All 34 entries tagged Wards
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June 01, 2020
For the last two weeks, I’ve been continuing with my work on the Gerontology ward at University Hospital Coventry. Gerontology is care of the elderly and the ward deals with general medical problems in this patient population. Many of the patients have a condition called delirium which means they are acutely confused (i.e. the confusion is new and has a rapid onset). Delirium can be caused by infections or even just by being admitted to hospital, but it is often reversible and the confusion gets better when the patient's medical condition improves. In addition to this confusion, many of the patients have existing dementia, where their confusion and cognitive abilities are impaired due to this long-term condition. This has made it very challenging at times when trying to encourage these patients to eat and whilst tending to their personal needs as they are often confused when and do not understand what you are doing or why.
I’ve worked on the ward for two months now and I think while I haven’t done much actual medicine in this time, I have developed what people call the “soft” skills which I think make the difference between a good doctor and a great doctor. It is not just about being able to recognise a cancer, for example, but being able to communicate with the patient about what their wishes and needs are. Communication is the most important skill a doctor has to have and is the cornerstone of what doctors call the ‘therapeutic relationship’ – a partnership between doctor and patient. When trying to communicate with confused patients, it is crucial to speak very clearly (which can be difficult wearing a mask), and I definitely think my own communication style has changed. Since I was a child, I have always spoken very quickly in general, to the extent that I used to get told off as a child because no-one could understand me! I also had a stutter for certain periods of my childhood, and I think working with these patients where communication is absolutely fundamental has led to lasting changes in the way I verbally communicate. I would say the speed of my speech when talking to patients has slowed down and I use clearer phraseology. I also have learned that if someone doesn’t understand, that is it essential to check if they usually wear a hearing aid and, indeed, if it is turned on!
I have really started to miss studying. It sounds strange when most people hate studying, but I find learning and working towards the goal of finally qualifying one of the most satisfying things in my life. There is a strange sense of dislocation when a goal you have worked towards for 3+ years suddenly seems further away and the goalposts shifted. I think the sense of dislocation comes from the questions and uncertainty due to COVID. Will we restart placement in July as the Medical School has planned? When will our final exams be? Will we have an elective period? Will we be as well equipped to pass finals as the students who have gone before us with potentially less time on placement? Healthcare students around the world face the same dilemmas and uncertainties and I hope things go back to normal soon for all of our sakes.
One flash of light in all of this uncertainty has been a revival of peer support. Warwick is known for being very strong when it comes to peer support, which is when the years above run sessions and teach to help the younger years. Our fantastic finalists have been true to that tradition and have been running online sessions to help us with some of the questions we have. They have done sessions on our final exams and what helped them, as well as practical tips for getting through this period. I think having this support run online at this time has certainly given me hope that we will come through this and be able to rise to the challenge of finishing the course successfully. It’s comforting to have support from those who have been through it and come out the other side.
May 15, 2020
Week 8 of lockdown, aren’t we? To be honest, everything feels so much of a blur and all the weeks have moulded into one. It does however feel like an age since I was last wearing my stethoscope on the wards trying to appear like I knew what I was doing. Covid 19 has truly changed our lives and we as medical students are no different. As you have probably seen from Jordan’s updates, we have been given the option to work in local trusts and I have been allocated George Eliot's (Geliot) A&E department. I was amazed when I got offered it and I really have enjoyed it. I even have done my very first night shifts which are strange. Trying to stay up the night before is hard and I don’t think I would have gotten through the first one if it wasn’t for my good friend, Red Bull (other brands are available).
I have been lucky as it’s given me the opportunity to practise my clinical skills and I have mastered the art of small talk whilst doing cannulas. I have grown so much in confidence with these, just need to work on putting in the next gage (bigger diameter cannula) up as I seem to struggle with my pinks. One of the best parts has been having a good old chat with the patients. I had a lovely human the other night and we spend an hour chatting about the original VE day, being evacuated, the bombing of Coventry Cathedral (one of my favourite facts about WW2 purely because it was in a Sherlock episode) and the rest of their life. We found out we have families in similar parts of the UK and we chatted about Megan and Harry and baby Archie. It has been nice to get to do this as the department has been…let’s say…. Less populated than usual. We normally get to 3am and one have one patient in majors, so we sit and chat as a team. I even got my ECG done the other day!
