All 151 entries tagged Wms
February 21, 2019
So, the beginning of February brought the end of block three and the beginning of block four. I felt a little sad as I really had enjoyed block three and it had cemented for me the reason of why I want to pursue neuro as a career. I had really enjoyed the labs with the last one recording EEG measurements. This was basically an excuse to nap of the floor of the lab for half an hour …. I gladly took that sacrifice for my team. However, it had to come to an end and we now are on block 4…. The penultimate block before the E word of which our Anatomy Professor has already mentioned once.
I am enjoying the content of the block, but it is taking me A LOT longer to pick things up, even in the anatomy side of things which is normally my strong point. The lower limbs are surprisingly complicated but all it is going to take is some hard work and I’m sure it will click in the end …. Hopefully. It is proving to be a weirdly entertaining block however as so far in lectures we have been standing up holding our own bums (demonstrating gluteus maximus), dragging each other standing up (demonstrating the sliding filament theory) and everyone is performing weird movements in the anatomy labs. Something tells me that I will be able to tell if any block 4 questions are being answered in the exam room.
We also had to submit our first written work this week which was our community day reflections. I found this hard because I had to essentially reflect on a conversation I had with a patient as part of a group. If you have ever tried to reflect on a conversation before you can probably see where I am coming from. It felt strange and for someone who must work at communication more than most (I have Asperger’s) it was a challenge to know what to write about. However, there was plenty of support and I did my best so hopefully it gets a pass. We also started another written assignment this week which was the case reports. Essentially, we have to find a patient and write their presentation up and submit it to our clinical tutor. We had an SDL session for this where we could go around the hospital at will, find a ward, find a patient and write up what we find. Terrifying for a first year. What if the ward does not want to let us in? What if the patient is too complicated? What if no doctors want anything to do with you? These were all the thoughts racing through my mind on Tuesday but Maariyah and I braved it alone and ended up on the cardio ward. The nurse we met was lovely and thankfully Maariyah did most of the initial talking as I was too nervous to put words into my own mouth. I relaxed a bit after we found a patient and I enjoyed looking through notes to build up what we knew about the patient and getting to talk and examine a patient without supervision. I’ve said it before but moments like this where all the work you do outside of the hospital comes into its own. It is also nice for the old self esteem as you realise how much you have picked up (even though you think you haven’t learnt anything) since you started.
I am also making sure I take a break from medicine and it’s in the form of my own blog that I am rather proud of. It’s developing slowly and I also use it to take stock on what I have done every week by writing a bit of a weekly summary. I looked at week one the other day and (after getting over how excited I was) it really did hit home how far we have come since those naive days in September. I also got some messages this week from people I had given advice to throughout the application cycles saying they had got into Warwick! This really did make me happy as I liked the fact, I may have had some small input to helping them.
Looking towards the E word, I really do need to start learning the drugs list (sorry WMS I haven’t started it yet). However, I had a bit of an epiphany moment when I woke up this morning (because what else are Saturday mornings for) and I realised that I know most of the drugs by what their packaging looks like as I worked as a dispenser for over a year, so why not put that to use?!
It’s the little things that keep you going ….
February 18, 2019
The week started on Monday with me teaching my BLS (Basic Life Support) to first year medical students. This was my last session as a trainee BLS instructor (like a probationary period), and after completing it, I am now qualified as a fully-fledged BLS Instructor! We will hopefully be teaching some of the first-year medical students here at Warwick Medical School very soon, providing high quality BLS training. Watch this space!
Tuesday is GP day, which has quickly become one of my favourite days of the week. In GP we get to lead several consultations per day each, which is very fun, and a little bit of lucky dip, because you aren’t sure who will walk through the door! The GP supervising us is very supportive, and tries to encourage us to take the consultation, even when the medical issue the patient has isn’t straight forward. This is great because it gives us a chance to deal with conditions and issues that we might not be totally confident with but means that we get to push ourselves and try and learn as much as we can. The great thing is that if we do get stuck or go off topic, our GP is observing and jumps in to help out. Overall, it’s a great chance to practice our skills, to try and develop, but is in a safe environment with us being watched by experienced hands.
