All 9 entries tagged Medicine

# NOF, #cutebabies

Last weekend I took part in the second year MOSCE day. A MOSCE is the same thing as an OSCE, but a mock/practice version. Second year is quickly coming to an end, with only 5 weeks left until our end of second year exams, one aspect of which is our OSCE (or clinical examinations). The MOSCE was kindly set up and run by current third years, and was set up like an actual mock-exam, where we rotated around various stations. In these we did various clinical skills, for example a history-taking for chest pain and then interpretation of an ECG.

In our first year OSCEs last year we would have 10 minutes to conduct a clinical examination or history (so one station would be 10 minutes taking a chest pain history). This year, however, we only have 7 minutes and we are expected to complete multiple tasks in that time (so it can be a short history, an examination and interpreting a test result all in one station). These are much closer to how we will actually be working as doctors, but that doesn’t make it any less daunting. There is a real time pressure to complete the various tasks in the time – its almost like a quiz show where the prize isn’t a holiday in Hawaii, it’s a step in the road to a medical degree!

On Monday I had my last labour shift for this year. We’ve had three labour shifts across this block and I have been lucky enough to see a variety of different births (including caesareans, natural births, forceps deliveries). I’ve been really lucky to have the chance to see so much, and I feel as though I’ve seen a good variety of cases to provide a good grounding for more detailed training on Obs & Gynaecology next year. I feel hugely privileged to have been present at these births and a very small part of seeing these babies into the wide world. Nothing beats the blues like seeing a cute baby!

Today I attended Fracture clinic with my Orthopaedic consultant. When I started this block and found out my consultant was an Orthopaedic surgeon, I was dreading having to spend time in Orthopaedics as so far on the course I really hadn’t enjoyed it at all. For whatever reason, I just didn’t find bones, tendons or muscles (the remit of Orthopaedics) interesting in the slightest. However….I have really enjoyed my time this block! This has surprised me (and probably everyone around me), but we’ve done some cool things and seen some complicated fractures and bone injuries. I am really drawn specifically to the Trauma aspect of Orthopaedics (so broken bones and car accidents etc), and look forward to hopefully spending more time in fracture clinic and in theatre soon.

Medicine sometimes feels like another language, so here is one abbreviation to help demystify things slightly. Your femur is your thigh bone, and at the top there’s a narrow area we call this the neck. In patients with osteoporosis (brittle bones), this neck is a weak area which can break with falls and accidents. For whatever reason, a fracture is written as a hashtag (#), so a fractured neck of femur is called a # Neck of Femur (#NOF for short).

Lucinda Sidbury : 13 Aug 2019 09:24 |  Tags: Gem Graduate-Entry Jordan Mbchb Medicine Student University Warwick Wms |  Comments (0) |  Close comments |  Report a problem

Community Psychiatry and the SJT

All of us Phase-III students are now in the third week of our final Specialist Clinical Placement rotation. It’s hard to believe but we’re almost at the end of this year’s formal medical instruction. We’ve all been working really hard and I hope something comes out of it. 2017 has just flown by

We’re about halfway done with our Psychiatry block, and it’s proven fascinating thus far. Of the six-week block, three weeks are meant to be spent in the community, one spent with an old-age consultant, and two on acute care. Our community placement has been in a lovely clinical practice in the community (i.e., not at a hospital) with several psychiatrists (including consultants and registrars), psychologists, and care coordinators all working together for each patient’s wellbeing. I gather that most patients won’t be seen by a psychiatrist unless they are referred by a medical professional or a police officer, depending on the circumstances. We’ve seen lots of varying presentations in the clinics, including severe depression, emotionally unstable personality disorder, paranoid schizophrenia and many other things. And we’ve seen patients at various stages of treatment as well, including new-onset, follow-ups after initial therapy, and some patients who’ve been under treatment for decades and have come in for medication reviews. It’s fascinating to see all of these presentations at once, after having read about them for so long.

Most patients have been really open with me and my clinical partner when we ask them questions about their conditions, including symptoms, duration and treatment of their condition – and it’s great when they are able to help us learn. Elements of the psychiatric history can be quite personal, as they involve intimate details about a patient’s upbringing and social life, and so sometimes it takes some effort to get comfortable posing them, but when you realise that you need to handle an intimate psychiatric exam the same way you’d handle an intimate physical exam – with sensitivity and professionalism at all times, focusing on the patient’s wellbeing – it becomes easier with practice.

Over the next few weeks, we have old-age and acute psychiatric placements. I’m really looking forward to them, especially the acute part. About a year and a half ago, we had an introductory week on a psychiatric intensive-care ward and it was absolutely brilliant. Now that we have gained a lot more medical knowledge, and in particular have spent the past few weeks bolstering our knowledge of psychiatric conditions and how to treat them, I hope it will be that much better and more useful.

