All 223 entries tagged Wms
January 18, 2021
I’ve come into this block feeling refreshed and rejuvenated after the Christmas holidays and have just completed the first two weeks of my Surgical Patient block (my final specialist block of medical school!!) When I look back over the last three (and a bit) years, they have been filled with highs, lows and plenty of hard work – but I wouldn’t change it for the world. I feel as though things have come in a neat roundabout circle as my last block is surgery and Gastrointestinal medicine, and my first block in my first year covered the basics of this area of medicine. I, too, feel like I have come full circle in terms of motivation and drive. I started Year 1 with energy and determination and I again feel energised and ready to approach the next few months with the necessary determination to hopefully finish the course.
…Which is good as there is a lot to do. I have two prescribing exams at the beginning of February, and then written and practical exams in March. As well as this, I still have to engage with this block and learn enough about surgery to be able to cope as a junior doctor on a surgical ward. So, what have I been up to? Well, for this block I have not one, but two surgeons, making me slightly spoilt for choice. I have a general surgeon (so digestive system amongst many other things), and a urologist (male reproductive tract and male and female urinary systems) as my consultant supervisors. Last week I was lucky enough to attend general surgery clinic which I found really interesting, which sort of surprised me. I am still unsure what career path to go down but had thought general surgery wasn’t for me up until this point. I found the clinic really interesting and actually quite innovative with some of the novel techniques they use to sort digestive problems. One of these techniques is what they call a seton, which is essentially a specialised string which they put through false passages which helps the passage heal correctly – very cool stuff!
We have also had lots of tutorials from experienced surgeons in this block, and one of the most engaging of these was a session I had last week where we were taught how to suture. Suturing is one of the most basic surgical skills, but that doesn’t mean it is easy! All doctors need to be able to suture, of course surgeons need to be able to suture to close wounds, but also doctors working in A&E or General Practice need to be able to close small wounds and injuries if necessary. We had three experienced consultant surgeons teaching us how to handle the equipment and do a basic interrupted suture. This is where the needle goes through the base of the skin and is then tied above the skin to close the wound. We were also offered a challenge – one of the surgeons had created a laparoscopic training ‘game’. Laparoscopic surgery is commonly called ‘keyhole’ surgery as rather than large incisions, small incisions are made, and a camera and tools are used to complete the surgery. The game involved a webcam and two tools inside a box, and involved picking up rubber bands and putting them on small pegs. The person who did the most of these was the winner and would get a certificate, and unbelievably, I won! As I said earlier, I haven’t really considered surgery as a career in seriousness, but I found the game fun and have really enjoyed this block so far, so you never know…
December 17, 2020
The last two weeks have been…very busy! I have been continuing my Care of the Medical Patient (CMP) block, which covers most of general and internal medicine. Because it covers so much of medicine, it has been very busy because there is simply a lot of content to cover. However, I do think that this block has been one of the best learning experiences. One of the most useful things that I have been able to do this block is attend bedside teaching sessions. One of the original proponents of bedside teaching was the great physician William Osler (after whom several clinical signs are named), who believed that medics learned best at the bedside, by doing. This seems odd to us today, where we would expect trainee doctors to come into contact with patients but 100 years ago this wasn’t necessarily the case. Derived from the practices of William Osler, our bedside teaching in my CMP block is where two medical students are joined by a doctor and they go and see a patient. One medical students usually take a history (i.e. ask the patient what brought them into hospital) and the other student often does a physical examination of the patient. The doctor observes and teaches and gives us students feedback on our history and examination skills. Because of COVID, we have had less opportunities than normal to be able to see patients, so getting this practice under supervision has been really useful. Having an experienced doctor observing and providing feedback allows us to identify our strengths and also areas where we may improve.
Last week I also had an exciting opportunity to attend a Diabetes outpatient clinic with one of the Professors from the Medical School. We have known this professor since first year so it was interesting to observe them doing consultations and experiencing their reputation for amazing teaching first-hand. Diabetes is a really common condition and often comes up in medical final exams – so much so that if I was a betting man, I would say it will definitely come up somewhere. It was really good preparation to go over the basic management of Diabetes.