Today we spent our first proper day with the Respiratory department at George Eliot hospital. For each CCE block we have to get specific activities signed off, including examinations, histories and procedures and also what is called a Case Based Discussion. We do these with the education doctors (Clinical Education Fellows - CEFs), who then give us feedback on our skills. We wanted to get our Case Based Discussion done today (roughly by the middle of the block) so we booked a session with one of the CEFs to try and get this signed off.
There was only one thing missing – a patient! A CBD is where we see a patient on our own (doing a history and examination), and then meet up with the CEF afterwards and discuss the case, including how the diagnosis was made and what management we would provide for the patient. Our CEF session was booked for 9am, and we needed to have seen a patient before then, so my clinical partner and I went in for an early start at 8:10 and went straight to the ward. We ended up finding a lovely patient and doing our history and examination and also having a nice chat – bonus! All in all, it went well and our history and exam definitely went more smoothly than it was at the start of this block (only in January, 5 weeks ago). It’s a nice feeling when it comes together, and you feel like you’ve done a really comprehensive history and good exam. In CCE we do history and examinations pretty much every day (and multiple times a day on GP days), so we have plenty of time to really improve our skills.
After doing our Case Based Discussion, we headed to the ward to find someone to shadow and just get settled in, including just introducing ourselves to everyone. The ward was very busy so it took us a little while to find someone who was free to talk, but in the end we found a lovely registrar (the level in between foundation doctor and consultant) who let us follow while they saw some of the sickest patients on the ward. They asked us to read an ECG and work out the diagnosis which is never, but between the two of us we seemed to work out that the ECG was normal, and the registrar confirmed that it was. I think it was beginners’ luck! The registrar also ended up seeing a sick patient and having a very difficult conversation with a relative about the prognosis of the patient, which was extremely difficult to witness, but unfortunately an important part of the work of a junior doctor. The registrar did a very good job, and I took notes as to good practice and an example of how to do it well. It is important while on the wards and clinics to find doctors who can act as good role models of how to be a compassionate and competent medic and I learned a lot today about how to have a sensitive conversation.
All in all, it has been a busy and challenging week. Despite this, there is definitely a feeling of growth – I don’t feel nearly as out of place as I did at the beginning of this block and have sort of worked out who we need to speak to on the wards to find the best learning opportunities. It’s weeks like this that remind you how amazing it is to be a doctor – to be with people in the best and worst times of their lives. Hopefully you can make them feel better too!
February 04, 2019
Block three has been chugging along and it is my favourite block of the year. The anatomy content has been sticking in my head and I am enjoying learning more about the anatomy and physiology of neuroscience, building on what I had been taught in my undergraduate degree. A couple of us have also been contacting a neurosurgeon up at UHCW with the possibility of observing/ working on projects with them.
We also had our second community day. This time we had a paediatric patient which I was excited about as I know I want to go into paediatrics when I specialise. We had some problems initially as the area we were visiting had no signal and all we had was a rough map of the area to find the house, so we were touring the area before we finally found it. It was a different experience to last time as we were not talking to the patient but rather to the parent. It was slightly hard as we only found out about the condition 5 minutes before we arrived, so we were doing some quick thinking as we walked up to the house. The parent was knowledgeable about the condition, so it was easier for us to interview them and we got a lot of information out of the day. The child was also sweet and shy at first but, after lapping the living room on their toy car several times, they gained the confidence to come up to us and show us their hands as they related to the condition they had. It’s difficult to describe this case as it is rare so could be easily identifiable.
We must present our cases next week, so this is going to be something we must keep an eye on. We also visited the local primary school and we all had flashbacks to when the only stress in life was who you were going to line up with to go to assembly. The school was fantastic, and we were told about the adjustments that schools make for children with needs and policies regarding the safeguarding of vulnerable children. The teachers were lovely and the headmaster offered us the opportunity to go back for some experience or to work with the school. I was excited about this as I want to run a STEM outreach day at some point and it would be interesting to look at the affect of outreach days on children’s wellbeing.
We also visited the hospital to talk to a nurse about pre-natal screening in which we were told about the pathways used when a mother is identified as Hep-B / HIV positive. They also highlighted a new test coming into the NHS which will screen the baby’s DNA that is circulating in the mother’s blood which is safer than taking a sample of the amniotic fluid and more accurate than taking measurements from a scan. We finished at 3.00pm and due to some problems with the roads we could go straight to campus, so I was able to get some work done before my student seminar in the evening.
