All 97 entries tagged Student

One exam down…only a gazillion more to go

First exam done! All Warwick students sat the national Situational Judgement Test (SJT) last week. This is an exam that makes up 50% of our total score for our Foundation job applications so while it doesn’t test your medical knowledge it’s still very important! The SJT focuses more on the qualities expected of a doctor and how you handle difficult situations that we will be faced with such as confidentiality issues, explaining mistakes to patients and prioritising our workload. It’s a tricky test to prepare for so I’m glad it’s out of the way.

Apart from SJT practice I’ve still been enjoying my musculoskeletal block, we’ve been in the plaster room practicing putting casts on each other and I’ve also been in the trauma theatres. A day with the trauma team starts early with the 7.30am trauma meeting where all the traumas that came in the previous day are discussed and operations planned and prioritised. The team on call then head off to fracture clinic and the junior doctors respond to any trauma bleeps from A&E. The following day the same team then is in the trauma operating theatre doing any operations that are required on trauma patients that have come in over the previous few days. The day that I was in theatres we had a huge variety of different hip fractures, an unusual fracture in a teenager and then more common types of hip fractures that occur in the elderly. When we first learnt about falls in the elderly and hip fractures in second year I could not believe how much they cost the NHS with some studies suggesting they cost £1 billion per year, they are also a significant cause of mortality with a significant proportion of elderly patients not surviving even just 1 month after a hip fracture. All the studies show that if you treat a hip fracture quickly the mortality goes down no matter what the age of the patient is. For that reason, we had patients in their 90s on the trauma list to fix their hip fracture to preserve their mobility so they don’t become unwell and suffer any further complications.

Operations to fix hip fractures aren’t the most pleasant to watch and there is an awful lot of hammering and banging that makes you appreciate why people are so sore after their operation. I don’t have the best track record when it comes to fainting in theatres so I was slightly apprehensive about attending trauma theatres. So far during medical school I’ve hit the deck on a ward during a chest drain insertion as well as in theatre during a C-section, both times staff were lovely and understanding but both times I was completely mortified so I ate the biggest breakfast I could manage before heading into theatres. I must admit then when I was scrubbed up and quite close to the action I did feel quite queasy but I managed to stay standing! Hopefully I’ll have plenty of opportunities to further desensitise myself during our assistantship so I don’t continue to be a falls risk!

Joshua Galvin : 04 Dec 2017 09:57 |  Tags: Joanne Mbchb Student Warwick Wms |  Comments (0) |  Close comments |  Report a problem

To study or not to study…

Two weeks into my final block and my fellow students and I are counting the days, not until Christmas, but to our exams! I’m already a week behind on my revision timetable and I seem to spend more time thinking about all the time I’ve wasted rather than getting on with my revision!

My last block is the musculoskeletal block. Our year group is split into 7 groups and each one has done the blocks in a slightly different order, so everyone is finishing on something different. Some students are happy they are finishing on General Practice so they can practice and revise almost every subject, other people are glad they are doing Paediatrics or Obstetrics and Gynaecology so that all the information covered in those blocks stays fresh in their mind for exams. Musculoskeletal isn’t a bad block to finish on, this block covers rheumatological conditions which are a favourite of medical school clinical exams and covers orthopaedic surgery so we are seeing lots of patients with osteoarthritis and painful joints, which also come up a lot in our exams. Many rheumatological conditions don’t just affect the joints but have effects on other areas of the body so it’s actually very good revision for other organ systems as well as ensuring my anatomy hasn’t been completely forgotten.

One of our teaching sessions can be slightly nerve-wracking with a consultant who likes to sit in the middle of a circle of nervous students and swivel on his chair and directing questions at us about almost any subject in medicine and surgery! Trying to think of another side effect of steroids when all the ones I remember have been said already or been asked to name 4 causes of clubbing (a clinical sign of disease in the nails) is quite exhausting but it’s also helpful! Our consultant helps us if we are struggling with a range of comedic actions and facial expressions and we all leave with a smile on our face knowing that while we got some answers right, it didn’t matter which ones we got wrong as now we know which areas of medicine we need to work on!

