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January 26, 2017

Musculoskeletal Health Care…

Our cohort is a few weeks into the first of our eight Specialist Clinical Placements (SCPs) and 2017 is stretching out before us. Although it seems long, the time is actually going by quite quickly. I wouldn't say it's exactly fun, but I'm enjoying myself tremendously on this block and am learning a great deal.

My first rotation is the MSK block (musculoskeletal health), which is pretty self-explanatory. In this block, we become more familiar with problems of joints, muscles and bones (and nerves and connective tissue and some skin and so many other things as well...). Many people run a mile when they think of anatomy and memorising lists of muscles and bones, but block 4 in the first year (Locomotion) was actually my favourite block and I'm loving the MSK placement. We've seen so many things that I wasn't expecting and we're only just over three weeks in.

As is probably fairly obvious, a lot of the work revolves around bones and joints - so we see fractures and their treatment, joint replacements, and that sort of thing. But of course they don't exist in a bubble - for instance, fractures are often accompanied by soft-tissue injuries and we have to know all of the repairs that come along with them. Getting a new knee or a new hip is a major operation and can take weeks or months to recover from fully. A lot of the learning we've done in earlier years around the biological, psychological and social impact of health conditions has come in very handy in understanding the lives that our patients live and how injuries might change them. It's proven incredibly applicable now that we are seeing more patients in a clinical setting than we did in the first years of the course.

I was not expecting that we'd be taught rheumatology as much in this block as we have been. It's a very diverse field and there's so much going on! The more I see of it and the more I learn about the speciality, the more interested I become. The patients are very interesting and diverse, and being an effective rheumatologist requires extensive knowledge of many branches of medicine and the ability to pull them all together very quickly. Since rheumatological diseases can affect multiple body systems, specialists in this field need to be quite broad in their knowledge and approach. We have seen patients with rheumatoid arthritis (of course) but also psoriasis (and the multiple effects that it has), polymyalgia rheumatica, systemic lupus erythematosus and several other conditions that we've only seen in textbooks before now.

I'm enjoying the block so much, I'm really gutted that it is coming to an end so soon. But of course new adventures await in the next placement, too.

John


January 16, 2017

New Year's resolutions…

The start of a new year is always filled with hope and ambitious plans for the year ahead. For myself my new year’s resolutions were to continue to maintain a good work/life balance so I had time to exercise and look after myself and I also wanted to work consistently throughout the year so I could avoid the exam panic that I experienced in my second year. Two weeks in and my first specialist clinical placement (SCP) is creating problems for both my resolutions!

My first SCP is in General Practice. I was lucky to get my top choice of practice which means I can cycle or walk to my placement, this helps with my new years resolution to keep active, however the days in GP are very long so the work/life balance is a bit skewed at the moment. I really enjoyed our GP placements in second year, so was looking forward to it this year. Now that we are 3rdyear students we are expected to be able to complete the whole consultation (including management) for most cases. This was really scary at first, but even just two weeks in I can see how much I have improved. In my first week I wasn’t even sure of my examination findings and would let the GP take over for the management part of the consultation but now I am happy reporting my findings and saying what I think, safe in the knowledge that the GP will correct me if I’m completely wrong!

I’m also really enjoying the variety that comes with GP. Not only do you see medical conditions affecting all the different systems of the body but there is also a big range in terms of severity. It’s certainly not just coughs and colds! I also enjoy getting to know patients better, something we are encouraged to do in GP. The social aspects of the history are very important in GP, the job a person does may affect their illness or pain management and their situation at home may have a bigger impact on their mental health than any medication we can give. As a GP you need to understand the patient and their illness in the context of their life, something that is often forgotten in other specialities.

