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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.
July 07, 2020
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.
June 01, 2020
For the last two weeks, I’ve been continuing with my work on the Gerontology ward at University Hospital Coventry. Gerontology is care of the elderly and the ward deals with general medical problems in this patient population. Many of the patients have a condition called delirium which means they are acutely confused (i.e. the confusion is new and has a rapid onset). Delirium can be caused by infections or even just by being admitted to hospital, but it is often reversible and the confusion gets better when the patient's medical condition improves. In addition to this confusion, many of the patients have existing dementia, where their confusion and cognitive abilities are impaired due to this long-term condition. This has made it very challenging at times when trying to encourage these patients to eat and whilst tending to their personal needs as they are often confused when and do not understand what you are doing or why.
I’ve worked on the ward for two months now and I think while I haven’t done much actual medicine in this time, I have developed what people call the “soft” skills which I think make the difference between a good doctor and a great doctor. It is not just about being able to recognise a cancer, for example, but being able to communicate with the patient about what their wishes and needs are. Communication is the most important skill a doctor has to have and is the cornerstone of what doctors call the ‘therapeutic relationship’ – a partnership between doctor and patient. When trying to communicate with confused patients, it is crucial to speak very clearly (which can be difficult wearing a mask), and I definitely think my own communication style has changed. Since I was a child, I have always spoken very quickly in general, to the extent that I used to get told off as a child because no-one could understand me! I also had a stutter for certain periods of my childhood, and I think working with these patients where communication is absolutely fundamental has led to lasting changes in the way I verbally communicate. I would say the speed of my speech when talking to patients has slowed down and I use clearer phraseology. I also have learned that if someone doesn’t understand, that is it essential to check if they usually wear a hearing aid and, indeed, if it is turned on!
I have really started to miss studying. It sounds strange when most people hate studying, but I find learning and working towards the goal of finally qualifying one of the most satisfying things in my life. There is a strange sense of dislocation when a goal you have worked towards for 3+ years suddenly seems further away and the goalposts shifted. I think the sense of dislocation comes from the questions and uncertainty due to COVID. Will we restart placement in July as the Medical School has planned? When will our final exams be? Will we have an elective period? Will we be as well equipped to pass finals as the students who have gone before us with potentially less time on placement? Healthcare students around the world face the same dilemmas and uncertainties and I hope things go back to normal soon for all of our sakes.
One flash of light in all of this uncertainty has been a revival of peer support. Warwick is known for being very strong when it comes to peer support, which is when the years above run sessions and teach to help the younger years. Our fantastic finalists have been true to that tradition and have been running online sessions to help us with some of the questions we have. They have done sessions on our final exams and what helped them, as well as practical tips for getting through this period. I think having this support run online at this time has certainly given me hope that we will come through this and be able to rise to the challenge of finishing the course successfully. It’s comforting to have support from those who have been through it and come out the other side.
May 15, 2020
Week 8 of lockdown, aren’t we? To be honest, everything feels so much of a blur and all the weeks have moulded into one. It does however feel like an age since I was last wearing my stethoscope on the wards trying to appear like I knew what I was doing. Covid 19 has truly changed our lives and we as medical students are no different. As you have probably seen from Jordan’s updates, we have been given the option to work in local trusts and I have been allocated George Eliot's (Geliot) A&E department. I was amazed when I got offered it and I really have enjoyed it. I even have done my very first night shifts which are strange. Trying to stay up the night before is hard and I don’t think I would have gotten through the first one if it wasn’t for my good friend, Red Bull (other brands are available).
I have been lucky as it’s given me the opportunity to practise my clinical skills and I have mastered the art of small talk whilst doing cannulas. I have grown so much in confidence with these, just need to work on putting in the next gage (bigger diameter cannula) up as I seem to struggle with my pinks. One of the best parts has been having a good old chat with the patients. I had a lovely human the other night and we spend an hour chatting about the original VE day, being evacuated, the bombing of Coventry Cathedral (one of my favourite facts about WW2 purely because it was in a Sherlock episode) and the rest of their life. We found out we have families in similar parts of the UK and we chatted about Megan and Harry and baby Archie. It has been nice to get to do this as the department has been…let’s say…. Less populated than usual. We normally get to 3am and one have one patient in majors, so we sit and chat as a team. I even got my ECG done the other day!
The PPE was a novelty at first, but I wish I could get away with not having it on. The mask dries my mouth out quickly and constantly breathing in your own C02 makes a 12 hour shift that much harder. We haven’t had a problem with PPE at Geliot apart from the nice elastic masks running out meaning everyone has to wear the tie-on masks which we all hate. One positive spin is that the team cannot see how much I yawn at 3am! It’s one of the only times I have liked being someone who smiles till their eyes disappear.
I got to experience being in full PPE the other day as we had a peri-arrest Covid positive patient come in. I was only in it for 2 hours, but I was boiling and thirsty. The ICU team are heroes! The patient was fine, and I put in their cannula and took their bloods and before long, they were sent to the wards. I have also seen someone extremely sick from Covid. They unfortunately passed away in the department and I felt heartbroken for the family who couldn’t see their relative in their final moments. It was also the first patient I have seen pass away and it's a moment that will forever stick with me. Night shifts bring everything to the table.
Outside of ward work, we have been given our SSC2 projects to do. We are all currently doing a systematic review. I found a topic similar to that of my original project but I am finding the software…..tricky. Let’s say I have come close to sending my computer on a horizontal trajectory through the window and onto the ground outside. However, it’s no different to the problems I faced in my undergrad dissertation except this time, it’s computer software and not human brain cells letting me down.
We are due back to placement at the end of June pending on how the third years get on. The crisis will impact my degree even beyond this year as we found out our third-year placements will be one week shorter and, depending on any future lockdowns, my second-year placements could also be made shorter. It’s scary to think, but this will affect the future training of doctors. Interestingly, I prefer doing the 12 hour shifts as opposed to turning up onto a ward hoping for something to do. I have learnt a lot more, even my ECGs are coming along! I think we would benefit training like student nurses and having shifts instead of popping in. That is just me though, I have a lot of time on my hands at the moment!
'Til next time!