And here we are, Merry Christmas! Or…not quite! We break up next week, but first there is one last hurdle before that long-awaited break. The Situational Judgment Test (SJT) is an exam that has featured in my blog previously, and I think that pays tribute to just how important it is. The SJT is an exam which is based around what you would do in certain ethical and workplace dilemmas. My result in the SJT will be an important factor in what doctor jobs I will get when I graduate, and even decides the area you are placed. Thus, the result is really important, and it is a very high stakes exam – if you get below a certain mark, you are removed from the job application process and may not get offered a job as a doctor. I’m told this is very unusual, but that doesn’t stop the worry that I could be one of the only ones…So over the last few weeks I have been doing practice questions and reading ethical guidance to hopefully get me over that line, get a good result and hopefully get the chance to be a doctor next year. I can’t wait for Christmas to just relax after a stressful year, and I’m sure many of you reading this will feel the same. Wish me luck in my SJT exam and I hope you all have a great Christmas!
My current placement is Care of the Medical Patient, which is an overarching block which touches on many different areas. Medical patients include cardiology patients, respiratory patients, gastroenterology patients and many others. One area which comes under the umbrella is neurology and stroke care and for this block I have been attached to a stroke ward at George Eliot Hospital. Initially, I was apprehensive about being on a stroke ward because of how poorly stroke patients can be. In addition to this, I would say that personally neurology and stroke is one of my weakest areas academically. I think the anatomy of the brain and spinal cord is so complicated, I struggle to get my head around it. I suppose it’s good that I will get some practice in this area and hopefully become more comfortable with this area. Last week we attended a ward round on the stroke ward with one of the stroke consultants during which the consultant did some teaching about the management of various types of stroke. It was a really useful experience and we even got the chance to do some examinations as part of the round which was a good recap of the neurological examination (one of the hardest ones!)
Then, last Friday I attended an outpatient clinic looking after Parkinson’s Disease patients. Parkinson’s is a disease where one of the chemicals in our brain (dopamine) becomes depleted and this leads to issues with movement, including tremor amongst other issues. Having never seen a patient with Parkinson’s disease before I hadn’t appreciated the fact that there are many different types of the disease and that the course of the disease is so individual. Some patients progress quickly and some people remain stable and do not get any worse for years and decades. I also hadn’t realised how multi-disciplinary the management is. For example, Parkinson’s patients often have help not only from doctors, but specialist nurses, speech and language therapists, physiotherapists and dieticians.
This week I had been booked on to attend an ILS course (Immediate Life Support). All medical students have to have this course to be able to graduate as doctors and it teaches resuscitation in a hospital setting – including skills such as managing an airway, doing CPR and using a defibrillator. I really enjoyed the course and it sort of drew together and consolidated several sessions we have had before. None of the information or skills were new to us, but the application and practice using simulated sessions really refreshed that knowledge and I’m sure will be really useful revision for finals.
The week ended with Friday afternoon which was small group teaching on ECGs and heart problems. Being able to interpret ECGs (electric scans of the heart) is one of the most difficult skills expected of junior doctors, so having some recap and revision of some of the most common rhythms was useful. I haven’t seen an ECG in a long time as I have been doing Paediatrics, Obstetrics and Orthopaedics, so I had completely forgotten everything! Luckily, I quickly clicked back in with looking at ECGs and feel much more confident having a go now! Next week will be a busy one, with a few teaching sessions and hopefully some clinical skills practice. It should be a good one!
November 30, 2020
The last two weeks have been very busy. Firstly I have been completing the last couple of weeks of my Child Health/Paediatrics block. I have seen a couple of interesting things. One of my days I spent observing and helping with the NIPE checks. NIPE stands for Newborn Infant Physical Examination and this is a general health check completed on newborn babies, and the first is done within 72 hours of birth and the second check is done at 6 weeks of age by their GP/family doctor. I was observing the first check which is usually done in hospital and often done my midwives or junior doctors. The check is an all-round physical for the baby and looks at things such as oxygen saturations, reflexes, movement, whether they have a heart murmur, and looking for any birth defects. Essentially the check aims to find any issues which may impact on the health of the baby and the ability of the baby to cope when they go home. I enjoyed helping with the checks and seeing some very cute babies, and learned some interesting and important things which the check looks for. One of the coolest things I learned was about the reflexes that babies have to help them survive – one of these reflexes is one which you may know about, and that is the grasping reflex where if you offer a baby your finger, they automatically hold on to your finger. I find it amazing that these reflexes are present from birth and without the baby having to learn anything.
