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June 01, 2020

Viva la Peer Support

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 20, 2020

Fluid Charts and HCA life

I have been continuing my employment as a Medical Student Clinical Assistant at University Hospital Coventry. I feel as though I have really settled into my job role and learned how to do it proficiently. Things which at the start were a total mystery to me are now not so mysterious, nor nearly as scary. Specifically, aspects such as filling in fluid balance charts, attending to the personal hygiene of the patients and dealing with confused patients. These are things which we are taught the theory of at medical school, but never get the chance to practice in reality as these jobs are often done by the nursing and healthcare assistant staff. I’ve definitely exercised a completely different skillset to that which I was using as a student!


I had a lovely chat with one of the experienced staff nurses this week about how valuable this experience will be when I go back to placement and eventually (hopefully) start work as a junior doctor. Whilst medical school prepares us well in terms of our understanding of conditions and their management there are some things that I have only experience during my time working on the wards. For example, whilst we are taught in detail about the science of fluid metabolism I had never encountered a fluid balance chart before but now realise how crucial being able to both fill in and interpret one will be when I am a junior doctor. It goes to show there is only so much lectures and workshops can teach you and that there are many lessons to be learned by being immersed in the clinical setting!

I’m hoping some of my present experiences will make the transition to a junior doctor easier when that does happen, but presently I do feel as though gaps remain.


Another thing that I have enjoyed during my time working is how I feel like part of the team. I am, indeed, expected to contribute to the work of the HCAs and nurses and I feel as though I have approached the work with gusto. I have done lots of observations, some ECGs and even some bloods. I know that medical students who are working are all having different experiences and I am sad that I haven’t had a chance to do some more bloods, cannulas etc, which would provide good experience for me at this stage. I know other students working on other wards have had the chance to do these, but there isn’t much demand for these skills on my ward.


That brings me to an update about when placement will resume. We have been told that placements may resume either in July or September, depending on the NHS situation. We would still need to do all of the placements that we would have done anyway, but of course we have now missed at least 4 months of placement. I think the discussions at the moment are of moving our final exams to later in the year, not having an elective period and reducing our summer holiday before starting work. At the moment there are lots of “maybes” and it really depends on the course of the coronavirus. I hope that we do get back to placement soon, as I really miss Medicine. So stay inside, for my sake!



May 15, 2020

What day of the week is it again?

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!


May 11, 2020

Uncertainty

For the last two weeks I have been continuing my employment at University Hospital Coventry as a Medical Student Clinical Support. As I discussed during my last blog, this is to help the NHS deal with the increased demand expected because of the COVID-19 pandemic. So, what have I been up to? Well, I am currently working 24 hours a week, which is 3 days of shifts from 12:00-20:00. Whilst at work, I am acting as a Healthcare Assistant, so helping to wash, dress, reposition, feed and just generally look after patients on the ward. In addition, I am allowed to carry out observations. These are done regularly for all hospital patients every couple of hours or so, usually by the qualified nurses on the ward. A standard set of observations includes blood pressure, pulse rate, breathing rate, consciousness level and temperature. We have been very busy on our ward, so I have helped the nurses by doing some of these observations and letting them get on with the drugs rounds and other duties that require a qualified member of staff. Medical students are taught to do observations as part of examinations (i.e. pulse for cardiovascular examination), but we aren’t taught to do observations in the same detail as nursing students. Having the opportunity to carry out so many has definitely increased my confidence and is hopefully a useful skill to take forward into my medical career when we finally go back to placement.


I have been settling into my ward and getting used to working again, as well as learning everyone’s names, which is slightly more difficult when you’ve never seen their whole faces as everyone permanently wears a mask while at work. I’d never realised before having to wear a mask which covers my mouth just how expressive my face can be and how much I use facial expressions to convey meaning whilst talking. I’ve been quickly learning how to use my eyebrows more to express more emotion – an unintended side effect of PPE (Personal Protective Equipment!)


Then I suppose I should discuss what’s happening with our course currently. Things are on hold until the NHS has dealt with the COVID-19 outbreak, at which point we should resume placements. It’s very difficult to say when the NHS will be stable enough to also deal with teaching us, but the University has posited July as a potential resume date, at which point we will have lost 3-4 months of placement. Final exams would be potentially pushed back from February to May and we would then do placement well into 2021 (when originally without COVID-19, placements should have ended December 2020 before revision and then finals in Feb 2021). There is a lot of uncertainty at the moment which is causing a lot of anxiety for everyone, and this is worst for the current third years who are the most senior medical students and so have the least time to make up any lost learning before graduating.


All of this anxiety about the future has been affecting me personally and my course-mates – we have joined the course to become doctors, but not just doctors for the sake of it. We want to be good doctors, who are able and good at doing the job of looking after people. For me personally, I don’t want to qualify and then feel like we aren’t as good as the years that have gone before us and those that come after us. Thus, it seems like a steep climb to the end – we will be out of practice with everything having had a 4 month gap, with less time to get to the same standard as our forebears in a changed NHS which may be unable to give us the same education as previously. I think this mountain must be surmountable – but at what cost? Added to that is the generally gloomy news; of economic uncertainty, of social isolation, of deaths in the news daily. The mental health impact on the UK mustn’t be discounted and I think will haunt us for years to come. As a former historian, I feel as though we are watching history unfurl before us – a turning point as real as the world wars, the nuclear age, the bubonic plague. As before, the solution is courage in the face of adversity – believe in better times and look after each other and we may yet see an end to this nightmare.



April 29, 2020

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!


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About our student blogs

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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