All 182 entries tagged Student

Accidents and Emergencies

For the last two weeks, I have been on placement as part of the ‘Acute Block’. I have been excited to experience as much as possible during this block as I’ve always considered ‘Acute Medicine’ as a potential career path after graduation. The block includes a variety of placements including A+E, the Intensive Care Unit, Anaesthetics, etc. There’s something I find exciting about the challenge of not knowing what’s going to come through the door and having to work quickly to make the patient better. (This may just be because I’ve got a short attention span, but I’ll let you decide!)

Last week I had two shifts in Warwick Hospital’s A+E department. One shift was in ‘See and Treat’ from 1.00pm - 9.00pm and another in ‘A+E Majors’. ‘See and Treat’ is where patients have problems that can be treated on the spot without need for lengthy hospital admission. I thought that I would be shadowing at first and then may be able to see some patients later, however I was immediately told to go and see patients. Having just come out of the 6 week ‘Psychiatry Block’ I was quite apprehensive as it had been some time since I’d put my knowledge of physical medicine into practice. Quickly enough, though, I was able to remember how to examine a suspected broken foot and I knew what questions to ask to rule out a bleed on the brain after a head injury. Most of the patients had suspected fractures, so I also got a fair helping of X-ray interpretation. One of the Advanced Nurse Practitioners was keen on teaching and went through some good radiology revision with me, as well as the criteria for a head scan after trauma.

This week I have also had shifts on ‘A+E Majors’ at UHCW, our main teaching hospital, and also a regional Major Trauma Centre (MTC). I didn’t really know what a MTC was before this block, but it basically means that it is a centre of excellence for dealing with major traumas such as car crashes, stabbings, shootings etc. Not all hospitals are MTCs, so it’s sort of neat that our main hospital is. It also means that patients are brought in from all over – so if you had a car accident outside for example Warwick Hospital, even though there is an emergency department at that hospital, the ambulance service would drive you all the way to UHCW. The theory is that because UHCW is used to dealing with these major traumas, the survival rate is better. I think I saw a research paper that showed that structuring services like this does save lives every year, so it does work. Because of this, during my time in A+E Majors, I have seen several traumas, along with heart attacks, pneumonias, sepsis and many other things.

During my second shift, Majors was busy, so I went over to the “Rapid Assessment and Treatment” unit, where they assess patients and decide where they need to go next. Up until now I had only done 3 cannulas and failed 2 of them so I was feeling less than confident. However, in the Rapid Assessment unit, almost all of the patients need cannulas – so this was my chance to get some practice in. I managed to try and do 3 more and managed to get all of them, massively improving my overall success rate. Towards the end of this shift I went back over to Majors and was told that there was a patient having a heart attack. I was able to go over and see the patient and observe while they got their treatment. In the media, you only ever see negative stories about our NHS – for example how the targets aren’t being met, or when it failed to give good care. Today, however, I saw how the NHS does work when it matters – for example, someone can have a heart attack, have the paramedics turn up, be taken to a specialist hospital with a specialist cardiac unit, be seen in A+E, and then be taken to the catheter lab to have the clot removed within an hour and a half. This saves their life. The NHS isn’t perfect by any means, and there are lots of inefficiencies. However, when someone is really sick and in need, the NHS delivers, and it delivers the best standard of care imaginable. To make it even sweeter, it costs patients nothing at the point of care.

Hattie Trigg : 13 Mar 2020 16:34 |  Tags: Jordan Mbchb Student Warwick Wms |  Comments (0) |  Close comments |  Report a problem

Acute Block

This week we started Acute block which is our 6-week placement where we experience A+E (Accident and Emergency), AMU (Acute Medical Unit) and ITU (the Intensive Care Unit). Over the six weeks we have two shifts on A+E Majors (what they like to call “big sick”), one on Resuscitation (very unwell patients), some time on ITU and AMU wards. This week was week 1 and neither I nor my clinical partner were timetabled any shifts, which gives us a nice opportunity to settle into the block and remind ourselves of some actual physical medicine first!

