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December 17, 2020
My current placement is Care of the Medical Patient, which is an overarching block which touches on many different areas. Medical patients include cardiology patients, respiratory patients, gastroenterology patients and many others. One area which comes under the umbrella is neurology and stroke care and for this block I have been attached to a stroke ward at George Eliot Hospital. Initially, I was apprehensive about being on a stroke ward because of how poorly stroke patients can be. In addition to this, I would say that personally neurology and stroke is one of my weakest areas academically. I think the anatomy of the brain and spinal cord is so complicated, I struggle to get my head around it. I suppose it’s good that I will get some practice in this area and hopefully become more comfortable with this area. Last week we attended a ward round on the stroke ward with one of the stroke consultants during which the consultant did some teaching about the management of various types of stroke. It was a really useful experience and we even got the chance to do some examinations as part of the round which was a good recap of the neurological examination (one of the hardest ones!)
Then, last Friday I attended an outpatient clinic looking after Parkinson’s Disease patients. Parkinson’s is a disease where one of the chemicals in our brain (dopamine) becomes depleted and this leads to issues with movement, including tremor amongst other issues. Having never seen a patient with Parkinson’s disease before I hadn’t appreciated the fact that there are many different types of the disease and that the course of the disease is so individual. Some patients progress quickly and some people remain stable and do not get any worse for years and decades. I also hadn’t realised how multi-disciplinary the management is. For example, Parkinson’s patients often have help not only from doctors, but specialist nurses, speech and language therapists, physiotherapists and dieticians.
This week I had been booked on to attend an ILS course (Immediate Life Support). All medical students have to have this course to be able to graduate as doctors and it teaches resuscitation in a hospital setting – including skills such as managing an airway, doing CPR and using a defibrillator. I really enjoyed the course and it sort of drew together and consolidated several sessions we have had before. None of the information or skills were new to us, but the application and practice using simulated sessions really refreshed that knowledge and I’m sure will be really useful revision for finals.
The week ended with Friday afternoon which was small group teaching on ECGs and heart problems. Being able to interpret ECGs (electric scans of the heart) is one of the most difficult skills expected of junior doctors, so having some recap and revision of some of the most common rhythms was useful. I haven’t seen an ECG in a long time as I have been doing Paediatrics, Obstetrics and Orthopaedics, so I had completely forgotten everything! Luckily, I quickly clicked back in with looking at ECGs and feel much more confident having a go now! Next week will be a busy one, with a few teaching sessions and hopefully some clinical skills practice. It should be a good one!
November 30, 2020
The last two weeks have been very busy. Firstly I have been completing the last couple of weeks of my Child Health/Paediatrics block. I have seen a couple of interesting things. One of my days I spent observing and helping with the NIPE checks. NIPE stands for Newborn Infant Physical Examination and this is a general health check completed on newborn babies, and the first is done within 72 hours of birth and the second check is done at 6 weeks of age by their GP/family doctor. I was observing the first check which is usually done in hospital and often done my midwives or junior doctors. The check is an all-round physical for the baby and looks at things such as oxygen saturations, reflexes, movement, whether they have a heart murmur, and looking for any birth defects. Essentially the check aims to find any issues which may impact on the health of the baby and the ability of the baby to cope when they go home. I enjoyed helping with the checks and seeing some very cute babies, and learned some interesting and important things which the check looks for. One of the coolest things I learned was about the reflexes that babies have to help them survive – one of these reflexes is one which you may know about, and that is the grasping reflex where if you offer a baby your finger, they automatically hold on to your finger. I find it amazing that these reflexes are present from birth and without the baby having to learn anything.
This week I have also been booking my Situational Judgement Test (SJT). I have spoken about the SJT on my blog before, but just to recap, it is a really important test that final year medical students sit and the score that you get gives you a score. If you have a higher score, you are more likely to get the Foundation doctor job that you want. You also have to get a decent score to get any doctor job at all! This year the test has changed, as it used to be sat at Medical Schools but this year we have to go to a test centre. This is similar to the UCAT/UKCAT which some of you may have sat or be aiming to sit soon. The SJT has questions which cover ethical and practical dilemmas and then your answer is how you would respond to these dilemmas. I have booked my test for mid-December to try and get it out of the way so that I can concentrate on finals when I return from the Christmas holiday. I am nervous about this test but also it is a tricky one to revise for. I am generally quite good at the type of thinking that the test is looking for, which I think is courtesy of my History degree days. Hopefully I do okay on the test.
Overall, I have found the Child Health block challenging for all sort of reasons, including just how many things there are to do, and anticipation of finals just around the corner. My next block is Care of the Medical Patient which is a block which covers lots of different areas, all concerning general medical patients. These patients suffer from heart issues, respiratory issues, brain and nerve problems and also gastrointestinal problems. I think it will be a really useful block for recapping and building on my existing knowledge and building a wide knowledge base before finals. In addition, I am heading back to George Eliot Hospital which I had a good experience at in my first and second years of med school and hopefully it’s a productive block!
November 12, 2020
The last 2 weeks have been very busy for me. The time has come for us to apply to the Foundation Programme. I have spoken about the Foundation Programme in my blog before, but just for a brief recap, the Foundation Programme is a 2-year programme which new doctors complete. It is, as the name suggests, a Foundation – a 2-year programme where you are a qualified doctor but work in specific roles where there is plenty of support and training to allow you to build your confidence and abilities as a new doctor. The application process is relatively straightforward and pretty much nothing like a normal job interview. Your medical school ‘nominates’ you, and then there is a brief online form, and then you rank geographical areas where you want to work. There is no nerve-wracking job interview, just a ranking process based on your performance at Medical School and in an exam called the Situational Judgement Test (SJT). The SJT asks you certain dilemmas and asks you how you would respond, and you get points for the most correct answer. We have to sit the SJT in December or January.
