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July 07, 2020

A holiday, of sorts

Working for the NHS during the COVID-19 pandemic has certainly been a rewarding experience, not only for my education and life experience but also financially. Before I started medical school, I worked full-time for two years, so returning to life as a student was certainly an adjustment! Having the opportunity to earn a bit of money has been really helpful as the nature of our course means that it is difficult to earn money, so my overdraft has definitely thanked me in recent months!

I finished working at the beginning of June, to give me time to get some academic work done before resuming placement. Over the last 2 weeks, I have been using some of the amazing online resources available to us. Many resources are now free to medical students due to COVID-19, and one that I have found really useful is the K2 Obstetrics and Gynaecology website. We currently have access to all of these resources, and the K2 packages are very good, interactive introductory courses on Obstetrics. I am a very visual learner and love pictures and videos to help me to remember things, making the online resources a really useful way of reintroducing myself to the world of medicine.

I have also been using Warwick Medical School’s own online resources. All of the lectures delivered at the medical school are automatically recorded and uploaded for us to re-watch whenever we want to. As my next block is Musculoskeletal, I have been revisiting some of the anatomy lectures delivered in our first year. I thought I had forgotten all of my anatomy knowledge, but actually once I start watching the lectures, all of that information comes rushing back. It really does demonstrate that actually whilst there is a lot of content to learn at medical school, actually a lot of the information is revisited in every phase of the course, with actually little new information being added. Thus, by the time of final year, there is less new information and lots of revision. Let’s hope I feel that way when I go back to placement on Monday!


Hanging up my PPE (for now!)

The last two weeks have brought a partial reversion to normality. Last Saturday was my final shift on the Gerontology ward at University Hospital and the end of my COVID-19 work placement. Reflecting on my time, it has certainly been a worthwhile and enlightening experience. Whilst it has been a struggle (and a worry) to step away from the usual studies and placements of a medical student, the COVID pandemic has still provided key learning opportunities that I will carry forward as I pursue my medical career. My fellow students and I have taken on roles with more direct patient care – such as bathing, feeding and helping to mobilise patients. These are jobs that we have not really trained for, so it has been a steep learning curve at times! We have also been doing some observations, which are normally done by the nursing staff. I feel as though while I haven’t done much medicine for the last 3 months, I have learned a new and complimentary set of skills. Interacting with confused patients is something I was very anxious about before my time on the Gerontology ward. Now, I feel as though I can look after these patients much better. I hope that when (if) I pass my final exams and graduate, that the acclimatisation to clinical practice will be that small part easier because of the work I have put in now.

I’ve now left my job and it was really sad to say goodbye! I have really gotten on well with the nurses and other staff members I have worked with and they’ve said that I’ll be missed. I feel as though the one big change in me over the course of the COVID situation is my confidence. Everyone has wobbles and doubts from time to time, but I think that maybe I’m more prone to these than most. There probably hasn’t been a day since I started the course that I haven’t secretly wondered if I’m good enough to complete the course and graduate and be able to be a doctor. I think from the positive feedback I have received while working from my colleagues, I may finally feel slightly more confident (get it!) at putting those doubts to rest. I think the lightbulb moment came during my last week at work. It so happened that two patients needed cannulas putting in and someone needed to do it. Despite my nerves, I managed to do both. I think the nurse could tell I was terrified – they cheered when I did it successfully and gave me some sage advice from their experience. They said to me – it doesn’t matter how scared you are – say yes to every opportunity to do a skill or put a cannula in or examine a patient as this is how you build your confidence. I think I was quite good before at getting stuck in, but now I will approach these clinical opportunities with less fear, and less self-doubt.

Since finishing work, I have really gotten stuck back in to my medical studies. I start my Musculoskeletal block at the end of June and I am determined to do everything I can to be prepared and do well during the block. I’ve decided to revisit my anatomy teaching from first year to prepare – I definitely need a refresher! Anatomy teaching at Warwick is superb, and I have been watching the lectures again, and am slightly reassured that they make a lot more sense in hindsight, and that a lot of the detail has come rushing back. What I once knew, but had forgotten, has been (at least partially) remembered. Clinical practice really is so dependent on that basic anatomy and physiology knowledge that you learn in First year of the course. Going back to basics provides a strong foundation on which I can hopefully build during my musculoskeletal block which begins soon.