This term has given me a bit more breathing room to start thinking about how to build up my portfolio and as someone who wants to go into surgery, I want to make sure I stand out from the crowd. The surgical society put on a “Women in surgery” evening where some surgeons from the local trusts came and talked to us about their careers. They were very keen to highlight the point of finding a good mentor and not letting a career in surgery become a choice between being a surgeon or having a family.
This weekend I also took a trip down to London along with a couple of other Warwick Meds to a conference on Careers in Neurosurgery. This is a field I have dreamt of going into after reading Henry Marsh’s book in Year 13. Henry Marsh was meant to be at the event, but he was ill on the day so could not attend. However, it was still a great day and I picked up a lot of tips and information about how to build up my portfolio to stand a good chance of getting an interview. There were some other presentations about the tools used in Neurosurgery and the ones that are being developed. One memorable one was the AI camera which could analyse the procedure and tell the surgeon when it was time to move onto the next step. It wasn’t perfect but it could help to train new surgeons and I am watching the world of AI as this is going to become a more commonplace in hospitals as we progress through our career.
January 29, 2019
How time flies – its Week 3 of CCE already! CCE (Core Clinical Education) is 30 weeks long, and to think that it is already one tenth completed is quite a daunting thought to say the least. The transition to clinical medicine that CCE represents has definitely brought both opportunity and challenge in equal measure. For example, the majority of our time is self-directed now – the only “sign-in” sessions, so to speak, are workshops (1 hour a week) and academic days (1 day a fortnight). For the rest of our time, we are expected to decide on which clinical activities are most useful for our learning, whether that be outpatient clinics, inpatient ward rounds, theatres, etc. This is great as we can go to the activities that we have found most useful. So far, my clinical partner and I have mostly attended outpatient clinics, as these are the activities which our assigned consultants mostly conduct. These have been great for practicing our history and examinations on patients under the experienced eye of a consultant. It also means that we have the chance to listen to real pathologies. For example, so far most of our patients in OSCEs have been healthy, which is great when learning the basic steps in an examination, but means that we haven’t heard many heart murmurs for real. We identified that we wanted to hear some real heart conditions, so we went to a cardiology clinic and had the chance to listen to actual patients with heart murmurs. Listening to YouTube videos of murmurs can be useful, but listening for real is the only way to gain experience in what the various murmurs sound like and (hopefully!) remember these for exams.
One downside to the self-directed nature of being a clinical medical student is that it can be hard to know where to go sometimes to use your time most effectively, and even when you decide you want to i.e. attend a certain ward round, it doesn’t always go to plan. We have attended hospital twice over the last few weeks and found that it wasn’t possible to attend the activity we intended to go to. This happens because sometimes the ward doesn’t have capacity to have us because they are busy, or that other medical students have got to the ward first. This means we have found ourselves at a loss of what to do, and have ended up wondering hospital wards asking if there are any patients we could see or anything we could attend. Last Monday this happened to us and we couldn’t go on ward round with our consultant because they weren’t around, so we ended up going around surgical wards asking the nurses whether there were any patients who it would be good to talk to. We ended up on a gastrointestinal surgery ward, with patients recovering from abdominal surgery or waiting for surgery.
We had the chance to take some good histories on our own, with me and my clinical partner giving each other feedback on how to improve our histories and examinations. We were reading the patients notes when a very friendly FY1 (Foundation Year 1 doctor, which is the first year as a doctor after medical school) asked if we were medical students and whether we wanted some teaching – we said yes! The FY1 offered to watch us do a history and examination and then talk through our performance and the case with us. This was much useful than us just giving each other feedback and we received some good advice on how to approach exams as the FY1 was actually a Warwick graduate! This meant that they knew the level we were at and was able to give us some useful tips on how to approach exams. It can be difficult to find someone to teach you, but when you do, it is definitely worth it.
This Tuesday we had our GP (General Practice) placement. We had already had a taster GP session last term which gave us some idea about how our placement would work, and now we have 21 days of GP over CCE (so roughly 1 GP day a week, every Tuesday). Coming into medical school, I had already done one week of GP shadowing before applying and had already decided that GP was not for me. I couldn’t have been more wrong! The entire day was structured in that the GP we were assigned to would pre-screen each patient to see if the case could be suitable for us to see, and then took consent as well from the patient for them to see us.