The PPE was a novelty at first, but I wish I could get away with not having it on. The mask dries my mouth out quickly and constantly breathing in your own C02 makes a 12 hour shift that much harder. We haven’t had a problem with PPE at Geliot apart from the nice elastic masks running out meaning everyone has to wear the tie-on masks which we all hate. One positive spin is that the team cannot see how much I yawn at 3am! It’s one of the only times I have liked being someone who smiles till their eyes disappear.
I got to experience being in full PPE the other day as we had a peri-arrest Covid positive patient come in. I was only in it for 2 hours, but I was boiling and thirsty. The ICU team are heroes! The patient was fine, and I put in their cannula and took their bloods and before long, they were sent to the wards. I have also seen someone extremely sick from Covid. They unfortunately passed away in the department and I felt heartbroken for the family who couldn’t see their relative in their final moments. It was also the first patient I have seen pass away and it's a moment that will forever stick with me. Night shifts bring everything to the table.
Outside of ward work, we have been given our SSC2 projects to do. We are all currently doing a systematic review. I found a topic similar to that of my original project but I am finding the software…..tricky. Let’s say I have come close to sending my computer on a horizontal trajectory through the window and onto the ground outside. However, it’s no different to the problems I faced in my undergrad dissertation except this time, it’s computer software and not human brain cells letting me down.
We are due back to placement at the end of June pending on how the third years get on. The crisis will impact my degree even beyond this year as we found out our third-year placements will be one week shorter and, depending on any future lockdowns, my second-year placements could also be made shorter. It’s scary to think, but this will affect the future training of doctors. Interestingly, I prefer doing the 12 hour shifts as opposed to turning up onto a ward hoping for something to do. I have learnt a lot more, even my ECGs are coming along! I think we would benefit training like student nurses and having shifts instead of popping in. That is just me though, I have a lot of time on my hands at the moment!
'Til next time!
April 29, 2020
The last two weeks since my last blog have been…well, strange, as I am sure you are aware.
I have now been employed as “Medical Student Clinical Support”, and have been placed at University Hospital Coventry and Warwickshire (UHCW), which is the largest partner NHS trust affiliated to the Medical School. My ward is normally used for care of the elderly but it is looking after patients with suspected or confirmed COVID-19 at the moment. I am essentially working as a Healthcare Assistant, which involves duties such as bathing and moving patients, cleaning and general support. In addition, however, we are allowed to practise the clinical skills we have been signed off for in line with how competent we are. For example, this includes things such as venepuncture (taking blood), cannulation, setting up oxygen, doing Electrocardiograms etc. This has prompted me to think about my competencies – how confident/competent am I at performing these skills in the real world?
As a medical student, and indeed as a doctor, the phrase “act within your competencies” is used quite a lot to determine what you are able to do. But what does this mean practically? In years gone by, doctors operated by the adage “see one, do one, teach one”. For example, if a student/junior doctor had seen a certain operation (let’s say a hip replacement), then they would progress to doing one, before then teaching this skill to others. This would be how doctors would learn pretty much everything, but of course this method has its drawbacks – primarily that this isn’t an effective way to learn how to do something safely. I could watch someone lay a road, but that doesn’t mean that I would be happy to then “have a go” and I’m sure the results would be terrible!
What has happened then, in recent years is that things have moved towards competencies and a more holistic way of teaching and learning skills. So at medical school, we have to learn certain skills that all doctors must be able to do – for example inserting a venous cannula or administering oxygen therapy. We receive formal teaching on how to perform these skills which are called T-DOCs, and at the end we are assessed by the tutors as being signed off, meaning that we can practice these skills as long as we are supervised by more senior colleagues. You can then practise (of course with appropriate consent) and with supervision until you build up confidence and ability to perform these skills. You do the training for most of these skills in Year 2 of the course and they include lots of different skills. I have only had the chance to practice a couple of them so far on real patients – I have done about 20 cannulas, taken blood about 20 times, set up oxygen a couple of times, and have a reasonable rate of success.
