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February 24, 2021
The Last Day of Placement
I had my Prescribing Safety Assessment (PSA) last Monday and I would be lying if I said I didn’t find it tricky! It was a weird experience sitting the exam at home, made more difficult by the lack of the adrenaline of the exam hall to really get you into exam mode. However, I sat it and it’s done – results pending. No-matter the outcome, I’m simply happy to move on and get stuck into revision for real.
Last week was my final official week of medical-school placements as my surgical block came to end. Whilst it was a milestone moment I felt it was all rather anticlimactic as I have spent much of the last fortnight revising for my two prescribing exams instead of at the hospital. However, we did have a mock-OSCE on Wednesday which was arranged by the block lead and some of the doctors involved in teaching the block. Just to remind you of what an OSCE is, is a clinical-style exam where you do activities and have a discussion with the examiner. This was just a practice but actually it was really useful for getting back into the swing of doing timed OSCEs and also for gauging where we are in relation to the level expected of us for finals. It feels strange to say, but I quite….enjoyed the exam! It involved various stations including one station where we had to do a suture whilst being observed. We were given marks for each station and then the highest scoring candidate gets a certificate. I’m proud (and very, very surprised) to say that I got the highest mark! I have to say that I probably struggle with confidence generally, but receiving this good news gave me a little boost and definitely makes me slightly more confident going into finals revision. Added to this is the fact that the surgical block has re-ignited my passion for medicine in general. I do think that in my surgery block I have seen the best of what medicine can do for people – seeing people at their worst moments, their moments of pain and tragedy, but also seeing how medicine can improve people’s lives.
What will I be doing now placements have ended? The next 8 weeks are a revision block called Advanced Clinical Cases (ACC), which is largely self-directed in nature. This means that the medical school and hospitals are putting on activities (such as examination practice), but it is totally up to us what we decide to go to depending on our own learning needs. I’ve booked in a couple of ward sessions to practice my examinations and history taking and also a couple of procedure practice sessions (so practicing taking blood on mannikins) – as these procedural skills do come up in finals. Warwick uses the ‘spiral’ curriculum method, which basically means that essential topics are visited several times throughout the course. The topics we learned in Phase I and Phase II come up again in finals, just in more depth. This means that we go over the basics several times and become really confident at managing common conditions such as heart attacks, lung infections and diabetes, because we’ve learned the principles of these conditions throughout the course. The next 8 weeks are sure to be tiring, but I’m excited to learn and improve. Bring it on!
Megan Earle
24 Feb 2021 13:44
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February 02, 2021
Prescribing
The last 2 weeks have been full of prescribing. Here at Warwick, we have to sit 2 prescribing exams in our final year – one of these is a national exam, the Prescribing Safety Assessment (PSA). All final year medical students in the UK have to sit the PSA, which covers the most common drugs and prescribing scenarios newly qualified doctors are likely to encounter. The PSA covers a lot of emergency situations such as prescribing drugs for conditions such as anaphylaxis, infections, and heart attacks. In addition, newly qualified doctors work on medical and surgical wards, so some of the questions ask about long term management of common conditions, including high blood pressure, kidney problems and lung conditions. Other questions may be based around the complications of commonly used medications – one common example is high potassium levels in the blood, which is a very common side effect of blood pressure medications. There are a LOT of medications which are used in medicine, which can be daunting to learn. However, the scenarios in the PSA exam mostly focus around the most common drugs and drug categories, meaning that revising for it is actually really useful preparation for life as a doctor. This is because we will be seeing patients who take these medications on a daily basis. The PSA is mostly theory based and asks about the theoretical knowledge of prescribing.
The other prescribing exam we final years here at Warwick have to complete is the Warwick Prescribing Assessment (WPA). This exam is slightly different to the PSA in that only Warwick students sit it, and the content of the exam is more practically based. So, for example, the PSA may ask a question about what drug you would use for x condition, but the WPA will have a drug chart and ask you to prescribe it for use. I quite like the WPA in that it tests the actual skills required for prescribing – its good practice. That first time being asked to prescribe an anti-sickness medication as a new doctor will be less scary knowing I’ve done it several times before in practice for this exam. I feel as though this is in keeping with Warwick Medical School’s ethos that graduates should be good doctors who can fit into teams well and do the job to a high standard from the very beginning. COVID-19 has had an impact on our WPA exam, so rather than sitting it in an exam hall, this year we are doing the same exam at home whilst being invigilated remotely. This of course still tests the same knowledge but means that we can have a cup of tea with us for the exam which will surely help with those exam nerves.
