All 51 entries tagged Patients
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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!
July 29, 2020
The last two weeks have seen my Musculoskeletal specialist placement continuing. A regular feature of our placement has been attending ‘fracture clinic’ every Tuesday. Fracture clinic is exactly what it says on the tin – if you’ve suffered a fracture and been to A+E, they will often pop a cast on to stabilise the injury then refer you to fracture clinic the next day for review by a specialist orthopaedic surgeon. As the specialists they can easily decide if a fracture will heal fine by itself or if it needs an operation to aid recovery. It was fab to see patients in fracture clinic and we got the chance to take a history here and there which was good practice to brush up our skills. A large part of the work of Musculoskeletal healthcare is to treat fractures and trauma and we’ve learned some important principles. By far the most important principal is that any treatment must maintain the a) length, b) rotation and c) rotation of any bone or limb. In short, this means that after the bone has healed, the limb should look and function as much like it did before as is possible.
Our opportunities to see patients face-to-face has reduced since we have returned to placement since COVID-19 began. There are less clinics running in order to protect patients from exposure to the virus. There are telephone clinics running, but these aren’t that useful for learning how to do a physical examination. Instead, the MSK doctors teaching us have tried to give us the same teaching (as much as possible) and one of the ways they have tried to do this is by offering us more teaching and simulation of examinations. For example, shoulder clinics aren’t running so one of the shoulder surgeons allowed us to practice a shoulder examination on each other while the surgeon watched and then offered us feedback. The surgeon then also showed us some tricks and techniques to optimise our shoulder examination techniques. This was really useful and in the absence of practicing on patients, was a good substitute to make sure we can effectively examine a shoulder in our final exams and beyond.
We also had some simulation teaching for our end of block OSLER. What is an OSLER I hear you ask? An OSLER is a practice patient encounter – so we are observed doing a history, conducting an examination and then it ends with a viva style discussion about what we think is wrong with the patient, what tests we would order and what treatment we would like to offer the patient. We have to do at least one per block. Again, the OSLER is meant to be done on a real patient, but for this block we had a volunteer – the block lead! I won’t pretend that doing a knee examination on the block lead wasn’t slightly terrifying. But it was good practice and he offered some good pointers for improving our technique and also showed us he would examine a knee or hip, which was handy to reinforce the technique.
This week ended with a presentation on the Friday about polytrauma. Every Friday we have a case presentation, where a student does a presentation or brings an interesting patient case to discuss and all learn from. These sessions are facilitated by one of the doctors who specialise in medical education and are generally very good quality. This week, I had volunteered to bring a topic and a case, and the subject for discussion was polytrauma. I did a short presentation on managing major trauma (i.e. a road traffic accident) and then presented an interesting case that we had seen. I was nervous for the presentation, but actually it went quite well and some of my cheesy jokes definitely helped break the ice.
That’s my rundown for my last 2 weeks! I finished Friday afternoon and decided to have a spontaneous weekend in Newquay, made better by the fact we have Monday off. Medicine does have its perks!
July 16, 2020
Placement has resumed. Hoorah! For the last two weeks I have been on my musculoskeletal placement which was delayed for 3 months due to COVID. Thankfully, things are back to (nearly) normal. Monday started with induction, where the administrator of the block gave us our timetables and our new uniform – scrubs! So far in the course for placement we have been expected to wear smart clothes – for me a white shirt with the sleeves rolled up to the elbows, smart trousers and smart shoes. However, due to infection control, we have been told to wear scrubs, which can be washed at higher temperatures and more often to kill any nasty bugs. I’m certainly not complaining – while I like wearing my own clothes, ironing all my shirts on a Sunday night is not the relaxing activity you need before the start of a new week. Scrubs are comfortable and easy to wear, with no thought about which trousers go with which shirt. It does feel very informal to be wearing what basically feels like comfortable pyjamas, but I’m not complaining.
On Tuesday we spent all day in theatre with our consultant working through the trauma list, so the operations were focussed around fixing acute problems such as broken bones. It was pretty cool to be back in theatre and a welcome reintroduction to medicine after 3 months off. I have to admit, I had sort of forgotten….well everything really. But luckily there were some lovely scrub nurses around to help remind me how to scrub in for theatre. “Scrubbing in” is an odd term really, but what it actually means is washing your hands in a very specific way to remove any bacteria or viruses and then donning a sterile gown and gloves in a very specific way to make sure they are clean and don’t infect the patient. I’m sure on TV you’ve seen the surgeon and their assistant wearing a long gown and gloves right next to the patient while everyone else stands further back just wearing scrubs. In theatre we get a chance to put on the gown and stand next to the surgeon, and even help out a bit by holding tools and things like that, which was pretty cool. Our consultant is very good at explaining what is happening at stages of the operation, which really helped. I think all medical students should spend time in theatres seeing common operations. Even if you don’t want to be a surgeon, you should know what an operation involves and by seeing it done, you will be better at explaining it to patients. For example, even a GP will be doing some of the aftercare of a hip replacement, and if you’ve never seen one, it can be harder to explain what it involves and recognise when the patient may have complications afterwards. As well as that, it helps things stick in your memory for final exams!
I also got some news this week – I’m a final year! We were told that we progressed from third into final/fourth year. It was more of a formality than anything else, as we basically just needed to be signed off for our first two blocks to progress with no exams this year, but it was still nice news. It does feel slightly odd to change my introduction when talking to patients from “Hi I’m Jordan and I’m a third-year medical student”, to “I’m a final year medical student”, and hits home that I am on the final stretch. It seems both a long time ago and only yesterday when I was the scared first year trying to understand anatomy and not knowing how to talk to patients other than “Have you got any pets?”. Ironically whether they have pets tells you more about their medical condition than you might suppose…Anyway, In one year, I will have done finals, and (hopefully) have passed and become a doctor. Scary indeed, but I’m ready to face the challenges ahead.