May 20, 2020

Fluid Charts and HCA life

I have been continuing my employment as a Medical Student Clinical Assistant at University Hospital Coventry. I feel as though I have really settled into my job role and learned how to do it proficiently. Things which at the start were a total mystery to me are now not so mysterious, nor nearly as scary. Specifically, aspects such as filling in fluid balance charts, attending to the personal hygiene of the patients and dealing with confused patients. These are things which we are taught the theory of at medical school, but never get the chance to practice in reality as these jobs are often done by the nursing and healthcare assistant staff. I’ve definitely exercised a completely different skillset to that which I was using as a student!


I had a lovely chat with one of the experienced staff nurses this week about how valuable this experience will be when I go back to placement and eventually (hopefully) start work as a junior doctor. Whilst medical school prepares us well in terms of our understanding of conditions and their management there are some things that I have only experience during my time working on the wards. For example, whilst we are taught in detail about the science of fluid metabolism I had never encountered a fluid balance chart before but now realise how crucial being able to both fill in and interpret one will be when I am a junior doctor. It goes to show there is only so much lectures and workshops can teach you and that there are many lessons to be learned by being immersed in the clinical setting!

I’m hoping some of my present experiences will make the transition to a junior doctor easier when that does happen, but presently I do feel as though gaps remain.


Another thing that I have enjoyed during my time working is how I feel like part of the team. I am, indeed, expected to contribute to the work of the HCAs and nurses and I feel as though I have approached the work with gusto. I have done lots of observations, some ECGs and even some bloods. I know that medical students who are working are all having different experiences and I am sad that I haven’t had a chance to do some more bloods, cannulas etc, which would provide good experience for me at this stage. I know other students working on other wards have had the chance to do these, but there isn’t much demand for these skills on my ward.


That brings me to an update about when placement will resume. We have been told that placements may resume either in July or September, depending on the NHS situation. We would still need to do all of the placements that we would have done anyway, but of course we have now missed at least 4 months of placement. I think the discussions at the moment are of moving our final exams to later in the year, not having an elective period and reducing our summer holiday before starting work. At the moment there are lots of “maybes” and it really depends on the course of the coronavirus. I hope that we do get back to placement soon, as I really miss Medicine. So stay inside, for my sake!



May 11, 2020

Uncertainty

For the last two weeks I have been continuing my employment at University Hospital Coventry as a Medical Student Clinical Support. As I discussed during my last blog, this is to help the NHS deal with the increased demand expected because of the COVID-19 pandemic. So, what have I been up to? Well, I am currently working 24 hours a week, which is 3 days of shifts from 12:00-20:00. Whilst at work, I am acting as a Healthcare Assistant, so helping to wash, dress, reposition, feed and just generally look after patients on the ward. In addition, I am allowed to carry out observations. These are done regularly for all hospital patients every couple of hours or so, usually by the qualified nurses on the ward. A standard set of observations includes blood pressure, pulse rate, breathing rate, consciousness level and temperature. We have been very busy on our ward, so I have helped the nurses by doing some of these observations and letting them get on with the drugs rounds and other duties that require a qualified member of staff. Medical students are taught to do observations as part of examinations (i.e. pulse for cardiovascular examination), but we aren’t taught to do observations in the same detail as nursing students. Having the opportunity to carry out so many has definitely increased my confidence and is hopefully a useful skill to take forward into my medical career when we finally go back to placement.


I have been settling into my ward and getting used to working again, as well as learning everyone’s names, which is slightly more difficult when you’ve never seen their whole faces as everyone permanently wears a mask while at work. I’d never realised before having to wear a mask which covers my mouth just how expressive my face can be and how much I use facial expressions to convey meaning whilst talking. I’ve been quickly learning how to use my eyebrows more to express more emotion – an unintended side effect of PPE (Personal Protective Equipment!)


Then I suppose I should discuss what’s happening with our course currently. Things are on hold until the NHS has dealt with the COVID-19 outbreak, at which point we should resume placements. It’s very difficult to say when the NHS will be stable enough to also deal with teaching us, but the University has posited July as a potential resume date, at which point we will have lost 3-4 months of placement. Final exams would be potentially pushed back from February to May and we would then do placement well into 2021 (when originally without COVID-19, placements should have ended December 2020 before revision and then finals in Feb 2021). There is a lot of uncertainty at the moment which is causing a lot of anxiety for everyone, and this is worst for the current third years who are the most senior medical students and so have the least time to make up any lost learning before graduating.


