course I still will have all of my book learning to do at home. I will keep you updated as always as we go through this challenging journey together, which I’m sure will be a steep learning curve for us all.
March 23, 2020
It’s only been 2 weeks since my last blog, but it feels like a lifetime in so many ways! Coronavirus has gone from a distant virus circulating in China to the main news story every day and a major concern for everyone.
Starting with last week, I had a shift at the UHCW A&E Resuscitation department on Saturday night. This is where the really sick patients come in to be stabilised before they move on to other areas of the hospital. These patients have a variety of serious conditions including sepsis, major pneumonias, major trauma, major bleeds, heart attacks etc. I really enjoyed this shift and how fast paced the work was. The patients are “big sick” and the job of resus is to treat them as quickly as possible, stabilise them and send them to the wards/theatre etc. The doctor who was supervising me was great and encouraged me to go and talk to patients, put in cannulas and take bloods, all of which I managed to do! It really built my confidence to be able to actually be useful and help the team, rather than the ever-present feeling of just being a burden as a medical student. I also got a chance to practice and perfect some airway manoeuvres, which are skills that are difficult to practice apart from in a Resuscitation environment. One of these is called the jaw thrust and involves pushing the jaw forward to keep the airway open while holding an oxygen mask over the patient’s face. You then have to monitor the oxygen and carbon dioxide in their blood to make sure you are oxygenating them successfully. Although this was daunting, I had lots of support, teaching and supervision from the very talented staff in Resus and managed to do this successfully.
I really wanted to avoid talking about coronavirus/COVID-19, but it’s impossible to do when it has had such a big impact on everything, so I thought I would update you from a medical student’s perspective. What is happening depends on which medical school you are at, but for third years at Warwick (i.e. me!), there has been little change. Overall, from this week the first years are being taught online/via lecture recordings, the second years are off placement and we are continuing until we finish this block in one week’s time. I think the thinking behind this is that our specialist placements are very time limited because they run until December and then we have finals, so there isn’t much time to make up for any lost teaching. Completing this block means that if there is any future disruption, at least we have this block completed and banked. I am glad we are still on Acute block as I have enjoyed it so far and it is an important one overall.
I think the next few months will be very challenging based on the news, but I also think it’s important to make sure that we look after one another and reach out to any members of our community that are vulnerable and may need extra support. There has been talk in the news of medical students supporting the NHS, but I think that is more the current final years as they are more useful clinically and can help with some basic jobs. What about us? Well, there has been some talk online about junior medical students maybe helping with babysitting NHS staff member’s children and odd jobs to help out but I haven’t heard anything officially. I will keep you posted!
March 13, 2020
For the last two weeks, I have been on placement as part of the ‘Acute Block’. I have been excited to experience as much as possible during this block as I’ve always considered ‘Acute Medicine’ as a potential career path after graduation. The block includes a variety of placements including A+E, the Intensive Care Unit, Anaesthetics, etc. There’s something I find exciting about the challenge of not knowing what’s going to come through the door and having to work quickly to make the patient better. (This may just be because I’ve got a short attention span, but I’ll let you decide!)
Last week I had two shifts in Warwick Hospital’s A+E department. One shift was in ‘See and Treat’ from 1.00pm - 9.00pm and another in ‘A+E Majors’. ‘See and Treat’ is where patients have problems that can be treated on the spot without need for lengthy hospital admission. I thought that I would be shadowing at first and then may be able to see some patients later, however I was immediately told to go and see patients. Having just come out of the 6 week ‘Psychiatry Block’ I was quite apprehensive as it had been some time since I’d put my knowledge of physical medicine into practice. Quickly enough, though, I was able to remember how to examine a suspected broken foot and I knew what questions to ask to rule out a bleed on the brain after a head injury. Most of the patients had suspected fractures, so I also got a fair helping of X-ray interpretation. One of the Advanced Nurse Practitioners was keen on teaching and went through some good radiology revision with me, as well as the criteria for a head scan after trauma.
This week I have also had shifts on ‘A+E Majors’ at UHCW, our main teaching hospital, and also a regional Major Trauma Centre (MTC). I didn’t really know what a MTC was before this block, but it basically means that it is a centre of excellence for dealing with major traumas such as car crashes, stabbings, shootings etc. Not all hospitals are MTCs, so it’s sort of neat that our main hospital is. It also means that patients are brought in from all over – so if you had a car accident outside for example Warwick Hospital, even though there is an emergency department at that hospital, the ambulance service would drive you all the way to UHCW. The theory is that because UHCW is used to dealing with these major traumas, the survival rate is better. I think I saw a research paper that showed that structuring services like this does save lives every year, so it does work. Because of this, during my time in A+E Majors, I have seen several traumas, along with heart attacks, pneumonias, sepsis and many other things.
During my second shift, Majors was busy, so I went over to the “Rapid Assessment and Treatment” unit, where they assess patients and decide where they need to go next. Up until now I had only done 3 cannulas and failed 2 of them so I was feeling less than confident. However, in the Rapid Assessment unit, almost all of the patients need cannulas – so this was my chance to get some practice in. I managed to try and do 3 more and managed to get all of them, massively improving my overall success rate. Towards the end of this shift I went back over to Majors and was told that there was a patient having a heart attack. I was able to go over and see the patient and observe while they got their treatment. In the media, you only ever see negative stories about our NHS – for example how the targets aren’t being met, or when it failed to give good care. Today, however, I saw how the NHS does work when it matters – for example, someone can have a heart attack, have the paramedics turn up, be taken to a specialist hospital with a specialist cardiac unit, be seen in A+E, and then be taken to the catheter lab to have the clot removed within an hour and a half. This saves their life. The NHS isn’t perfect by any means, and there are lots of inefficiencies. However, when someone is really sick and in need, the NHS delivers, and it delivers the best standard of care imaginable. To make it even sweeter, it costs patients nothing at the point of care.
