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June 02, 2021
Whilst I have loved my month off after completing my medical finals, I now feel as though I am ready to go back. Watching daytime TV has been great, but I do feel as though I now need a new challenge to give me motivation and drive. Lucky, then, that this week, we started our Assistantship block. I don’t think I really understood the Assistantship block until this point. Essentially, the block is where you are paired with a current Foundation Year 1 doctor, who you “assist” and help in their daily duties. Medical School is quite unlike most other degrees – it is both vocational and academic but is purely preparing you for one job. For example, my previous degree, History, was solely academic and I had to use the transferable skills I obtained to find my vocation (which turned out to be totally unrelated to History!). Medicine instead teaches you the academics and vocation of being a doctor, but we all go on to do the same job afterwards – that of a Foundation Doctor. So, in addition to knowing about diseases, being able to do clinical skills, we also have to know the practicalities of the job. So far, for example, we may know that a patient needs a CT scan. However, how do you practically make that happen in the workplace? Where are the forms and what information needs to go on them? How do we prepare the patient? The Assistantship block aims to polish these more practical skills.
The Assistantship is 8 weeks long and during this time we are paired with a Foundation Doctor in one of the local hospitals. I am placed at the George Eliot Hospital in Nuneaton for this block. I am really happy about this, because I have so far really enjoyed my time at the George Eliot as all of the members of staff are supportive and it a smaller hospital so hopefully will be an easier place to start. I am attached to Upper GI Surgery for the first 4 weeks and then Acute Medicine for the last 4 weeks. I am really happy to have these attachments as my first doctor job is in Upper GI surgery, so hopefully I will have some experience before starting work. During the Assistantship, we have a list of tasks that we need to work through with our attached Foundation Doctor. These include various things such as putting on PPE, taking bloods, giving injections, writing prescriptions (not signing) and verifying deaths. These tasks are the day-to-day tasks that most junior doctors will be doing so it is vital we become familiar and confident at completing them. Of course, we are not yet GMC registered, so all tasks are supervised by our attached Foundation Doctor.
The first two days of the assistantship, we had lectures covering some common topics that junior doctors need to know about. The lectures covered things such as death certification, infection control, and management of major bleeding. In comparison to our lectures previously, these lectures were very practically focused, covering how to manage these situations in hospital, with less emphasis on the theory underpinning these topics. I have really enjoyed being back in hospital and seeing patients again, with the added excitement that I will soon be working full time in hospital. This week I’ve already learned how to do discharge paperwork and how to document on the ward rounds, and I feel as though over the course of the block, I will hopefully become comfortable with the day-to-day tasks of a junior doctor so that when I do start work, I feel more confident and less overwhelmed. Tune in to my next blog, when I will give more updates about how my assistantship block is going!
May 24, 2021
As I described in my last blog, I found out a couple of weeks ago that I had passed finals and would be starting work as a doctor in August. I feel as though the news still hasn’t sunk in, and it feels surreal, even receiving cards from family and friends referring to “Dr. Moss”. All I can think is, who is this Dr. Moss and what does he want from me? It does give me slight panics every time I hear this and think about starting work as a fully-fledged doctor in 4 months… In all seriousness, I feel as though I finally have some certainty in my life. The last 4 years have felt like repeated anxiety in waiting for exam results and having the question of whether I will pass medical school or not. I feel as though I’ve reached a “cash-out” point – think of “Who wants to be a millionaire?” when they reach £32’000 and that means they can’t go home with nothing. I feel as though at last; I hopefully can’t go home with nothing!
One of the exciting things to happen recently was receiving a text from the General Medical Council (GMC). The GMC is the regulatory body for all doctors, and you must be registered with the GMC to practice as a doctor in the UK. The GMC set the medical school curriculum, check your qualifications, produce guidance about how doctors should behave and investigate if a doctor fails to meet these standards. The GMC is very much in the 21st century, and it was a text through to my mobile phone which informed me that I was now able to start my application for a licence to practice medicine. It was slightly out of the blue, but it feels like a huge step in my career. During the application, the GMC ask questions about any criminal convictions, fitness to practice issues and health conditions, to ensure that we will be safe to practice as a doctor and that patients will be safe having us as their doctors. All of these questions sound scary, but the important thing to know is that this process is supportive – all of the process is designed to ensure the safety of our patients. As a future doctor, I am keen to engage in the process so that I can safely start work come August.
I have also now got my rotations for the next 2 years as a Foundation Doctor. I am very pleased with the hospital and jobs that I have been allocated – I am working in: Upper GI surgery, Liver surgery, Respiratory medicine, Intensive Care, General Practice and Genito-Urinary medicine. Each of these placements is 4 months long and the programme is supervised by more senior doctors so that we can apply and develop the skills we have developed at Medical School in a safe environment. I have had to do all of my employment checks for my new hospital – lots of paperwork, but at least it is hopefully now sorted for the next 2 years so I have some stability.
Us Warwick final years have had a break for one month since our finals ended, and, boy have I needed a break! I think while doing my finals I have really understood the term “burn-out”, which hereby means complete exhaustion and depletion of one’s drive and energy. This is, I think, a natural consequence of the challenges of a Medical degree, and especially so when doing a Graduate entry programme, which means covering the same content in 4 years rather than 5. During my month off, I have really spent some time just getting back in touch with myself – going for long hikes and walks, watching TV, reading and getting in touch with people I haven’t spoken to in a while. In addition, I have been doing some general life admin, including things like my aforementioned employment checks, sorting out finances, paperwork and sorting out my indemnity for starting work as a doctor. I’ve done no medicine at all, which has been a total refresh, mentally and physically. Next week we start on our assistantship block, the final placement of my time at Warwick Medical School, which I will talk about in my next blog.