All of this anxiety about the future has been affecting me personally and my course-mates – we have joined the course to become doctors, but not just doctors for the sake of it. We want to be good doctors, who are able and good at doing the job of looking after people. For me personally, I don’t want to qualify and then feel like we aren’t as good as the years that have gone before us and those that come after us. Thus, it seems like a steep climb to the end – we will be out of practice with everything having had a 4 month gap, with less time to get to the same standard as our forebears in a changed NHS which may be unable to give us the same education as previously. I think this mountain must be surmountable – but at what cost? Added to that is the generally gloomy news; of economic uncertainty, of social isolation, of deaths in the news daily. The mental health impact on the UK mustn’t be discounted and I think will haunt us for years to come. As a former historian, I feel as though we are watching history unfurl before us – a turning point as real as the world wars, the nuclear age, the bubonic plague. As before, the solution is courage in the face of adversity – believe in better times and look after each other and we may yet see an end to this nightmare.



April 29, 2020

The Frontline

The last two weeks since my last blog have been…well, strange, as I am sure you are aware.

I have now been employed as “Medical Student Clinical Support”, and have been placed at University Hospital Coventry and Warwickshire (UHCW), which is the largest partner NHS trust affiliated to the Medical School. My ward is normally used for care of the elderly but it is looking after patients with suspected or confirmed COVID-19 at the moment. I am essentially working as a Healthcare Assistant, which involves duties such as bathing and moving patients, cleaning and general support. In addition, however, we are allowed to practise the clinical skills we have been signed off for in line with how competent we are. For example, this includes things such as venepuncture (taking blood), cannulation, setting up oxygen, doing Electrocardiograms etc. This has prompted me to think about my competencies – how confident/competent am I at performing these skills in the real world?

As a medical student, and indeed as a doctor, the phrase “act within your competencies” is used quite a lot to determine what you are able to do. But what does this mean practically? In years gone by, doctors operated by the adage “see one, do one, teach one”. For example, if a student/junior doctor had seen a certain operation (let’s say a hip replacement), then they would progress to doing one, before then teaching this skill to others. This would be how doctors would learn pretty much everything, but of course this method has its drawbacks – primarily that this isn’t an effective way to learn how to do something safely. I could watch someone lay a road, but that doesn’t mean that I would be happy to then “have a go” and I’m sure the results would be terrible!

What has happened then, in recent years is that things have moved towards competencies and a more holistic way of teaching and learning skills. So at medical school, we have to learn certain skills that all doctors must be able to do – for example inserting a venous cannula or administering oxygen therapy. We receive formal teaching on how to perform these skills which are called T-DOCs, and at the end we are assessed by the tutors as being signed off, meaning that we can practice these skills as long as we are supervised by more senior colleagues. You can then practise (of course with appropriate consent) and with supervision until you build up confidence and ability to perform these skills. You do the training for most of these skills in Year 2 of the course and they include lots of different skills. I have only had the chance to practice a couple of them so far on real patients – I have done about 20 cannulas, taken blood about 20 times, set up oxygen a couple of times, and have a reasonable rate of success.

We had a general induction and also some basic Healthcare Assistant training on the first few days. We were told how to clean effectively and how to bathe and feed patients etc, which are skills we don’t regularly get taught how to do during medical school. After this we started shifts on the wards. On my ward, everyone is really friendly and approachable and keen to teach and show you how to do things, which makes the whole thing of being a new member of staff so much easier. We have also been given uniforms which we have to change out of at the end of every shift and also been given appropriate PPE. At all times on our ward, because there are suspected and confirmed COVID-19 patients, you have to wear a surgical mask (which is fine for half an hour, but when worn for the whole of an 8-hour shift, your mouth dries out and cracks). When approaching and caring for patients, we then have to put on an apron, gloves and a plastic visor. Wearing all of this makes looking after patients so much more difficult and a lot warmer too, which isn’t great when its 25 degrees+ outside. So far, I have helped with general patient care including repositioning, feeding and cleaning and it’s amazing to feel like part of the team and like I am helping, if only a bit! Sometimes it can be really sad, especially because visitors aren’t allowed except in exceptional circumstances, which means that the only human the patient sees is you. I have been trying really hard to chat to the patients when I can and make sure they have everything they need to be as comfortable as possible in the circumstances. It has certainly been a different challenge to what I normally experience whilst on the ward, but rewarding and important nonetheless. Stay safe!


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Our Med Life blogs are all written by current WMS MB ChB students. Although these students are paid to blog, we don’t tell our bloggers what to say. All these posts are their thoughts, opinions and insights. We hope these posts help you discover a little more about what life as a med student at Warwick is really like.

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