We had a general induction and also some basic Healthcare Assistant training on the first few days. We were told how to clean effectively and how to bathe and feed patients etc, which are skills we don’t regularly get taught how to do during medical school. After this we started shifts on the wards. On my ward, everyone is really friendly and approachable and keen to teach and show you how to do things, which makes the whole thing of being a new member of staff so much easier. We have also been given uniforms which we have to change out of at the end of every shift and also been given appropriate PPE. At all times on our ward, because there are suspected and confirmed COVID-19 patients, you have to wear a surgical mask (which is fine for half an hour, but when worn for the whole of an 8-hour shift, your mouth dries out and cracks). When approaching and caring for patients, we then have to put on an apron, gloves and a plastic visor. Wearing all of this makes looking after patients so much more difficult and a lot warmer too, which isn’t great when its 25 degrees+ outside. So far, I have helped with general patient care including repositioning, feeding and cleaning and it’s amazing to feel like part of the team and like I am helping, if only a bit! Sometimes it can be really sad, especially because visitors aren’t allowed except in exceptional circumstances, which means that the only human the patient sees is you. I have been trying really hard to chat to the patients when I can and make sure they have everything they need to be as comfortable as possible in the circumstances. It has certainly been a different challenge to what I normally experience whilst on the ward, but rewarding and important nonetheless. Stay safe!
April 07, 2020
In my previous blog, I think I said nothing has changed. Well... I have been proven dead wrong in the last two weeks. Week 5 of Acute block was delivered normally, and we were told on Sunday evening that Week 6 (the final week) of Acute block would go ahead as much as possible. So we turned up for teaching on Monday morning and were told that everything had changed and sent straight home with all teaching and placement cancelled. We then had an online meeting from the Medical School saying that our next block (for me, Musculoskeletal care) had also been cancelled.
Usually in the last week of Acute block, you have lots of teaching sessions and then at the end you have a practical exam where you are observed performing an assessment of a patient and are then signed off for the block. However, considering the COVID-19 situation, this was cancelled and instead we were signed off by telephone by the block lead. I think mostly this was to make sure that were signed off for the block so we had it “banked” and wouldn’t have to re-sit it afterwards. For the rest of Week 6 of Acute block I mostly just did some book work and got on top of my notes to make sure I was using the time productively. To be honest, I was behind on my note-making so the week off was helpful.
The Medical School have been trying to update us as much as possible about what is happening, but of course its difficult as no-one really knows how things are going to go. For us third years it brings added uncertainty. Phase III (Years 3 & 4) are very tight for time. We have 8 specialist rotations January - December with only a two-week break in August. And then we have a revision block in January before sitting our final exams in February. In actual terms I have my 8 x rotations January 2020 - December 2020, and then January 2021 - February 2021 revision block and then final exams in February 2021. However, because of COVID, if we miss one 6 week block, we still have to do these hours somewhere else so we would lose revision period and/or exams would need to be moved to facilitate a revision period. So, by losing placement time now, it has potentially large repercussions for the course. The Medical School have been great in terms of working tirelessly to try and make sure missing things has the least impact possible, but of course it is hugely challenging for them to restructure the whole course for 4 years groups all of which have different requirements and challenges! I will keep you updated!
Another development in the last few days is the opportunity to work/volunteer in the NHS. The NHS is on the frontline of the epidemic and is struggling at the moment with staff illness and also an increase of demand, so they need more support than ever to deal with the consequences of the virus. To this end, they have asked medical students to help out within their competencies as far as possible. It's completely voluntary but we are going to get paid to help out with basic medical tasks. For us third years, this means that we are able to help with doing ECGs, cannulas, taking bloods and direct patient care (washing, dressing etc). I thought long and hard about whether to help and have decided that I will go for it, partly for myself in terms of keeping my clinical experience up to date and engaged, but also on a wider level to help out. COVID-19 is unprecedented and the event of a generation and anything that I can do to help, no matter how small, I feel duty bound to help, as (hopefully) a future doctor, a current medical student and also as a human being.
All of the blogs that follow will document this interesting journey until we get back to a “business as usual” medical school. Although formal medical education has been postponed for now, I think that education of a different type will happen whilst I’m working in this role and of course I still will have all of my book learning to do at home. I will keep you updated as always as we go through this challenging journey together, which I’m sure will be a steep learning curve for us all.
February 10, 2020
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.