All 102 entries tagged Student

The End of The Block…

After what feels like the longest year that most of us can remember, we are finally done with our last block of the Specialist Clinical Placements. It’s hard to believe that from now on, it’s all going to be revision and clinical apprenticeships (presuming finals success…). I’m glad that we ended with the Psychiatry block, however, as it allowed us to focus on an area of medicine that we don’t see very much of outside of psychiatry, and hopefully having this block so late will keep the information fresh for our upcoming exams.

Our last week of Psychiatry involved more time spent in an acute-ward setting, and enabled us to see far more presentations of common psychiatric conditions, including Emotionally Unstable Personality Disorder, severe Generalised Anxiety Disorder and many other fascinating presentations. We were also able to see another assessment under the Mental Health Act, something which is taken very seriously (for obvious reasons) and is very thorough and complete. I’m glad that so much effort is put in place to safeguard patients who might not be in a safe mental state to manage their own mental-health conditions, and it’s good that the process is so robust and observed so closely. There really is a lot of legal scrutiny for the process of detaining patients in hospital, and every professional I have worked with has agreed that this is entirely appropriate.

Looking back on 2017, it’s really amazing to think of how much ground we have actually covered; there is so much that I didn’t know at the start of the year but have picked up throughout the course of the year through many different means: we’ve had large-group teaching, small-group teaching, one-on-one teaching, ward-based exposure and of course loads of self-study. My notes, however, are a complete horror show and I could easily spend the majority of the next two months just reorganising and getting everything into shape! But of course we don’t have time for that right now. It’s all about accessing, revising and hopefully committing to memory all of the information that we’ve learned over the past three-and-a-half years. The task is daunting, but I think we’ve climbed steeper hills (first year, I’m looking at you). My main goal for the first day of revision is to at least get everything on one disk drive!

Now that we are done with our last Specialist Clinical Placement, most of our cohort are now off on Christmas break – which will be nice, but of course we will have the additional spectre of upcoming final exams looming over our heads. I’m looking forward to leaving the UK for a couple of weeks – Coventry is lovely, but I think I need a change of scenery to keep from going mad – and hopefully some slightly warmer weather and creature comforts will be the perfect environment to start my revision.

John

Joshua Galvin : 03 Jan 2018 09:12 |  Tags: Joanne Mbchb Student Warwick Wms |  Comments (0) |  Close comments |  Report a problem

The Acute Block… the Pressure Mounts

We’ve recently started our acute-medicine block, which is a very descriptive title. This block has us students at the very thin end of the wedge as far as treatment and patient management goes, and the block also has the reputation for being one of the most enjoyable of all specialist clinical placements. I can see why – it’s fast-paced, exciting and the timetable is laid out really, really well. Our opportunities are wide and varied and all of the doctors whom we work with are willing to help and get us involved. It’s a very collegial and inclusive atmosphere, at least from what I’ve seen so far. This is a branch of medicine that I could really see myself liking a lot.

The people designing the timetables have worked hard to give us exposure to a huge variety of disciplines at both a large hospital and a smaller one. We have rotations in the Intensive Treatment Unit (ITU), in the ‘majors’ and ‘minors’ departments of both large and small hospitals, a couple of shifts on the resuscitation wards, and a whole lot of other things as well. It’s really interesting. I feel like we are also being taken very seriously as medical students finally – perhaps when you reach the final year, doctors know that you’re more experienced and are happy to supervise you in your role but give you less guidance – which is exactly what we’ll need as F1s. On several shifts, I have been given the opportunity to clerk patients (conduct an initial history and examination) and present my summary along with differential diagnoses and a management plan to the doctor in charge, and I have always got useful and worthwhile feedback afterward.

I recently spent some time on the resuscitation ward within the larger of our two hospitals, and loved every minute of it. It was an evening shift – this is so that we can see patients at the busiest time of the day – and there were loads of interesting presentations. The purpose of resus is to stabilise each patient and make sure that all life-threatening conditions are neutralised before they are transferred to more appropriate care – which usually means another ward within the hospital. On my most recent resus shift, we saw several people with complicated fractures – treating these involved taking x-rays, putting on emergency plaster casts and sometimes re-applying the cast if the subsequent x-rays weren’t showing what the doctors wanted to see. I got to hold lots of legs in place for stability whilst wet slabs of plaster were slapped on and wrapped up. All I can say is: thank goodness for aprons!