We are also spending time with the orthopaedic team in fracture clinic, seeing new patients as they are sent round from A&E with a variety of injuries. We are getting lots of practice with our history and examination as well as getting the chance to look at some painful looking X rays!

Aside from our MSK block and revision I am also trying to fit in some revision time for the Situational Judgement test, a national exam that will determine 50% of the score I get for job application to the foundation programme. Fingers crossed for the start of exam season!

Joshua Galvin : 21 Nov 2017 09:21 |  Tags: Joanne Mbchb Student Warwick Wms |  Comments (0) |  Close comments |  Report a problem

High security….

With just one 6 week block to go before my last Christmas holiday of medical school its all getting a bit scary. My fellow final year students are all getting a bit jittery at the mere mention of exams and some of us are still in denial that exams are happening at all. Helping at my final societies fayre a few weeks ago it felt strange to be asked what my plans were after graduation, how I had found the course and if I had any tips from eager first years when it doesn’t seem that long ago that I was in their shoes! It was great fun welcoming new students and handing over to the new president of the Psychiatry Society, a society that I’ve enjoyed been part of since I started medical school. I’ve been involved in organising some great events, increasing the size of the society and getting the chance to promote a speciality I feel passionate about. I’ve also met lots of people that will hopefully help in future job applications-perhaps I’m getting a little ahead of myself but its preferable to thinking about exams!

Overall, I’ve really enjoyed my psychiatry block, I’m even more keen to pursue it as a future career and being interested in the subject makes it that bit easier to study! For the last two weeks we have been assigned to a community psychiatrist who specialises in psychosis. It was interesting to be in these clinics where the focus wasn’t on treating every single symptom but on improving their level of functioning so they could remain in the community. To my surprise this often meant that patients had untreated delusions or hallucinations but as the consultant pointed out if the patient is safe and is not distressed by these symptoms then is it worth the risk of unpleasant side effects? On one occasion, a patient presented to clinic acutely unwell and was very agitated, I must admit I was quite nervous and unsure if I should pull my personal alarm (to call for help) but the consultant was able to calm the patient down an arranged to follow them up at home with the rest of his team. I was glad I hadn’t called for help unnecessarily in contrast to the previous week when I accidently set my alarm off and only realised when several people burst into the room!

Dealing with difficult patients is a vital skill in all branches of medicine but especially important in psychiatry, and particularly in forensic facilities. A great thing about the psychiatry block is that we can organise additional placements within different subspecialties, I organised time with the eating disorders team, the perinatal psychiatry team and also arranged a 1 day placement at a local Medium secure hospital. Secure units aren’t just for people who have committed crimes that require psychiatric treatment, some have challenging behaviour that is difficult to manage in normal inpatient settings and there may be a high risk of criminal behaviours. Apart from additional security within the building the ward environment wasn’t very different. Forensic services are different in that patients tend to remain in hospital for longer periods of time and continuity of care is highly valued with the same consultant responsible for their care when they leave hospital as an outpatient. Following up patients over the course of their illness and see someone literally get their life back on track must be very rewarding and wasn’t something I expected to think after visiting a secure unit!

I’m sad to see my 6 weeks of psychiatry come to an end but time marches on-so off I go to my final block, musculoskeletal medicine here I come!

Joshua Galvin : 10 Nov 2017 09:15 |  Tags: Joanne Student Warwick Wms |  Comments (0) |  Close comments |  Report a problem

Psychiatry: the Last Frontier

Our cohort is in the first week of our last specialist clinical placement, and there is a certain feeling of conclusion in the air. For the vast majority of our group, this is the last medical rotation we will do at Warwick Medical School. It’s hard to believe that we’re so close to being done (well, there’s just that small matter of final exams…), but at the same time it feels like we’ve been learning for a very long time (actually, we have!) and so the fact that the end is in sight is a bit of a relief. We’re very much looking forward to progressing onto the next phase of our lives and careers.