On Monday we had induction from the block lead, who is one of the A+E consultants over at Warwick Hospital. This was exciting and also terrifying because we were told of some of the extreme things that we may experience during this block – including cardiac arrests and potentially helping out with CPR. While this is a very scary prospect, I do teach CPR to other medical students, so at least I’m somewhat prepared. Despite this experience, I am sure that actually having to do CPR on a real person for the first time will be daunting and probably something I will always remember. Let’s see what the block brings!

On Tuesday we had lectures on the A-E approach and trauma. The A to E approach is a way of assessing a very unwell patient where A stands for Airway, B for Breathing, C for Circulation, D for Disability and E for Exposure. These are meant to be done in order, so you look at the airway first, then assess breathing etc. This approach is something that we were taught last year, but the standards are a lot higher now that we are third years. We also had a lecture on trauma (complete with grisly pictures!) and how to manage this. UHCW (the main hospital for Warwick Medical School) is also a Major Trauma Centre, so you can often hear the helicopters landing with a trauma call. A+E and trauma are aspects of medicine I am keen to explore as potential career options, not that I wish there to be any major traumas during my placement!

On Wednesday we had our first session in the simulation suite at Warwick Hospital. Simulation is quite new to medical education in general, but it can be a very useful and safe way of learning what to do in clinical scenarios. The patient for these sessions is “Sim-Man” which is a rubber mannikin hooked up to a computer. This mannikin is amazing with the things it can do – it breathes, can blink, can make noises and even has pulses! The operator on the computer can even make it breath with a wheeze. The session was facilitated by a Consultant Anaesthetist who also gave us a quick lecture on prescribing fluids, and then we were into the room with Sim-Man. My scenario was a patient who was on Morphine for pain and then his breathing was slowing down. Added to this, he had low blood sugar. It was quite stressful trying to remember how to treat the Morphine overdose and what to administer to raise his blood sugars, but helpfully I had two other medical students who were my “Assistants” and were helping me to assess and treat the patient. Overall it was one of the most useful things I’ve done here and actually seemed quite realistic. The only difference was that Sim-Man is made of plastic…

Hattie Trigg : 05 Mar 2020 12:42 |  Tags: Jordan Mbchb Patients Student Warwick Wms |  Comments (0) |  Close comments |  Report a problem

Happy birthday!

Labour ward here I come! I may have dragged my tired brain out of bed when my alarm went off at 5 so I could grab the first bus off campus but it was so so worth it.

On my first shift, I was assigned to the Lucina ward where low risk births happen. The rooms were beautiful with huge birthing pools, lots of beanbags, and fairy lights in the ceiling giving the impression we were under the nights sky. Unfortunately, we had no patients (which I think is a first for the NHS) and the Lucina ward was shut down. I ended up shadowing the midwife who was originally on Lucina with me. I went into the room of a mother who was having contractions and I ended up chatting to the student midwife there. We don’t get an awful lot of interaction with other healthcare students as student nurses are so busy, you feel bad for disturbing them. She taught me about interpreting the CTG (the machine producing the wiggly line you see on one born every minute) and I began to see the wood for the trees with interpreting the lines.

As the pregnancy progressed, I saw how midwifes cope with the transition to the final part of labour and before I knew it, I was watching a beautiful baby boy being born. Mum was exhausted and it struck me just how misshapen babies heads are when they are first born. I was so happy for the rest of the day and I got to do some minor tasks around the ward such as taking blood and doing general obs. It felt amazing to be included in the team and I went home a happy student, if slightly tired.

My next shift, however, was one I will never forget. The first part of the day was quiet, and we were waiting around for something to happen. This is the norm on labour ward. When we turned up the midwives were joking around saying we should have turned up 12 hours earlier as they had birthed 14 babies overnight. I got to experience the delights of the labour ward toast (a legend passed down in the medical school) and attempted to draw blood. I decided to make it a mini-cex so I had a ST4 anaesthetist shadowing me which was terrifying. I was struggling to get the blood so eventually, he had to step in to help, which was slightly annoying as I couldn’t use it as a sign off but hey ho!