One skill in particular that is very important in GP which I still need to develop, is learning that it is ok to do nothing. It’s sometimes much harder to listen to a history from a patient who has been really unwell with a terrible cough and who is short of breath and tell them that they don’t have a chest infection and just need rest and paracetamol, than it is to hand out a prescription. During medical school I’ve been trained to recognise signs of illness and what to do when I find them, but saying to a patient that you don’t think anything is wrong and being confident in that decision is a skill in itself. Knowing when to do nothing and stopping unnecessary medications are a huge part of a GP’s workload. We have visited local care homes with our GP tutors and most of the visit has been crossing off unnecessary medications which might actually be doing more harm than good. All Doctors take the Hippocratic Oath which says “Do no harm”, I now understand that “Do no harm” isn’t just about treating disease, it’s knowing when not to treat, and that is actually much harder.

Joanne


January 06, 2017

The Start of Specialist Clinical Placements

We third-year students have successfully navigated a lot in our medical career so far, but it looks like 2017 is going to be the busiest – but most exciting! – phase yet. We’ve had a year and a half of pre-clinical work, covering all major systems of the body and lots of multi-system disease presentations. We’ve had a long spell of core clinical education. We’ve all done our own research projects, complete with lengthy write-ups and, of course, reflection. We’ve been through two cycles of exams and have made it out the other side. And now we have just started the final push: earlier this week, we began the first of our Specialist Clinical Placement (SCP) blocks, where our education now focuses on particular areas of medicine in preparation for finals and practice beyond.

Our cohort is split into eight groups of roughly equal size, and these groups rotate through eight placements across our main hospital sites. My clinical partner and I are in the Musculoskeletal Healthcare (MSK) block, which is actually extremely interesting – much more interesting than I was expecting. The great thing about the Warwick curriculum is that it is spiral learning, which means that we are encountering topics and building upon knowledge that we’ve got several times throughout the course. For the MSK block, this means that a lot of knowledge we gained in Block 4 of the first year – the one called Locomotion – is really coming in handy now. Our knowledge of muscle and bone anatomy, innervation and blood supply is being called upon with alarming regularity!

Of the five blocks we had in the first year, my favourite was actually Block 4. I liked the tangibility and unchanging nature of human anatomy. There are some structures that are complex, but they just need to be learned. And once the difficult material has been learned, it really isn’t going to change. Now I’m most looking forward to seeing how specific pathologies present and how they are corrected, and spending some serious time in clinic with specialists. I’m also looking forward to surgery and watching some hands-on reconstruction work happening.

And even though I was expecting this SCP block to be heavily anatomy-based, there is a great deal of rheumatology taught as well. This is a topic area to which we aren’t exposed very much in Phase I and Phase II, but we are making up for it now in Phase III. We are scheduled to attend several rheumatology-teaching sessions and have already spent lots of time in rheumatology clinics and so on. It’s been really interesting and we’ve seen a wide variety of cases – obviously there is rheumatoid arthritis, but also polymyalgia rheumatica, psoriasis, osteoarthritis and lots of other conditions. Patients of course will also have several comorbidities as well. I know this sounds naïve, but I had no idea the field of rheumatology was so varied and interesting. I might have to look into it further for possible career options...!


John


December 13, 2016

It's beginning to look a lot like Christmas…

For myself and the other 3rdyears it’s the start of our Christmas holidays. The 2ndyears have already had a week off, the poor first years still have a week to go and the 4thyears are in finals revision mode! I managed to conquer the data analysis of my SSC2 project and handed my project in on time (phew!), however the work on my project doesn’t stop there. My supervisor wants us to publish which would be very exciting but this will inevitably mean more writing and more stats (boo!).