Very shortly, members of our cohort will also be sitting the SJT, or the Situational Judgement Test. This is a test that all final-year medical students are required to take before entering the foundation programme, which is hopefully at the end of summer 2018 after graduation. The SJT is designed to assess students’ ethical judgement through asking us to respond to various realistic scenarios. One common scenario presents us with a fictional but realistic hospital situation and asks us to rank, in order of appropriateness, the options on how to proceed. Although you cannot officially revise for this exam, its administrators issue official practice tests, and there is no shortage of revision courses and materials to help us get through. WMS have even included sample SJT questions at the end of our CBL cases as well, which has been very helpful. I’m looking forward to seeing what the exam contains, but more importantly, I’m looking forward to it being behind me!

Joshua Galvin : 27 Nov 2017 16:49 |  Tags: John Mbchb Medicine Warwick Wms |  Comments (0) |  Close comments |  Report a problem

10 fingers and 10 toes

Over the course of Core Clinical Education we have had several different themes running throughout. CCE1 was history and examination, CCE2 was investigations and CCE3 focused on basic management. Amongst all this we have also had several speciality areas which have been mixed in amongst all this; Obstetrics and Gynaecology, Orthopaedics, Psychiatry and Child Heath.

For Obstetrics and Gynaecology, we all had the chance to attend shifts on the Labour Ward and spend time with the community midwives. Everyone has an orthopaedics rotation at some point during CCE so we can learn about different types of fractures. For Psychiatry we all attended a Clinical case day with simulated patients to prepare us for our week long psychiatry placements. For child health we have covered a few different topics over the course of CCE which I have thoroughly enjoyed.

In CCE1 the focus was on the new-born assessment, screening programmes and baby checks. We had tutorials to take us through the theory and recap some material from Block 5 in Phase 1. We also spent a day split between the paediatric ward and the special care baby unit. Here we got the chance to see a baby check. The baby I observed in CCE1 was not impressed with us and the paediatrician moved at lightning speed so this week I arranged some time with one of the teaching fellows at George Eliot who specialises in paediatrics.

We found a very chilled out baby and she talked me through the baby check step by step and allowed me the chance to perform some of the examination. Listening to a new-born baby’s heart beating at 150 beats per minute is a bit alarming at first but for babies this is perfectly normal (compared to adults where our heart beat should be 60-90bpm). Getting some hands on experience is invaluable and I am so grateful for the parents who let me practice on their precious new-born.

In CCE2 the focus for child health was acute paediatric medicine. We had some lectures introducing us to history and examination in children. The questions in a paediatric history seem to be endless; you need to ask about the pregnancy, the birth, immunisations, what is their sleep schedule, what do they like to eat, do they have any friends? We spent a morning on the paediatric ward at UHCW speaking to patients and their parents. Some patients are more difficult than others but children are something else entirely, watching the paediatrician exam a wriggly child was as confusing as it was impressive!

In CCE3 the focus has turned to child development. We need to understand how to assess child development and common problems that can cause abnormal development. A full developmental assessment can take up to half an hour and is usually performed by a paediatric registrar. However, we still need to know what the developed milestones are and how we would assess them. We might come across problems in development in GP and we need to be able to assess them competently enough so we can be confident in either providing reassurance or deciding that further investigation and referral is needed.

I have really enjoyed all aspects of the child health theme. Learning the theory is fascinating as the physiology of children is actually very different compared to adults. This year we have had limited practical experience with children in hospital but I have come across plenty in GP. Working with children is hugely rewarding and fun, definitely something to think about when considering future career options!

Joanne

Catrin Davies : 27 Jun 2016 15:22 |  Tags: Children Joanne Mbchb Medicine Paediatrics Warwick Wms |  Comments (0) |  Close comments |  Report a problem

A New Block and a New Hospital

We’ve just started the final block of our Core Clinical Education module. It’s hard to believe that the second year is almost over – this officially marks the halfway point in our journey through med school. As with most students in our cohort, my clinical partner and I are at a new hospital for the final ten weeks of the year. With this comes an entirely new set of corridors to memorise, IT systems to navigate and ward-round schedules to memories. I think this is what it’s going to be like for a very long time if we continue pursuing our careers in the NHS! The rotations throughout the rest of med school and beyond – into the foundation programme and even specialist training – will see us rotated about like this as well.

As the first core-clinical education block focused on history-taking and examination, and the second block focused on investigations and diagnosis, this final block will focus on management of conditions, diseases and illnesses. And of course “management” is more than just giving someone some pills or scheduling a date for them to turn up to operating theatre. We are highly encouraged to take a wide approach to condition management, considering all aspects of a patient’s health. We adhere to the bio-psycho-social model, examining the biological component of condition management alongside any impact that a patient’s condition may have upon the psychological and social aspects of their lives. It’s fascinating to see how this plays out in practice.