The prescribing exams can appear quite daunting – there are so many different medications and it is impossible to know all of the drugs (including uses, side effects, monitoring) in complete detail. However, I feel as though some of my prior experience may come in handy - I worked for 2 years in between my History degree and starting medicine. For one of these years, I worked as a dispenser in a hospital pharmacy where I dispensed lots of medications and looked at quite a few drug charts. Hopefully that extra experience stands me in good stead for these exams. I will keep you updated!
Megan Earle
02 Feb 2021 10:58
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January 18, 2021
Care of the Surgical Patient
I’ve come into this block feeling refreshed and rejuvenated after the Christmas holidays and have just completed the first two weeks of my Surgical Patient block (my final specialist block of medical school!!) When I look back over the last three (and a bit) years, they have been filled with highs, lows and plenty of hard work – but I wouldn’t change it for the world. I feel as though things have come in a neat roundabout circle as my last block is surgery and Gastrointestinal medicine, and my first block in my first year covered the basics of this area of medicine. I, too, feel like I have come full circle in terms of motivation and drive. I started Year 1 with energy and determination and I again feel energised and ready to approach the next few months with the necessary determination to hopefully finish the course.
…Which is good as there is a lot to do. I have two prescribing exams at the beginning of February, and then written and practical exams in March. As well as this, I still have to engage with this block and learn enough about surgery to be able to cope as a junior doctor on a surgical ward. So, what have I been up to? Well, for this block I have not one, but two surgeons, making me slightly spoilt for choice. I have a general surgeon (so digestive system amongst many other things), and a urologist (male reproductive tract and male and female urinary systems) as my consultant supervisors. Last week I was lucky enough to attend general surgery clinic which I found really interesting, which sort of surprised me. I am still unsure what career path to go down but had thought general surgery wasn’t for me up until this point. I found the clinic really interesting and actually quite innovative with some of the novel techniques they use to sort digestive problems. One of these techniques is what they call a seton, which is essentially a specialised string which they put through false passages which helps the passage heal correctly – very cool stuff!
We have also had lots of tutorials from experienced surgeons in this block, and one of the most engaging of these was a session I had last week where we were taught how to suture. Suturing is one of the most basic surgical skills, but that doesn’t mean it is easy! All doctors need to be able to suture, of course surgeons need to be able to suture to close wounds, but also doctors working in A&E or General Practice need to be able to close small wounds and injuries if necessary. We had three experienced consultant surgeons teaching us how to handle the equipment and do a basic interrupted suture. This is where the needle goes through the base of the skin and is then tied above the skin to close the wound. We were also offered a challenge – one of the surgeons had created a laparoscopic training ‘game’. Laparoscopic surgery is commonly called ‘keyhole’ surgery as rather than large incisions, small incisions are made, and a camera and tools are used to complete the surgery. The game involved a webcam and two tools inside a box, and involved picking up rubber bands and putting them on small pegs. The person who did the most of these was the winner and would get a certificate, and unbelievably, I won! As I said earlier, I haven’t really considered surgery as a career in seriousness, but I found the game fun and have really enjoyed this block so far, so you never know…
Megan Earle
18 Jan 2021 08:28
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January 05, 2021
The Holidays
Usually at the beginning of a blog, I say that the last 2 weeks have been busy. Well, in a departure from our scheduled programming, the last 2 weeks have been relaxing. But before I talk about the Christmas break, I’m sure you will be wondering how my Situational Judgement Test (SJT) went. As you may know if you read my last blog, the SJT is a really important exam, which is a factor in deciding what jobs we are offered after medical school, and I sat mine in mid-December. This year for the first time, rather than sitting the SJT at medical school, we sat the SJT at a Pearson test centre. Pearson test centres are where people sit their driving test theory or their UCAT for entry to medical school. I had booked my SJT for the Birmingham test centre as I had sat my UCAT there, so I was familiar with the centre and it is nearby. So, the day of the test came and I planned to be 30 minutes early to allow for any traffic – unfortunately the traffic didn’t get the memo! There was really bad traffic in the centre of Birmingham that Wednesday at 11am for some reason, so my 30 minute lead soon vanished, with me stuck in my car and on the wrong side of the city. At this point I made the executive decision to abandon my car and jog across the city with 10 minutes before my test began. I parked up (legally, of course) and ran across the city to the test centre, making it with 5 minutes to go. I later found out that the traffic was awful and if I had stayed in my car I wouldn’t have made it in time. Phew! Despite the stress getting there, I still had the test to contend with. I believe the SJT is designed to be impossible to revise for and I left feeling unsure how the test itself actually went. This year we also had a new type of question which made it tricky to know how the examiners were going to mark these. However I felt about the test I was mostly just hugely relieved that it was over. The next I will hear about how the exam went is in March when I will be told which deanery I have been allocated to. Scary!