March 05, 2020
This week we started Acute block which is our 6-week placement where we experience A+E (Accident and Emergency), AMU (Acute Medical Unit) and ITU (the Intensive Care Unit). Over the six weeks we have two shifts on A+E Majors (what they like to call “big sick”), one on Resuscitation (very unwell patients), some time on ITU and AMU wards. This week was week 1 and neither I nor my clinical partner were timetabled any shifts, which gives us a nice opportunity to settle into the block and remind ourselves of some actual physical medicine first!
On Monday we had induction from the block lead, who is one of the A+E consultants over at Warwick Hospital. This was exciting and also terrifying because we were told of some of the extreme things that we may experience during this block – including cardiac arrests and potentially helping out with CPR. While this is a very scary prospect, I do teach CPR to other medical students, so at least I’m somewhat prepared. Despite this experience, I am sure that actually having to do CPR on a real person for the first time will be daunting and probably something I will always remember. Let’s see what the block brings!
On Tuesday we had lectures on the A-E approach and trauma. The A to E approach is a way of assessing a very unwell patient where A stands for Airway, B for Breathing, C for Circulation, D for Disability and E for Exposure. These are meant to be done in order, so you look at the airway first, then assess breathing etc. This approach is something that we were taught last year, but the standards are a lot higher now that we are third years. We also had a lecture on trauma (complete with grisly pictures!) and how to manage this. UHCW (the main hospital for Warwick Medical School) is also a Major Trauma Centre, so you can often hear the helicopters landing with a trauma call. A+E and trauma are aspects of medicine I am keen to explore as potential career options, not that I wish there to be any major traumas during my placement!
On Wednesday we had our first session in the simulation suite at Warwick Hospital. Simulation is quite new to medical education in general, but it can be a very useful and safe way of learning what to do in clinical scenarios. The patient for these sessions is “Sim-Man” which is a rubber mannikin hooked up to a computer. This mannikin is amazing with the things it can do – it breathes, can blink, can make noises and even has pulses! The operator on the computer can even make it breath with a wheeze. The session was facilitated by a Consultant Anaesthetist who also gave us a quick lecture on prescribing fluids, and then we were into the room with Sim-Man. My scenario was a patient who was on Morphine for pain and then his breathing was slowing down. Added to this, he had low blood sugar. It was quite stressful trying to remember how to treat the Morphine overdose and what to administer to raise his blood sugars, but helpfully I had two other medical students who were my “Assistants” and were helping me to assess and treat the patient. Overall it was one of the most useful things I’ve done here and actually seemed quite realistic. The only difference was that Sim-Man is made of plastic…
February 10, 2020
It has been another busy week for my clinical partner and I. Up until now most of our experiences with psychiatry have been in an outpatient and community settings, so we were both looking forward to seeing how acute psychiatric issues are dealt with. This week, we have been placed on an acute psychiatric ward this week, in a Psychiatric hospital. It was interesting being able to sit in on the ward rounds and see the various conditions the team must deal with on a day to day basis. These conditions are amongst some of the hardest to treat medical conditions and include; severe depression, anxiety, mania and personality disorders.
Our consultant was keen that we get involved and gave us the opportunity to practice our history taking with patients where we could get consent, although admittedly it was a whole new experience when compared to your standard history taking scenario. Some of the conversations we had and listened to this week were very emotionally difficult for all involved, and I have huge admiration for the staff and indeed the patients who have to work to improve often difficult situations.
This week we also had an academic day where we were given an introduction to prescribing. I had been looking forward to this for some time, as prior to starting medical school I worked in Pharmacy as a dispenser, so I was waiting for an opportunity for my pharmacy knowledge to become useful! We had lectures which focused on the basics of pharmacology relevant to prescribing, a lot of which was revision from our first-year studies (which feels like a long time ago!) We also had a lecture on some of the pitfalls of prescribing, for example, making sure that you write units in full to avoid confusion and also about some of the common errors junior doctors make. It turns out that junior doctors make 90% of prescribing errors, which I suppose demonstrates both how junior they are and also the fact that most hospital prescribing is done by the juniors. It was all slightly terrifying to think about how much responsibility we will have in just over a year’s time. I know first-hand from my previous work experience how crucial it is to get things right and minimise mistakes to make sure the patient gets the correct treatment.
We also had a lecture on the UK foundation programme, the two-year programme that all UK graduates must complete immediately after graduation. Up until this lecture I had happily forgotten how soon this process kicks off – by the end of this year we will have applied for our first jobs as doctors and ranked the areas we would like to work. Currently I want to stay in the West Midlands after graduation as I have had experience of many of the hospitals in the area, and I feel this will make the transition from student to junior doctor smoother. Allocation is completely points based, with 50% of your mark coming from your achievements at medical school and the other 50% coming from a test called the Situational Judgement Test. This test is sort of a test of reasoning. For example, the questions will be something along the lines of “This thing has happened. What is the most appropriate thing to do?”. We get lots of practice questions and cases in CBL, lectures and other aspects of the teaching so I hope that I will pick up the knack to it.
Next week is last week of our psychiatry placement, which means that we have to finish our sign-offs and say goodbye to our faculty team before moving on to our Acute placement block. Looking ahead at our timetable for Acute it looks to be a busy block, with lots of long days and night shifts. Some of these are in A+E, and others on acute medical wards. After Psychiatry, which is a very separate field to “physical” medicine, I have to admit that I am excited to get stuck in and have some exciting experiences on the very front-line of Medicine. However, it will be stressful – here’s hoping that my knowledge from exams comes rushing back….