Our time on the ITU was a little more sedate, although still very interesting. We saw patients who had usually come from A&E (although not always) and had usually suffered severe injury, several of which were to the brain. Several patients were in induced comas whilst their serious medical issues were treated. It took a little bit of getting used to, but once we were stuck in, it was really very exciting. We still have four weeks left of the acute block, and I’m really excited for what we have yet to see – watch this space!

Joshua Galvin : 22 Dec 2017 10:10 |  Tags: John Mbchb Student Warwick Wms |  Comments (0) |  Close comments |  Report a problem

Getting Stuck into the Acute Block

We’re in the middle of the acute block and it is really living up to its vaunted reputation. I am having a great time and learning a lot, and it seems like everyone in my rotation is having similar experiences. My clinical partner and I are lucky because most of our teaching and shadowing sessions are at a very large regional hospital; this appears to mean that we see lots of injuries and presentations that wouldn’t normally go to a regional hospital. There is a lot of trauma and some fairly serious acute medical presentations, and we get to see a lot of very interesting and cool things.

I’ve found that we are really encouraged to get involved once we tell the A&E staff that we are students, and this is a huge advantage of the acute block and being so far advanced in our careers as students. When we’ve been observing/helping out in A&E, most of our time is split between A&E minors (where people present with not-very-acute conditions) A&E majors (where people come for acute and serious but not life-threatening presentations) and A&E resus, which is geared toward stabilising patients, saving their lives and initiating immediate management before passing them along to more appropriate parts of the hospital.

Each area has its positives: the minors area is the least hectic and stressful of the three, which means that when we see patients here, we can spend more time focusing on their presenting complaint without the added pressure of it becoming urgent very quickly. In the majors area, the energy level is really high, and there are loads of doctors around, so as students we get support as soon as we need it and clinical contact all the time. And the resus area gives us the opportunity to see the bare face of medicine, where people’s lives need to be saved immediately. Both my clinical partner and I have seen some really eye-opening trauma in resus – let’s just say that I am absolutely never, ever getting on a motorbike in my life.

I feel that we’re lucky because our acute block is coming rather late in Phase III (much luckier than had it been our first rotation, for instance). It being so late has equipped us to consolidate a lot of the medical knowledge that we’ve built over the phase and indeed over the preceding years, and we also have a lot more confidence speaking to patients and getting straight to the point about what information needs to be uncovered. Unlike lots of other degrees, basically everything that we’ve learned throughout our time in medical school (especially a lot of the anatomy and physiology from Phase I) is relevant at all parts. The vocational nature of the degree means that everything is applicable at all times – we were quizzed the other day on the mechanism of action of bronchodilators, which we learned in November of our first year! In any event, the acute block has exceeded my expectations, and I am seriously considering a career in emergency medicine because of it

Joshua Galvin : 22 Dec 2017 10:09 |  Tags: John Mbchb Student Warwick Wms |  Comments (0) |  Close comments |  Report a problem

Fingers and toes crossed…

Well that’s it, I have officially completed my final specialist clinical placement as a final year medical student. I will be back in hospital in January for my revision block and then next stop finals!

I cannot believe how fast this year has gone, it feels like only yesterday I was checking my emails as a 3^rd year student to see where my first specialist placement would be and it doesn’t seem that long ago I was in the lecture theatres in first year. The amount I have learnt in such a short space of time is quite staggering, however it is equally alarming how much I need to learn and remember over the next 8 weeks!

