All 82 entries tagged Student

Fly on the wall

As a medical student, I spend a lot of my time hovering awkwardly behind consultants and other doctors as they see patients on the ward. In clinics, myself and my clinical partner are also squeezed into the room, often sat across from the patient, it feels like a follow up appointment in the form of a panel interview! I am always so grateful to patients and their relatives who are happy to put up with a committee of people on ward rounds and very crowded clinic rooms all so we can learn. I have been even more grateful over the last few weeks during my care of the medical patient block to patients and their families who have allowed me to sit in on clinics where doctors are regularly breaking bad news: the oncology clinics.

Cancer biology was not my strongest subject during my biomedical science undergraduate degree but in medicine it’s not just the underlying cellular and molecular biology that’s important, we need to know all the clinical manifestations so we can diagnose cancer, when to refer and what investigations are needed. So, in this block I decided to make a concerted effort to try and improve my clinical knowledge of both the diagnosis and investigation of cancer and of oncology as a speciality.

One of the clinics I attended was a fast track clinic for suspected lung cancer. GP’s can refer patients with symptoms or signs indicative of lung cancer and they will be seen in hospital within 2 weeks. Patients attending this clinic have often had a chest X ray and in some cases a CT scan before they attend so the consultant can in either reassure the patient or show the patient where the problem is that they need additional information from, perhaps in the form of a biopsy or a different scan. What struck me most in this clinic was the number of patients who were told that they had a suspicious mass in their lung but decided not to have further investigations, many were elderly and were quite clear that they didn’t want to undergo any further procedures. Having these conversations requires a very sensitive and perceptive type of doctor and is a very different type of medicine to what medical students probably envisioned before medical school.

Attending the oncology clinics, patients already knew they had a diagnosis of cancer but often didn’t know what treatment if any was available. These appointments lasted up to an hour and the doctors were clear that the appointment lasted until the patient wanted to leave, they encouraged questions from the patient and their family, and took the time to explain things multiple times. They comforted patients and relatives as they cried at the prognosis and then did it all again for the next patient.

All the time I’m sat in the room, a fly on the wall, observing how the doctor handles the different consultations, learning how they manage these complex patients, but all the while I’m trying my best to not get emotional too and reminding myself that it is a real privilege to be invited into people’s lives to experience their best and their worst times.

Joanne

Luke Pemberton : 05 Jul 2017 11:47 |  Tags: Joanne Mbchb Student Warwick Wms |  Comments (0) |  Close comments |  Report a problem

Starting the Care of the Medical Patient Block

We have just started our fifth specialist clinical rotation of Phase III and it’s really hard to believe that the time is flying by so quickly (this seems to be a recurring theme). This block is called Care of the Medical Patient (CMP for short) and I think we’re lucky to be doing it at a very big and busy hospital with lots of learning opportunities. Whereas most of our blocks have focused on more focused topics (paediatrics, musculoskeletal health, and obstetrics and gynaecology), the flavour of this block is more on general medical topics than many other blocks. This means that we see lots of traditionally core-medicine topics in quick succession and have many varied learning opportunities.

In Phase II (the latter two-thirds of our second year), our curriculum introduced us to “Core Clinical Education”, the purpose of which, I gather, was to give us a grounding in core medicine and help us students become proto-clinicians without getting carried away by too-detailed topics. At this point, it seems like the CMP block is expanding on these themes. We are getting a lot of teaching on core topics and talking about conditions – their diagnosis and treatment – in far more detail than we ever did in the second year. We seem to be focusing a lot of dermatology, neurology, renal medicine (I actually love kidneys), cardiology, gastrointestinal medicine and respiratory medicine than we have so far in any other block, and I’m really enjoying it. I have always had a great time with the core-medicine subjects and could possibly see my career developing in this direction.

In addition to being assigned to a base ward for the block (my clinical partner and I are on an endocrinology ward, so we see lots of diabetes and thyroid problems), we are also expected to attend lots of clinics of all sorts of flavours and also rotate through other wards for exposure. It’s pretty full-on. So far, I have attending two renal-medicine clinics (did I mention I love kidneys? I love kidneys!), a lymphoma clinic and a diabetes clinic – and we’re just a week into the block. It has been absolutely fascinating to see physiology come to life: when we first learned about the structure and function of the kidneys in October 2014 (Block 1 of year 1), I found it really overwhelming. But I committed myself to learning more about them, and I’ve slowly developed a begrudging yet abiding love for all things renal. Needless to say, the clinics have been great.