In the afternoon I ended up in a room with a lovely couple who were roughly my age. Being in that room was brilliant as everyone was joking around and we were chatting about everything from English lessons at school to favourite Disney movies. At one point I forgot I was on labour ward!

Eventually, the contractions got more frequent and before I knew it I was helping set up the labour equipment and the midwife was putting out sterile gloves for me and I was fully involved in the labour process. I could see the baby’s head appearing and before I knew it the midwife grabbed my hands and I helped the rest of the body to be born and passed baby up to mum with the midwife guiding my hands. I had just helped deliver a baby. I had the biggest grin on my face and I am not sure who was happier, the parents or I! I helped the midwife birth the placenta meaning I got to examine the placenta with the amniotic sac attached. It was incredible to remember that the placenta and the baby had all originated from two half cells. I wanted to stay to find out how much the baby weighed and its measurements as the parents had predicted and I wanted to see if they were right or not. When I looked at the clock after we had cleaned up I realised, I had done 14 hours on labour ward! However, I didn’t care. I had just helped a baby come into the world and no feeling could beat that.

I have two teddy cut outs on my wall now (pink and blue) to remind me of the two births I had seen. It will be an experience I will carry through me for the rest of this year and although I don’t think obs and gyne was for me, I enjoyed every second there.

Megan Earle : 21 Feb 2020 13:54 |  Tags: Abbie Gyne Mbchb Obs Student Warwick Wms |  Comments (0) |  Close comments |  Report a problem

Next Please!

This week we got to have our first taste at being a GP. I have to admit , it’s not a career that I have ever seen myself going into. I thought it was all going to be colds and coughs but, I was proved wrong!

Our GP is the Gabels Medi Centre so, it isn’t too far to get to and when they said our first week started at 10am, my tired brain celebrated! I could get up after 7am! We were welcomed and made to feel part of the team immediately and it felt amazing to be there. I was initially out in to observe a nurse and I got to see 12 month vaccinations. It sparked a conversation about the anti-vax movement which is increasing in the UK and the mum herself knew of someone who was anti-vax but had managed to be persuaded to give her child the vaccinations. It was interesting and gave me a bit of food for thought for the day.

In the afternoon we attended the sister practise up the road and met our mentor who was to oversee us through the next 7 weeks. We also run our own consultations in GP but I didn’t expect to be running them on the first day. I did feel a little out of my depth but I soon began to enjoy it. It’s nice having the GP there in the back of the room to glance to for help. In fact, on my first case I virtually ran to her in my mind as my patient had a rash from a suspected diabetic foot complication. They were a lovely patient but unbeknownst to me, I had severely over run my appointment! Must.Get.Better.At.Directing.Consultations......

However, my other patients were also lovely and the most surprising thing to me was the variety. I honestly did not expect to be jumping around each system between appointments, especially at this time of the year when colds and coughs are rife. It was also nice to get feedback from both my CP and GP and also give the same to my CP. I think we are both wobbly on histories and we both need to work on getting our consultations quicker but we came out of that day beaming.

It felt like we had made a difference to patient care, especially when the GP was going off our suggestions! I had my foot patient coming back for the next week so I need to read up on diabetic treatment. It felt amazing to be put on the spot but also to drag information from the depths of your brain and put it into practical use out in healthcare. I think we both went home thinking a lot more about GP as a potential career but I know that paediatrics is still my forward choice at the moment.

We’ve also had our first community midwife shifts and again, I loved every second. I met a two day year old baby and I had to control every fibre of me that just wanted to pick her up and have a cuddle. The visit was to check in on both mum and baby and to answer any questions mum and dad have. It was clear the little one was a tad early but apparently that’s all babies, appear when you’re not quite ready ! I also got to see a heal prick test carried out on a 5 day old which was nice to see as we were taught about these in Block 5 last year.

