All 32 entries tagged Wards

The Frontline

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!

Hattie Trigg : 29 Apr 2020 10:31 |  Tags: Hospital Jordan Mbchb Patients Student Wards Warwick Wms |  Comments (1) |  Close comments |  Report a problem

Changes

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.

Hattie Trigg : 07 Apr 2020 13:32 |  Tags: Jordan Mbchb Patients Student Wards Warwick Wms |  Comments (0) |  Close comments |  Report a problem

Next Please!

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.

Eden Villiers : 10 Feb 2020 08:49 |  Tags: Abbie Mbchb Patients Student Wards Warwick Wms |  Comments (0) |  Close comments |  Report a problem

Introduction to Prescribing

It has been another busy week for my clinical partner and I. Up until now most of our experiences with psychiatry have been in an outpatient and community settings, so we were both looking forward to seeing how acute psychiatric issues are dealt with. This week, we have been placed on an acute psychiatric ward this week, in a Psychiatric hospital. It was interesting being able to sit in on the ward rounds and see the various conditions the team must deal with on a day to day basis. These conditions are amongst some of the hardest to treat medical conditions and include; severe depression, anxiety, mania and personality disorders.

Our consultant was keen that we get involved and gave us the opportunity to practice our history taking with patients where we could get consent, although admittedly it was a whole new experience when compared to your standard history taking scenario. Some of the conversations we had and listened to this week were very emotionally difficult for all involved, and I have huge admiration for the staff and indeed the patients who have to work to improve often difficult situations.

This week we also had an academic day where we were given an introduction to prescribing. I had been looking forward to this for some time, as prior to starting medical school I worked in Pharmacy as a dispenser, so I was waiting for an opportunity for my pharmacy knowledge to become useful! We had lectures which focused on the basics of pharmacology relevant to prescribing, a lot of which was revision from our first-year studies (which feels like a long time ago!) We also had a lecture on some of the pitfalls of prescribing, for example, making sure that you write units in full to avoid confusion and also about some of the common errors junior doctors make. It turns out that junior doctors make 90% of prescribing errors, which I suppose demonstrates both how junior they are and also the fact that most hospital prescribing is done by the juniors. It was all slightly terrifying to think about how much responsibility we will have in just over a year’s time. I know first-hand from my previous work experience how crucial it is to get things right and minimise mistakes to make sure the patient gets the correct treatment.

We also had a lecture on the UK foundation programme, the two-year programme that all UK graduates must complete immediately after graduation. Up until this lecture I had happily forgotten how soon this process kicks off – by the end of this year we will have applied for our first jobs as doctors and ranked the areas we would like to work. Currently I want to stay in the West Midlands after graduation as I have had experience of many of the hospitals in the area, and I feel this will make the transition from student to junior doctor smoother. Allocation is completely points based, with 50% of your mark coming from your achievements at medical school and the other 50% coming from a test called the Situational Judgement Test. This test is sort of a test of reasoning. For example, the questions will be something along the lines of “This thing has happened. What is the most appropriate thing to do?”. We get lots of practice questions and cases in CBL, lectures and other aspects of the teaching so I hope that I will pick up the knack to it.

Next week is last week of our psychiatry placement, which means that we have to finish our sign-offs and say goodbye to our faculty team before moving on to our Acute placement block. Looking ahead at our timetable for Acute it looks to be a busy block, with lots of long days and night shifts. Some of these are in A+E, and others on acute medical wards. After Psychiatry, which is a very separate field to “physical” medicine, I have to admit that I am excited to get stuck in and have some exciting experiences on the very front-line of Medicine. However, it will be stressful – here’s hoping that my knowledge from exams comes rushing back….

Eden Villiers : 10 Feb 2020 08:48 |  Tags: Jordan Mbchb Patients Student Wards Warwick Wms |  Comments (0) |  Close comments |  Report a problem

Getting into the swing of clinical life

Term didn’t exactly start out how I wanted it to. I pictured jumping into clinical life, getting to know my consultant and getting to grips with managing hospital life with solo learning. My immune system, however, had different ideas. So, instead of getting sign offs done and (more importantly) enjoying paediatric week, I was at home with a mammoth ear infection (think IV morphine) thoroughly researching the patient journey. However, I eventually got back, managed to set off my hall’s fire alarm cooking biscuits (and suffered the mocking of 90X 18 year olds) and started my clinical life in care of the elderly.

I hadn’t thought much about this speciality to be honest. I was so driven on surgery and neuro that the idea of being on the ward caring for elderly hadn’t taken any of my interest but,now I’m drifting away from the idea of surgery, I found that I loved being on the ward and getting to know the patients there. We arrived at 9am on Monday morning and I felt immediately included into the team which was amazing. You always hear of these horror stories of being left out in the cold as such but it was like we were important to the doctors there. We sat in on the board round which involved a lot of medical abbreviations but thankfully I was able to keep up as I’ve decided to use a tablet to take notes, which means I can quickly google things I don’t understand. The team even stopped at one point to explain lasting power of attorney and what they can do if they feel the appointed person isn’t acting in the patients best interests. We were also alerted to a flu diagnosis on the ward meaning everyone was told to get their flu jab (my clinical partner was virtually dragged by a nurse to get his!). I had mine earlier as I wanted the free pen and sticker to go with it. Even at 23 years old I can’t resist a sticker…..

We were assigned to a consultant and as a group of three took a history, general and focused exam on a patient who had been admitted with shortness of breath. She was lovely and had so much to say so we were struggling to steer the conversation in the direction we needed to. I think it’s being British, we never want to be rude! My history taking has definitely taken a turn for the worse since OSCE’s last year (sorry, Prof Patel!) so I need to review my structure. We were then taken aside and given some tips on OSCE skills and common mistakes to avoid. I had some slight tachycardia during this point as I’m 60% sure the consultant was examining me in my exam last year when I completely forgot to ask patient details!

The rest of the week flew by and I got two sign off’s done. There was a potential third sign off but if I have learnt anything this week, it’s that elderly veins are hard to draw blood from. You can hit the vein and they will not bleed, yet when you remove the needle they bleed everywhere and you panic inside to stop the bleed and not look completely incompetent (totally didn’t happen to me this week).

We have also been in the presence of an amazing F1 who was chasing us around the ward telling us to go and see patients, recommending certain exams to do on them and offering us procedures at every stage. He was lovely and a Warwick grad! It does make you feel like there is a light at the end of this tunnel when you see someone who was once in your boat out there and doing well. He was also teaching us at every stage he could (even getting dragged away by the consultant because they had to get work done). I hope to be like that as an F1 one day. I know I am going home for F1 now just to save costs and be near family so, I will have Kings College and the new Kent and Medway Medical School students to teach so, I am hoping to pass down Warwick Wisdom. If I get there!

I love being able to teach myself the topics we need to know and I am finding it easier to retain information. I just have to get used to being tired after hospital as at the moment all I want to do is go to sleep! I'm looking forward to the rest of the block as I am on O&G, finally going to GP placement and going back into theatre with anaesthetics, a speciality of which is now growing on me. I guess that’s it for me now, good luck to all our amazing final years with their finals! You will all SMASH it!

Eden Villiers : 27 Jan 2020 08:44 |  Tags: Abbie Mbchb Patients Student Wards Warwick Wms |  Comments (0) |  Close comments |  Report a problem