Since our 8 week project finished we have been on Advanced Cases 2 which has been a mixture of lectures and time in hospital to refresh our clinical skills before our specialist placements in January. The lectures in AC2 have mostly been revision as well as information about our upcoming specialist blocks. It’s been really exciting to hear what we will be doing in our specialist blocks but also terrifying. My last block is the Musculoskeletal block, and hearing about the OSLER (a clinical exam) we will do at the end of that block terrified me. At that point next year I’ll be 6 weeks away from finals! My first block in January is GP, which I think will be a really good introduction to all aspects of medicine and a chance to practice all my examinations and histories. The GP block is going to have dedicated teaching days which sounds really helpful and we are also going to have filmed consultations. This sounds horrible but it’s actually really helpful. You might realise that when talking to patients you are always nervously biting your lip or that you say “like” in every sentence (I can’t help myself!).watching yourself on video gives you a chance to work on these bad habits as well as identifying things that you are good at and need to keep doing. The scary thing about the GP block is the “independent consultations”. This is where my clinical partner and I will take an entire consultation with a patient and only consult the GP at the end to see if we did everything right-eek!

Also during AC2 we started working with our new CBL groups. Having been with my first CBL group for 2 years I didn’t really want to change as we all got on so well but as a Doctor you will be changing teams every 4-6months so it’s important that get used to working with different groups of people. Our first task as a new CBL group was a small presentation on complementary and alternative medicines, not everyone’s favourite topic but certainly an interesting one! Although I didn’t know the people in my new group very well we all worked well together with the help of some home baked cookies thanks to one of my new CBL colleagues!

Over the last few weeks I’ve also been busy with The Psychiatry Society as we prepared for our December event “The West Midlands Forensic Psychiatry Symposium”. We had students from Birmingham and Keele attend, and a great turnout from Warwick Students. It’s been great working with the committee on such a big event and I’m excited for our upcoming events in the new year! Working with other students on the committee from other year groups reminds me of how far I’ve come, I can’t believe I’m now a 3rdyear medical student entering my final year of clinical placements. Here’s to 2017!!!


Joanne


December 09, 2016

Autumn Term drawing to a close.

The autumn term of our third year is drawing to a close and it’s hard to escape the feeling of mild terror that surrounds me. It’s been a great term, and I’ve learned so much, but I know that things are going to get a lot busier for the rest of my time at medical school after the coming Christmas break.

First we had eight weeks of our Student-Selected Component, a research project designed to acquaint us with the world of medical research. Students could either design their own projects or use one which was arranged by the medical school. I elected to do my own, and after a herculean feat of organisation and form-filling, managed to spend a month in The Gambia collecting data for an audit on tuberculosis investigations. It changed my life. The research project was very interesting, and it piqued my interest in global health – and especially the plight of those outside of the UK who are far less fortunate than we are. I read a lot of articles about TB diagnosis and spent (probably) far more time than I would have ever thought I would poring through WHO reports.

After SSC, we enjoyed three weeks of Advanced Cases 2, which combined lots of familiar elements of our course. Over the three weeks, we had Monday and Tuesday in lecture, and Wednesday through Friday on the wards. The lectures have been either covering old topics, introductions to the upcoming Specialist Clinical Placement blocks or covering an entirely new topic afresh. It’s been great to spend some time in the lecture theatre again after a few months of being away. I appreciate the structure and have found that it helps me learn better.

We also met our new CBL groups – after the first two years with the same CBL groups, we have now landed with an entirely different bunch of people. But the great thing about our course is that (I strongly feel) the people really are selected because of, among other things, their ability to work with others. I don’t know anyone in my group terribly well, but I know that we’ll get on just fine because everyone in the cohort is a very easy and personable person to work with. Initial suspicions have so far proven completely correct.

I’m looking forward to the start of clinical placements but have a little bit of apprehension as well. When I think of what we need to know – and know automatically, without hesitation! – before our final exams, a mere 14 months away, I am frankly terrified. But a very wise GP (also a Warwick grad, of course!) once told me that the key to memorisation is repetition. The more you see something, the more likely it is to stick in your head. I’m hoping she’s right. Now it’s just a matter of getting all that stuff onto paper and seeing it in practice. I know what I’m doing over my Christmas break!


John


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Our Med Life blogs are all written by current WMS MB ChB students. Although these students are paid to blog, we don’t tell our bloggers what to say. All these posts are their thoughts, opinions and insights. We hope these posts help you discover a little more about what life as a med student at Warwick is really like.

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