In addition to wards and clinics, we also get a fair amount of teaching from consultants and registrars. This is usually very useful. Today we got the first haematology teaching since second year, and I found it fascinating. I think my coursemates all think I’m mad, but I love talking about things like Tissue Factor and the Extrinsic and Intrinsic Pathways. I am really looking forward to the rest of this block and seeing more of what CMP has to offer. Maybe I’ll see if there are any extra kidney clinics as well!

John

Luke Pemberton : 30 Jun 2017 10:26 |  Tags: John Mbchb Student Warwick Wms |  Comments (0) |  Close comments |  Report a problem

Learning outcome number 1: Learn all of medicine!

My task this year, to learn medicine, all of it. The medical school would say I am exaggerating but this is what it feels like to be a medical student. It’s so difficult to know how much we need to know and in what detail, learning outcomes are supposed to be a guide and can therefore seem vague and textbooks vary so wildly that you start to believe that maybe Wikipedia does have all the answers (note to self, it doesn’t!). This is a universal problem for medical students but it’s especially true of the Care of the Medical patient block which I am just finishing.

In third year, our speciality placement blocks are just 6 weeks long. I’m sure I’m not alone when I say medical students are often quite organised people and are good at compartmentalising their learning. So far this has worked in my favour, Paediatric block, focus on children’s health, then for Obstetrics and Gynaecology focus on women’s health. This theory doesn’t work in Care of the medical patient…which bits of medicine, or just all of it in just 6 weeks? I started the block wanting to see and learn everything medicine had to offer but after trying to sort out a timetable and plan of action going forward quickly realised this was unrealistic and impossible!

Thankfully at UHCW our block lead had taken the time to give us a timetable to guide our learning with some gaps in that we could choose to fill (or not!). Every week we are assigned to clinics from different specialities to give us a flavour of the sort of patients those doctors see. I particularly enjoyed a haematology clinic where I learnt lots about haematological disorders (such as blood cancer) as well as loads about interpreting blood tests. I also got the opportunity to attend a Fast track clinic for suspected Lung cancer, this clinic has patients referred from GP with symptoms that could be indicative of lung cancer. Attending this clinic reinforced the symptoms and signs all doctors should be aware of to identify a lung malignancy and how you would investigate it. One day a week we are also assigned to a different speciality ward. Tied in joint first are my days on the Gastro ward and on the Stroke ward. The Gastro day saw us attend an epic 5 hour long ward round seeing patients with liver and pancreatic disease all over the hospital. On the stroke ward we got to take some interesting histories from some of the patients recovering from severe strokes which really helped me understand more about potential risk factors and warning signs for stroke, we also got the opportunity to examine patients and see neurological signs first hand.

As well as days and clinics in different medical specialities we are assigned to a care of the elderly (or geriatric) ward. Geriatric wards have bad reputation among medical students. Common beliefs are that all the patients have dementia or are confused so no one can give a good history, or that patients aren’t medically unwell so there’s no point in examining them. Having spent 6 weeks on the geriatric ward there is some truth to these beliefs but it doesn’t mean there is nothing to learn as a medical student. On the geriatric ward you learn more about co-morbid disease than anywhere else in the hospital, you learn how a person’s psychological state and their social situation impacts on their health and how this needs to managed by a whole team of people and not just a doctor with prescription pad.

So, I haven’t learnt the whole of medicine in 6 weeks but I’ve learnt a lot about being a doctor that can’t be specified in any learning outcome.

Joanne

Luke Pemberton : 30 Jun 2017 10:22 |  Tags: Joanne Mbchb Student Warwick Wms |  Comments (0) |  Close comments |  Report a problem

End of the Obstetrics and Gynaecology Block

It’s hard to believe that we’ve come to the end of our fourth specialist clinical placement. This is officially our halfway point for Phase III, which means that we’ve got four more six-week blocks to go. It’s such a cliché, but time really is flying past. Seeing all of the first-year students celebrating the end of their exams recently has brought home the uncomfortable realisation that my cohort was in the exact same position already two years ago, and it’s become even more difficult to believe that a new cohort is starting in just a couple of months! Thankfully I can rest comfortably in the knowledge that I will never, but never repeat my first-year exams again.