My assigned consultant for the first section of this block is a gastroenterologist, and my clinical partner has been given a cardiologist. Since our assigned consultants are employed in this aspect to support, teach and evaluate us, this means that we will spend a lot of time focusing on real core medicine with these doctors – the stuff we learned in the first term of the first year, and among my favourite part of the curriculum. It’s time to brush up on interpreting ECG tracings, hepatic metabolism of drugs and the mechanism of action for lots of different diuretics (among many other things)! This makes a major change from the previous block, where we were both linked with orthopaedic surgeons, and brings us back to some of the stuff we learned about quite early on.

Earlier this week we were lucky enough to see a few minor operations pertaining to cardiac abnormalities. First, we saw the placement of a pacemaker. The consultant cardiologist who performed the procedure was actually the same gentleman who lectured us about it back in Advanced Cases 1. Like most of these experiences, it was like an anatomy lesson come to life – in this case, he pointed out to us the patient’s cephalic vein, which he was going to use to access the heart (how he was able to find that vein and know that it was the right one, I will never know). The patient was conscious the entire time, and the entire procedure was conducted under local anaesthetic! We also saw the insertion of a few devices into other patients that function very similar to memory sticks – they collect information about a patient’s heart function over the course of months and even years. They are indicated in many situations, including strokes and various forms of arrhythmia. I look forward to seeing many more sorts of these procedures and many more over the coming weeks and months.

John

Catrin Davies : 09 Jun 2016 09:15 |  Tags: Cardiology Gastroenterology John Mbchb Medicine Student Warwick Wms |  Comments (0) |  Close comments |  Report a problem

Cradle to Grave…

Writing about web page http://www2.warwick.ac.uk/fac/med/study/ugr/

In medicine we are privileged to witness both the birth of new life and the end of life. During Core Clinical Education (CCE) 1 there were times when I started on the ward and enquired about a patient only to learn they had passed away; other students have been present for a patient's last moments and others have been present when families have been informed. All of these situations present unique challenges to doctors and to us as medical students. I still feel like an unwelcome intruder in these situations but the only way we will learn how to cope with these difficult times is by observing others. We have excellent teaching from doctors and nurses who work in palliative care in the local hospice, teaching us about care at the end of a person’s life. I’m grateful of any extra knowledge in the hope that it will help me when it’s my turn to cope with these difficult situations, although I'm prepared to feel like I said all the wrong things the first time knowing that after reflecting I will be better next time.

An equally pivotal moment in a patient’s life that we get to witness is their birth. In my first couple of weeks of CCE2 at University Hopsital Coventry and Warwickshire I have had shifts on the Labour ward (both day and night!) and have also spent time in the community with the midwives. These have been amazing experiences and have made me think a lot about what specialty I see myself in. Working with the team of midwives and Obstetrics and Gynaecology doctors was great, I got to spend lots of time with the patients and was able to provide a lot of practical help to the midwives as well as be a much needed distraction for some of the women whose contractions were pushing them over the edge! I was able to observe both natural deliveries as well as some emergency Caesareans.Seeing the team come together to ensure that it is no longer than 30 minutes from the time of the call to when the baby comes out was incredible. Seeing the midwives, anaesthetists, theatre staff and obstetricians all working as one to ensure both Mum and Baby are safe was incredible and I had tears in my eyes on several occasions. As a second year medical student we are limited in what we can do and therefore how helpful we can be, but we can talk to patients and reassure them, and nowhere is this needed more than on the Labour ward. Leaving my 13 hour shift and saying bye to a patient I had worked with for the last six hours I was really touched to be hugged by both the patient and the midwife who said I was a pleasure to work with, hearing this was so rewarding and makes you realise that no matter what stage of your medical career you can make a difference. I’ve learnt that One Born Every Minute is not entirely accurate but the Labour Ward is certainly filled with some very special moments that are great to be part of.

In our first year we learnt a lot about health inequalities and the effects of social deprivation on the health of both mothers and children. Nowhere is this highlighted more than when working with the community midwives. The community midwives spend a lot of time educating patients about their health and wellbeing and also take part in multi-agency schemes designed to support families in a variety of ways. Seeing pregnant mothers living in damp, overcrowded housing makes you realise just how important health professionals are in tackling poverty and social isolation. Working with the community midwives we spent a lot of time trying to find a good place to listen to a heartbeat in the antenatal clinic in cases where a baby was especially active (apparently a sign it’s a boy!) as well as spending time on postnatal visits ensuring families were coping and checking for signs of postnatal depression. What I really liked about Obstetrics and Gynaecology is that it is a specialty that takes a holistic approach, the whole family and social circumstances around a patient are relevant and can have a huge impact on outcomes.

As well as cooing over newborn babies I presented my summer project at the Warwick Academic Medicine Society’s annual conference, an amazing day filled with excellent talks from both staff and students and tonight I start my first week of the optional Student Selected Component (SSC) in Medical Education. There is definitely never a dull week as a medical student!

Joanne

Sarah Hill : 30 Mar 2016 09:58 |  Tags: Birth Caesareans Care Joanne Labour Mbchb Medicine Midwife Midwives Palliative Patient Student Ward Wards Warwick Wms |  Comments (0) |  Close comments |  Report a problem