We then took it in turns (my clinical partner and I) to take a history and examine the patient, under the watchful eye of the GP who would be observing. This was great as it was almost like being a doctor – seeing patients and conducting the consultation patients almost by ourselves. It was quite scary to do this at first, but we have been well prepared for this – we’ve taken histories from patients in hospital since halfway through first year, and the patient in GP generally have slightly less complicated histories and they tend to be less ill than hospitalised patients. In addition, patients in GP generally only come in with one presenting complaint, which means your history can be very focussed and can aim to address that complaint. GP is definitely back on my list of potential careers.
CCE so far is vastly different from first year and second year up until now – we are much more autonomous than previously and most of our learning is self-directed. This is scary, but I feel as though my clinical partner and I are getting the hang of finding our consultants in the hospital (the secretaries extremely knowledgeable and very friendly!) and deciding on the activities we want to attend to maximise our learning. We have 2 more weeks attached to our cardiology consultants and then we move on to Respiratory – how time flies!
January 21, 2019
So, it finally happened! We have had our first bedside teaching and it definitely lived up to my expectations. I am at UHCW for my first year and have my bedside teaching on Tuesday afternoons, which is a slight pain in the ass for parking at UHCW in the afternoon. However, Matt and I managed by sheer luck to grab a space within 40 minutes of getting there. We headed in and made it with 5 minutes to spare before the lecture welcoming us into the trust. We were told about what is expected of us, how to sign in and general admin before we were introduced to our consultants.
My consultant is lovely and approachable which is something I had been worried about as you hear a lot about the nature of consultants to hide away from medical students. So, I was happy to have an approachable teacher who was keen to get us straight on the wards. We went to the Medical Decisions Unit where patients are transferred from A&E and within 10 minutes, I was meeting my first patient.
I was nervous because this was all new and I did feel a bit sorry for the patient who suddenly had 4 medical students descend on them, plus a clinical fellow who was supervising us, so it got cramped in the cubicle but we got through. We carried out a history and some clinical examinations under the supervision of the clinical fellow who was writing down our findings into the patient’s actual notes! I carried out an abdominal and respiratory exam and it really hit home why we learn clinical skills every Friday. It is easy for it to become out of context but putting these skills into use allowed me to put Friday lectures into context.
After we finished, we were sent away to discuss treatment plans and differential diagnoses amongst ourselves and it really hit home why we are doing what we are doing. I’ve said it before, it's easy to get lost amongst the hours of lectures, workshops and self-study but when we get to put our knowledge into a clinical setting when there is a real life involved, it makes it all seem worthwhile.
I had a bit of an idiot moment at the end of the day as I spent 20 minutes trying to get into a locker that wasn’t mine. I mistakenly had written my name on the wrong locker and only by curiosity I had discovered my mistake – I think I need more caffeine in my life!
Coming back round to the academic life, we have started block three and it is as interesting and brilliant to learn as I thought it would be. I come from a neuroscience background so I had been virtually pining for some brains. It’s not easy and there is a lot to learn but it’s nice to hear familiar words again and I feel a bit more at home on my turf now. We are seeing brain MRI scans virtually every day and I am taking the opportunity to transfer my new knowledge onto my own brain MRI scan that I had done a couple of years ago.
My favourite lecture so far must be the one we had on consciousness. I was expecting the philosophical approach that I had sat through in my undergraduate degree. I was so wrong. We had a consultant neurosurgeon from UHCW (so I was in slight awe to begin with) and he approached it from the GSC score (how we assess how “awake” someone is). He was funny and gave a lot of insight into the scale so I took a lot away from the lecture. Neurosurgery is a career I am determined to pursue having completed two weeks as part of my pre-med work experience. I find the brain fascinating and to see it for the first time after the dura (a covering of the brain) was pulled back is an experience I will never forget. As you can imagine, I was inspired just by having a neurosurgeon in the room.
So far Term 2 has been intense but I have enjoyed it and I am on top of my work for once! I know these 5 weeks will give me the confidence boost I need with the exams drawing slowly nearer. On Sunday, we went as a flat to the local watering hole where I watched three of my flatmates devour 50 chicken wings between them before playing the QI board game. Well… there are worse ways to spend a Sunday evening.
Did you know that Scotland won the first ever elephant polo championships? Neither did I until 10pm on Sunday …!