Obstetrics and Gynaecology is really quite a diverse speciality – much more than I realised before starting. Obviously the focus is largely on women’s health (but not entirely…) but the clinical requirements on the doctors are really varied. It’s one of the only specialities I’ve come across which is a healthy mix between clinics, ward work, hands-on medicine and more than a little bit of surgery all in one role. Depending on the day of the week, doctors may find themselves performing hysteroscopies/colposcopies (visualising the vagina or uterus with a specialised camera), doing ward rounds, conducting caesarean sections, running clinics (either obstetric or gynaecological) and likely all of the above.

Being a student in this rotation has allowed us to see all of these and more. Our education department have done a great job of ensuring that we rotate throughout a few groups of learning opportunity: we have a labour week, a theatre week and a special-interests week, and we run through this cycle twice. I’ve probably enjoyed the theatre week the most of the three. It just amazes me to see open surgery (known as laparotomy, as opposed to keyhole surgery, which is otherwise known as laparoscopy). There is so much going on with the anatomy under the surface, and the doctors spend so much time concentrating on this and making sure that everything goes right; and then at the end when they patch everything up, all that’s left is a tiny little incision with invisible stitches which you can barely see. It’s such an amazing concept that it all tidies up so nicely and seeing it happen blows my mind every time.

This week in the theatre we’ve seen lots of gynaecological procedures, primarily dealing with ovarian and uterine disorders. We’ve seen the drainage and removal of several cysts (I’m not going to lie; it’s not for the weak-stomached among us), a couple of hysterectomies and a couple of removals of ectopic pregnancies. As is logical, we’ve seen women of all ages and all stages in life. Every woman is asked to provide her consent to our presence before we go into theatre and if she doesn’t want us there, then we observe her wishes. It’s been such a useful block and I’ve really got a lot out of it – I hope the remaining blocks are as good as this one has been.

John

Luke Pemberton : 19 Jun 2017 16:51 |  Tags: John Mbchb Student Warwick Wms |  Comments (0) |  Close comments |  Report a problem

Education, education, education!

You would have thought having gone through an undergraduate degree and then a PhD prior to coming back to medical school I would have had my fill of education but apparently not! Along with another student, I got involved in organising an optional course for third year students in medical education. Attending the course and then organising it this year has been a great experience and I’ve learnt so much about medical education and teaching theories and techniques. It’s helped me understand the different approaches the medical school use in our curriculum-combining lectures with more structured groupwork and then student led case based learning.

Before medical school I had some experience of teaching junior students in the laboratories I used to work in and at medical school I have taken part in OSCE teaching and student seminars, initiatives run by second year students in year 2 for students in first year. There are lots of opportunities to teach if this is something you are passionate about and its certainly something I would like to remain involved in as part of my future career. My enthusiasm for teaching and medical education has been encouraged by the medical school after I was asked to present my work on the medical education course at a regional conference. Myself and other students involved in student led medical education projects presented our work as part of a workshop, engaging with the audience and taking questions about our work. I also got to present my work at the local Warwick medical education conference. At both these events I got to learn so much about the challenges medical education faces and the new developments that are been made to continue improving medical education and training high quality and happy doctors.

Learning more about medical education theories certainly makes you assess your own learning from a new perspective! Having survived my speciality block 3 in Obstetrics and Gynaecology I have now moved onto my fourth block, which for me is Care of the Medical Patient. As the blocks fly by exams seem to be creeping ever closer and a sense of panic is starting to set in amongst myself and my fellow students.

Along with 3 other students I am placed at UHCW (the big hospital in Coventry) for my Care of the medical patient block. This block is designed to give us a broad overview of different medical specialities and allow us to fill in gaps we have from second year. There are a few things that I didn’t experience during core clinical education, so I’m hoping I can see more gastroenterology as I’ve made it this far through medical school without seeing many gastro patients! I would also like to see some procedures like endoscopy and bronchoscopy which I’ve never seen before. I think it’s much easier to explain a procedure to a patient if you have seen it done yourself and as this is a task that we can be asked to do as part of our clinical exams, I want to make sure I know what I’m talking about!

Watch this space to see if my enthusiasm for medical education theory can be translated into my own learning and practice!

Joanne

Luke Pemberton : 15 Jun 2017 15:44 |  Tags: Joanne Mbchb Student Warwick Wms |  Comments (1) |  Close comments |  Report a problem