The last two weeks of my musculoskeletal block have mostly been focused on rheumatology and our end of block assessments. I presented a patient case about Psoriatic arthritis (a condition that affects the skin and joints) to our consultant and was then quizzed about my knowledge of the case and of the disease, which was quite nerve wracking but good practice for our clinical exams. We also had our end of block clinical exam which is run exactly like our finals will be. Mine was in fracture clinic with a patient presenting with hip pain. He was such a lovely person and he was still in very good spirits when I saw him despite him already seeing another medical student due to a lack of patients. He was less impressed with my examination technique which involved making him manoeuvre quite awkwardly around the couch which would have been tricky even if his hip didn’t hurt! I certainly still have some way to go before my examinations are slick enough for finals!

In our last week my clinical partner and I were invited by our rheumatology consultant to attend a special clinic conducted by a Professor visiting from London. This professor specialises in a rare disease called scleroderma, a disease where the body’s immune system attacks different tissues in the body resulting in skin disease and various problems with other organs which can be life threatening. This is an incurable condition and it can be very difficult to treat, many of the patients in the area with this condition travel to London for treatment but once a year this professor visits Coventry to see particularly difficult cases and offer advice to the rheumatology team at UHCW. It was interesting to observe the UHCW consultants presenting cases (getting tips for my own exams!) and see how this world-famous Professor was still so down to earth and friendly with the patients. While medical students are often told not to worry too much about rare diseases, when you are in final year and preparing for clinical exams you start to believe all the rumours about some of the tougher clinical cases, with scleroderma rumoured to be one of them I wasn’t going to miss the opportunity to attend this specialist clinic!

Keep your fingers and toes crossed me and hopefully the next time I’m writing my blog it will be on the right side of finals!

Joshua Galvin : 18 Dec 2017 09:43 |  Tags: Joanne Mbchb Student Warwick Wms |  Comments (0) |  Close comments |  Report a problem

Psychiatry and Beyond

As 2017 draws to a close, it’s amazing to think of how much ground we have covered and how much we have learned since the start. We are now coming to the end of our eighth Specialist Clinical Placement this year, and once again it’s been a fascinating tour through a part of medicine that we’ve not had much exposure to up till now.

After spending the first three weeks of the block on a community psychiatric placement, we have spent the past two weeks learning about old age and acute psychiatry. Most of the care that we have had in these two sections has been ward-based, and we have had the opportunity to see some very interesting presentations of a more acute nature. These tend to be patients who have been asked to remain confined to a ward for their own good, as they pose a danger to themselves or other people and are in clear need of treatment. The legal process that doctors are required to go through in order to detain someone are very robust, and I think that this process is crucial to a beneficial and defensible medical service.

It’s easy to think of medicine in discrete blocks: a patient with a heart problem is only a heart problem, a patient with bipolar disorder is only bipolar disorder, etc. But what we have seen a lot of in this block is patients with multiple mental-health and physical-health comorbidities presenting at the same time. We have been able to see why psychiatry requires a strong foundation in physical medicine – doctors need an in-depth knowledge of physiology in order to understand side-effects of drugs and physical causes of mental ill-health, among many other things. Although my stethoscope isn’t getting much exposure during this block, the potential to use it is always there. Next week is our final week on psychiatry (and actually on Specialist Clinical Placements altogether!) and I’m really looking forward to what it will bring.

Along with several thousand other hopeful final-year medical students around the country, we sat our Situational Judgement Test exams last Friday. This is a relatively new assessment (in the past five or so years), which plays a large role in determining where we will go for our foundation-programme placements. We were presented with dozens of ethical scenarios and asked to respond to each, and even though Warwick Medical School do a really good job of preparing us for the exam (as much as they can), I think it’s fair to say that there’s no more preparation I could have done to have performed better or worse. It’s just so tough to prepare for this exam – I guess that’s the point, though! We’re expected to react instinctively and be evaluated based on this judgement. We won’t know the outcome until early March when we are given our foundation-programme placements.

And very soon our Specialist Clinical Placement blocks will draw to an end entirely, leaving us in the run-up for finals. It’s been a long road and a very busy year, but I’m looking forward to seeing what the next chapter brings!

Joshua Galvin : 13 Dec 2017 16:53 |  Tags: John Mbchb Student Warwick Wms |  Comments (0) |  Close comments |  Report a problem