May 04, 2021
Apologies for radio-silence since my last blog which was just before my final exams of medical school. The last couple of weeks have passed by in a bit of a blur, a kaleidoscope of exams and anxious waiting for the results.
First of all, the exams. Written exams came first, with 2 papers of multiple-choice questions. I found quite a lot of the questions in these papers tricky – there is a definite step up from Phase II of the course to Phase III (final year). The patients in these questions have more complicated medical histories and the questions require you to think and reason why it can’t be one condition as much as it requires you to know what condition it might be. Overall, I found paper 2 the easier of the two, although I know most of the year found paper 1 easier. I think this is probably just dependent on what we’ve read over in the weeks before the exam. It’s always difficult to gauge how well an exam has gone after sitting it, so I simply tell myself, ‘once it’s done, it’s done’, and keep moving forward. I think I could drive myself crazy if I devoted too much time to going over each question in my mind and casting doubt over my answers. Besides, there was no time to sit on my laurels after completing the written papers as OSCEs were imminently upon me.
OSCE day arrived, and it was an equally daunting, intense, stressful and exhilarating experience. There were 10 ‘stations’ (clinical scenarios) to work through and I felt a definite lull in concentration towards the end. The OSCE scenarios are 7 minutes each and the station usually requires some sort of clinical examination and then you are asked questions by the examiner. It always surprises me that, no matter how much practice you get, there is still something that catches you off completely off guard! However, I think this is good practice for life as a qualified doctor – patients always surprise you, no matter how experienced you are. By the end of the OSCE, I could definitely feel my energy waning, but there was still (just) one exam to go – the OSLER.
I have practiced many of these during my placements but of course nothing compares to one under exam conditions, as the stakes are far higher. An OSLER is a ‘long-case’, where you have to take a full medical history (10 minutes), then discuss tests you want to do and how to manage the patient (10 minutes). The exam usually ends with a communication aspect – so explaining how to take a drug or what a certain test involves to the patient. We have to complete 4 OSLER cases for our finals, all on one day with a short break in between each case. This exam tests everything, from your clinical knowledge to your history taking and patient communication skills, as well as how well you can integrate your knowledge and put it all together. The written exams test what you know, the OSCEs test what you can do, and the OSLERs test how well you can function as a doctor, a healthcare professional. The OSLER day was very long but actually flew by because of how busy it is.
So that’s it – finals done! I then had a week wait until results…and I passed! It still hasn’t really sunk in, but I’ve passed medical school and will be starting my first doctor job come august. In my next blog I will go through some more details about applying for my GMC registration and what my first doctor jobs will be. Don’t miss it!
April 12, 2021
The past couple of weeks feel as though they have gone both very quickly and very slowly. I think that’s just a reflection on every day being almost exactly the same. I’m sure that you already know from my last blog, but I am currently in the midst of the revision block before my final exams in almost exactly 2 weeks. This is week 6 of 8, and I feel as though I have made startling progress so far. Mostly I have been going over things by myself, practicing my academic and clinical knowledge together to try and integrate things and bring all of the knowledge and skills we have acquired over the course into a homogenous whole. The university has also run some practice sessions for us which are similar to the actual final exams – one of these was the GP session I had last week. This session was run online by one of our GP tutors and involved taking a history from a simulated patient whilst the GP watched and then asked questions at the end. Doing a history online is quite…awkward! It is difficult to read a patient’s cues and facial expressions when you can’t see them. However, I think the session went relatively well and I had some good feedback from the tutor. It was also good practice because our final 'long case' exams this year will be online so getting used to talking via webcam is useful.
The last two weeks have also been exciting for a whole different set of reasons. As well as our final exams, we also have to be applying for doctor jobs if/when we finish the course and graduate. This process is complicated and starts at the beginning of final year and essentially you rank areas and then jobs in that area and then are scored based on your Medical School performance, amongst other things. I am delighted to say that I got into my first-choice deanery (West Midlands) which was essential to me as my partner can’t move due to work. This means that we can live together when I start work as a doctor and both commute into Birmingham. I am originally from Birmingham, did my History degree there, and now I’m going back! I don’t know which hospital I’ve been assigned to yet, but I’m not really too fussed – the jobs are essentially the same and I was just keen to be going home and around family and friends for what I’m sure will be a busy and exciting two years of the Foundation Programme. I’m excited to be returning to the second city to start my career as a doctor. Coming to a Birmingham hospital near you! (If I pass my finals that is…)
This week we had a clinical skills practice session at the George Eliot Hospital. I have spoken of my fondness for the George Eliot (or 'the Eliot' as some call it) previously, as the clinical education staff are fantastic and really go above and beyond to make sure we have a good experience. For this session, the clinical education department had set out all the equipment so we can practice our skills on things that come up in practical OSCE exams. These skills include things such as taking blood samples, doing an ECG, catherization, feeding tubes, airway procedures and delivering drugs via various methods. Going over the skills was really good practice and actually reminds us of how much we’ve covered over the course – our training is very broad based to enable us to be pretty competent at a huge array of things. I particularly struggle with catheterisation as there are a lot of steps to remember to make sure infection is not introduced, so having the chance to practice was super helpful. Knowing that a job is waiting for me at the other end is a big morale and motivation booster. Not long to go now.
February 24, 2021
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!