My clinical partner and I have Psychiatry as our last rotation, and it’s proving to be very interesting and eye-opening. This is a branch of medicine about which I know very little, and so seeing the different presentations and the sheer variety on offer is really interesting. It’s also the one rotation that’s probably got the least to do with any other speciality, and so we really have to concentrate if we want to follow everything. Back in Phase II, we had a week’s exposure to the psychiatry speciality via a placement on a secure ward: it was interesting, but that placement was slightly more intense as it was psychiatric intensive care, whereas our current placement is almost wholly community-based. In any event, we’re seeing loads of very interesting presentations and the staff we work with are all very supportive and friendly, and they want to make sure that we learn as much as we can.

We’ve had lectures at many points in our medical-school career about the various types of psychiatric presentations, and like most of medicine, most of them are little more than words on a page until we see them in the flesh. However, up till now we have tended not to focus on a patient’s psychiatric co-morbidities if he or she is on a regular medical ward with a more pressing physical problem. For that reason, we haven’t usually been focusing on many psychiatric presentations until now, when it is the specific focus of our block. That’s why this block is helping us to see lots of new and exciting cases of conditions we’ve read about – it’s been a long time since a new branch of medicine was opened up to us like this!

We’re only a few days into it, but so far we have seen patients with schizophrenia, emotionally unstable personality disorder, severe depression and many other conditions that we’ve only read about up to now. It’s really a different flavour of medicine entirely. There is a lot of pharmacology (and with this come LOADS of contraindications and side-effects to learn), a lot of psychological therapies (mainly CBT, or cognitive behavioural therapy, typically administered by psychologists) and plenty of other therapies that we don’t see much of outside of psychiatry. I’m really excited by the potential, and I’m sure this block will live up to the excitement.

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

Lesson’s to be learnt…

Open any newspaper and you will be greeted with headlines telling of a “social care crisis”, of “bed blockers” and a “dementia time-bomb”. While many of the headlines are misleading and not helpful, the issue of an increasingly aging population and the increasing rates dementia are very real. As a medical student, we witness the problems increasing rates of dementia causes in the NHS on all our placements. On the Care of the elderly wards many patients were “medical fit for discharge” but remained in hospital due to social care issues, many patients with dementia can become aggressive and upset when they are confused and can be difficult for staff to manage and also upsetting for other patients. Observing the challenges dementia places on the healthcare system is no different in the psychiatry block. We spend some of our time in Old age psychiatry where most of the work focuses on dementia but also other mental illnesses that have presented in old age.

Spending time in the community memory clinics I saw patients presenting with a variety of memory problems. The memory clinic is designed to help improve detection rates of dementia and ensure patients receives the best medical treatment and social support. For example, if a patient is diagnosed early with vascular dementia, there is an opportunity to ensure they are on the best treatment for their high blood pressure and diabetes which could help reduce the decline in their memory. Slowing the memory decline can allow people to live independently for much longer and have a higher quality of life. Alongside the medical interventions, psychological interventions in the form of support groups for patients and carers can help maintain good mental health and help families cope in these difficult situations. Providing the right social support can also help patients stay at home longer with their families. Observing how the medical and nursing team all worked together to help these patients was interesting and it was great to see the positive impact the team had.

Treatment of dementia is focused on community care but sometimes it isn’t safe for patients to be at home or even in care homes if they have complex behavioural needs. As part of our placement we also spent time on the inpatient dementia wards. In contrast to any other ward I’ve been on, every patient had a completely individualised care plan that had been formulated through careful observation. Even though many of the patients had severe dementia, staff had spent time with them to find out what their interests were, what music did they like, what activities or food were there favourites? Spending the time getting to know the patient meant that staff could engage the patients in activities that they actually enjoyed and find out what was possibly upsetting them or causing anxiety. One patient that had previously been violent and aggressive was now calm and ready for discharge, no medication had been given, just time.

While I’m panicking about my prescribing exam it’s good to know that the answer isn’t always medication and that getting to know all of our patients, no matter what their condition, can make a huge difference. That’s certainly a lesson that will stick with me and I hope will make me a better doctor.

Joshua Galvin : 24 Oct 2017 15:59 |  Tags: Clinics Joanne NHS Patient Student Warwick |  Comments (0) |  Close comments |  Report a problem