The end of the SJT was also the beginning of my Christmas break. 2020 has been…interesting for many reasons, and I’m sure many of you will feel the same. Despite finals being in the new year, I had decided that I wasn’t going to do any medicine at all over the break. I think part of the secret to success at Medical school is being self-aware enough to know when to work and when your mind and body both need a break. And boy did I need a break! Over Christmas I did…nothing. I played some games, ate lots of food and spent time with my family. We usually always spend the holidays with my Grandparents but because of the pandemic situation they spent the holidays on their own and the most I saw them was from the end of the garden. I know this is minor compared to the trials and tribulations that some families are facing this winter, but it doesn’t make the absence of much-loved family any less painful.
On that note, you may have seen in the news that the pandemic is again becoming bad and that hospitals are swamped. This is hugely worrying for both patients, NHS staff and indeed, our education. Next week I start my surgical block and with the pandemic so bad, I do wonder what my experience will be like – and I find this a particular shame as I find surgery interesting. But in the grand scheme of things I am happy to be alive and well, with my family and friends also healthy. The lesson of 2020 for me – be grateful for the positive things in our lives. See you in my next blog, when I will have started my surgical block and I can give you an update from the hospitals and how our placements are going. Stay safe!
Megan Earle
05 Jan 2021 12:07
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December 17, 2020
One exam…
The last two weeks have been…very busy! I have been continuing my Care of the Medical Patient (CMP) block, which covers most of general and internal medicine. Because it covers so much of medicine, it has been very busy because there is simply a lot of content to cover. However, I do think that this block has been one of the best learning experiences. One of the most useful things that I have been able to do this block is attend bedside teaching sessions. One of the original proponents of bedside teaching was the great physician William Osler (after whom several clinical signs are named), who believed that medics learned best at the bedside, by doing. This seems odd to us today, where we would expect trainee doctors to come into contact with patients but 100 years ago this wasn’t necessarily the case. Derived from the practices of William Osler, our bedside teaching in my CMP block is where two medical students are joined by a doctor and they go and see a patient. One medical students usually take a history (i.e. ask the patient what brought them into hospital) and the other student often does a physical examination of the patient. The doctor observes and teaches and gives us students feedback on our history and examination skills. Because of COVID, we have had less opportunities than normal to be able to see patients, so getting this practice under supervision has been really useful. Having an experienced doctor observing and providing feedback allows us to identify our strengths and also areas where we may improve.
Last week I also had an exciting opportunity to attend a Diabetes outpatient clinic with one of the Professors from the Medical School. We have known this professor since first year so it was interesting to observe them doing consultations and experiencing their reputation for amazing teaching first-hand. Diabetes is a really common condition and often comes up in medical final exams – so much so that if I was a betting man, I would say it will definitely come up somewhere. It was really good preparation to go over the basic management of Diabetes.
And here we are, Merry Christmas! Or…not quite! We break up next week, but first there is one last hurdle before that long-awaited break. The Situational Judgment Test (SJT) is an exam that has featured in my blog previously, and I think that pays tribute to just how important it is. The SJT is an exam which is based around what you would do in certain ethical and workplace dilemmas. My result in the SJT will be an important factor in what doctor jobs I will get when I graduate, and even decides the area you are placed. Thus, the result is really important, and it is a very high stakes exam – if you get below a certain mark, you are removed from the job application process and may not get offered a job as a doctor. I’m told this is very unusual, but that doesn’t stop the worry that I could be one of the only ones…So over the last few weeks I have been doing practice questions and reading ethical guidance to hopefully get me over that line, get a good result and hopefully get the chance to be a doctor next year. I can’t wait for Christmas to just relax after a stressful year, and I’m sure many of you reading this will feel the same. Wish me luck in my SJT exam and I hope you all have a great Christmas!
Hattie Trigg
17 Dec 2020 18:47
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