In addition to preparing for the future I am also in the middle of the Paediatric and Child Health block. Last week we had Paediatric Basic Life Support training. We have had training in Adult Basic Life Support before on the course, but Paediatric life support is actually quite a bit different. In adults, you approach an unconscious causality and presume that they have had some sort of heart issue, whereas in children the most common cause of a collapse is a breathing problem such as choking. We had to practice on model babies which is an unsettling experience, even though it is only a doll. I really hope that during my time on Paediatric block I don’t need these skills, and luckily it is very rare for a child to be that poorly!
This week I have been placed on the Special Care Baby Unit (SCBU) at the George Eliot Hospital. This unit looks after babies in the first few weeks and months of life who have developed medical issues or are struggling to grow, feed or develop. We have also had online lectures about common issues that affect babies such as jaundice (yellowing of the skin) and various heart murmurs (some of which can be normal). I have also spent time this week observing the new-born baby checks. These are done by a trained midwife or one of the doctors and all babies have a check within 72 hours of birth which is done by the hospital. Another check is then done by the family doctor/GP at 6 weeks of age. These checks aim to identify any problems present from birth, for example birth defects or any issues which may impact on the baby and its ability to grow and live. It has been really interesting to observe these checks, and, of course, there is the added bonus of getting to see some very cute babies! All of the babies I observed were okay but watching the checks has opened my eyes to the many issues which can affect babies and their families – birth is just the beginning!
October 19, 2020
The last two weeks saw the end of my Obstetrics block and the beginning of the Child Health block.
My last week of Obstetrics was a busy one for many reasons – the main reason is that I have been running around trying to get my end of block sign offs from my consultant. Part of this is a mock assessment called an OSLER, which is, in short, an observed patient encounter. During the assessment you see a patient, take a history from them and perform an examination of them. Following this you have a discussion with the supervising consultant about the condition the patient may have and what you would do to manage their care. The patient I examined and took a history from was lovely which makes the whole process a lot less daunting. I always really appreciate the patients who allow us to examine and interact with them as being in hospital is stressful enough without having an eager student assessing you! Without the help of the patients we see our education would not be a true reflection of the career that lies ahead of us.
I have really enjoyed this block overall. Whilst it can certainly be a little bit more exhausting with the long labour shifts and sometimes emotionally charged situations, I have appreciated being able to get stuck in. I love interacting with patients and helping guide women through labour is so rewarding (and the cuddly with the new-borns are so cute!) the experience is something I know I will never forget.
The first week of my latest block, Child Health, has been steady for me, which is something I feel I have needed. I have certainly been feeling a little burnt-out the last week so have taken things a little steadier intentionally just to give myself a little breather. I’m looking forward to the week ahead and experiencing a side of medicine I have yet to go in-depth on since my enjoyable year working at Birmingham Children’s Hospital prior to coming to medical school.
This weekend I have had the privilege of attending GERMCON – which is the Graduate-Entry Medicine Research conference. By attend, I actually mean turned on my computer and listened as this year the conference was completely online due to COVID-19. It has been a strange experience attending an online conference but still interesting and still had some very inspiring talks, including from Professor Vinod Patel, who gave the keynote address on the last day of the conference. Professor Patel is Warwick’s Academic Lead for Clinical Skills and oversees our clinical skills education in first year and clinical exams later on in the course. Research is such a huge part of life in medicine, and it was great to see the diversity of projects and approaches to research that were highlighted in the conference.
October 07, 2020
This week I had three shifts on labour ward at Warwick Hospital. Each one started at 7:30am sharp with the midwife handover, and then I was assigned a midwife to help/shadow for the day. On my first shift I stayed with the same patient all day and things ended with a birth which was amazing to see. It does sound cheesy, but welcoming new life into the world is one of the highest privileges there is. And the babies are very cute!
On Saturday I received some great news – one of the block coordinators forwarded me some feedback sent into the ward by one of the families that I had worked with this week which mentioned me by name! Studying medicine is sometimes a process of continual confidence building, followed by realising how little you do know. A lot of the feedback we receive is about how to improve, which does sometimes feel like negative feedback as it concentrates naturally on what you didn’t do but should have done. This is of course all in the interest of patient safety – one must continually improve to ensure one reaches the competence expected of a doctor. It honestly makes such a difference to receive some positive feedback and after a long and tiring week makes it all feel worth it.
The positive impact this had on me reminds me of something I think I’ve spoken about before in this blog – Learning from Excellence (LFE). LFE is an initiative which was started by one of the consultants I worked with before medicine but is an idea which is gaining considerable traction. LFE focuses on inverting the traditional “Incident reporting” which operates in hospitals – i.e. where an incident occurs, and it is reported so that measures can be taken to prevent it happening again. LFE instead focuses on reporting excellent practice so that we can make sure it does happen again. Of course, both of these approaches have their place and really work in tandem – but LFE focuses on raising morale and also ensuring excellent care. Positive feedback about what went well is just as important as what didn’t go well.
Something else I think is very important is showing kindness and humanity to others in healthcare. When stressed it is so easy to get offended or start on a poor tone, but kindness and positivity has such an important impact. I believe it is key to try our best to be kind to everyone we meet – staff members and patients alike. One of the consultants at University Hospital Coventry actually gave an excellent TED talk which I would recommend – “When rudeness in teams turns deadly”, which talks about the direct consequences of being rude, or of being unkind and inversely the importance of being civil and being kind.
The lesson to take away is that kindness costs nothing apart from your time, and whether it takes the form of positive feedback or just being nice to someone - it can make all the difference. It could make someone’s week – it made mine this week!