This week I have also been booking my Situational Judgement Test (SJT). I have spoken about the SJT on my blog before, but just to recap, it is a really important test that final year medical students sit and the score that you get gives you a score. If you have a higher score, you are more likely to get the Foundation doctor job that you want. You also have to get a decent score to get any doctor job at all! This year the test has changed, as it used to be sat at Medical Schools but this year we have to go to a test centre. This is similar to the UCAT/UKCAT which some of you may have sat or be aiming to sit soon. The SJT has questions which cover ethical and practical dilemmas and then your answer is how you would respond to these dilemmas. I have booked my test for mid-December to try and get it out of the way so that I can concentrate on finals when I return from the Christmas holiday. I am nervous about this test but also it is a tricky one to revise for. I am generally quite good at the type of thinking that the test is looking for, which I think is courtesy of my History degree days. Hopefully I do okay on the test.
Overall, I have found the Child Health block challenging for all sort of reasons, including just how many things there are to do, and anticipation of finals just around the corner. My next block is Care of the Medical Patient which is a block which covers lots of different areas, all concerning general medical patients. These patients suffer from heart issues, respiratory issues, brain and nerve problems and also gastrointestinal problems. I think it will be a really useful block for recapping and building on my existing knowledge and building a wide knowledge base before finals. In addition, I am heading back to George Eliot Hospital which I had a good experience at in my first and second years of med school and hopefully it’s a productive block!
November 12, 2020
The last 2 weeks have been very busy for me. The time has come for us to apply to the Foundation Programme. I have spoken about the Foundation Programme in my blog before, but just for a brief recap, the Foundation Programme is a 2-year programme which new doctors complete. It is, as the name suggests, a Foundation – a 2-year programme where you are a qualified doctor but work in specific roles where there is plenty of support and training to allow you to build your confidence and abilities as a new doctor. The application process is relatively straightforward and pretty much nothing like a normal job interview. Your medical school ‘nominates’ you, and then there is a brief online form, and then you rank geographical areas where you want to work. There is no nerve-wracking job interview, just a ranking process based on your performance at Medical School and in an exam called the Situational Judgement Test (SJT). The SJT asks you certain dilemmas and asks you how you would respond, and you get points for the most correct answer. We have to sit the SJT in December or January.
In addition to preparing for the future I am also in the middle of the Paediatric and Child Health block. Last week we had Paediatric Basic Life Support training. We have had training in Adult Basic Life Support before on the course, but Paediatric life support is actually quite a bit different. In adults, you approach an unconscious causality and presume that they have had some sort of heart issue, whereas in children the most common cause of a collapse is a breathing problem such as choking. We had to practice on model babies which is an unsettling experience, even though it is only a doll. I really hope that during my time on Paediatric block I don’t need these skills, and luckily it is very rare for a child to be that poorly!
This week I have been placed on the Special Care Baby Unit (SCBU) at the George Eliot Hospital. This unit looks after babies in the first few weeks and months of life who have developed medical issues or are struggling to grow, feed or develop. We have also had online lectures about common issues that affect babies such as jaundice (yellowing of the skin) and various heart murmurs (some of which can be normal). I have also spent time this week observing the new-born baby checks. These are done by a trained midwife or one of the doctors and all babies have a check within 72 hours of birth which is done by the hospital. Another check is then done by the family doctor/GP at 6 weeks of age. These checks aim to identify any problems present from birth, for example birth defects or any issues which may impact on the baby and its ability to grow and live. It has been really interesting to observe these checks, and, of course, there is the added bonus of getting to see some very cute babies! All of the babies I observed were okay but watching the checks has opened my eyes to the many issues which can affect babies and their families – birth is just the beginning!