In the afternoon I got to sit in on some check up visits with mums still pregnant and help the midwife with urine dipsticks and got the chance to feel the bumps for babies' head and bum. It felt amazing to be allowed into such an important part of the couples lives and I was allowed to take a maternity information pack away with me to look at in my own time.

Im finding that I love the clinical side of the medical degree. It’s making me think of other career options and being able to put into place all the theory I learnt last year, put all that work last year into context. We’ve got labour ward shifts coming up which I am really looking forward to… well, apart from the early starts! 'Til next time – Abbie.

Eden Villiers : 10 Feb 2020 08:49 |  Tags: Abbie Mbchb Patients Student Wards Warwick Wms |  Comments (0) |  Close comments |  Report a problem

Introduction to Prescribing

It has been another busy week for my clinical partner and I. Up until now most of our experiences with psychiatry have been in an outpatient and community settings, so we were both looking forward to seeing how acute psychiatric issues are dealt with. This week, we have been placed on an acute psychiatric ward this week, in a Psychiatric hospital. It was interesting being able to sit in on the ward rounds and see the various conditions the team must deal with on a day to day basis. These conditions are amongst some of the hardest to treat medical conditions and include; severe depression, anxiety, mania and personality disorders.

Our consultant was keen that we get involved and gave us the opportunity to practice our history taking with patients where we could get consent, although admittedly it was a whole new experience when compared to your standard history taking scenario. Some of the conversations we had and listened to this week were very emotionally difficult for all involved, and I have huge admiration for the staff and indeed the patients who have to work to improve often difficult situations.

This week we also had an academic day where we were given an introduction to prescribing. I had been looking forward to this for some time, as prior to starting medical school I worked in Pharmacy as a dispenser, so I was waiting for an opportunity for my pharmacy knowledge to become useful! We had lectures which focused on the basics of pharmacology relevant to prescribing, a lot of which was revision from our first-year studies (which feels like a long time ago!) We also had a lecture on some of the pitfalls of prescribing, for example, making sure that you write units in full to avoid confusion and also about some of the common errors junior doctors make. It turns out that junior doctors make 90% of prescribing errors, which I suppose demonstrates both how junior they are and also the fact that most hospital prescribing is done by the juniors. It was all slightly terrifying to think about how much responsibility we will have in just over a year’s time. I know first-hand from my previous work experience how crucial it is to get things right and minimise mistakes to make sure the patient gets the correct treatment.

We also had a lecture on the UK foundation programme, the two-year programme that all UK graduates must complete immediately after graduation. Up until this lecture I had happily forgotten how soon this process kicks off – by the end of this year we will have applied for our first jobs as doctors and ranked the areas we would like to work. Currently I want to stay in the West Midlands after graduation as I have had experience of many of the hospitals in the area, and I feel this will make the transition from student to junior doctor smoother. Allocation is completely points based, with 50% of your mark coming from your achievements at medical school and the other 50% coming from a test called the Situational Judgement Test. This test is sort of a test of reasoning. For example, the questions will be something along the lines of “This thing has happened. What is the most appropriate thing to do?”. We get lots of practice questions and cases in CBL, lectures and other aspects of the teaching so I hope that I will pick up the knack to it.

Next week is last week of our psychiatry placement, which means that we have to finish our sign-offs and say goodbye to our faculty team before moving on to our Acute placement block. Looking ahead at our timetable for Acute it looks to be a busy block, with lots of long days and night shifts. Some of these are in A+E, and others on acute medical wards. After Psychiatry, which is a very separate field to “physical” medicine, I have to admit that I am excited to get stuck in and have some exciting experiences on the very front-line of Medicine. However, it will be stressful – here’s hoping that my knowledge from exams comes rushing back….

Eden Villiers : 10 Feb 2020 08:48 |  Tags: Jordan Mbchb Patients Student Wards Warwick Wms |  Comments (0) |  Close comments |  Report a problem