Finals countdown…

After a relaxing two week break I have emerged from my chrysalis as a fully-fledged final year medical student. Do I feel any different? Do I look any different? People certainly seem to be treating me differently, all the focus is now on job applications in October and final exams in February next year. Doctors teaching us in hospitals have high expectations and seeing students from the year above us now working as FY1 Doctors is inspiring fear rather than confidence! I don’t think I have felt this nervous since freshers week, nervous feelings about the task ahead have resurfaced now that my ambition to become a Doctor is almost a reality, with a few final hurdles to overcome.

I embark on my final year by starting on my Acute Medicine block. This block is split between UHCW in Coventry and Warwick hospital. We spend time in the emergency department and the acute medical wards, doing a variety of shifts so we can see as many patients as possible. I’ve spent the first two weeks of the block on the acute medical wards at UHCW. These are interesting places to be as a student as you get to see lots of patients presenting with common medical problems that will come up in finals. Patients are clerked in A&E and once its decided that they are stable and need medical treatment as an inpatient or are waiting the results of investigations they come to the Acute medical ward (AMU) at UHCW. The doctors on AMU then clerk the patient and then arrange or follow up investigations and start treatment. There is a huge variety of patients on AMU at any one time. Patients may have come in with chest pain and shortness of breath so things like heart attack or pulmonary embolism need to be ruled out even if you suspect a chest infection. Some patients may need to be admitted under a particular medical specialty and will move once a bed becomes available and for others they can stay on AMU and leave after a few days of treatment. As a student you can clerk patients, help take bloods, insert cannulas and attend ward rounds and because its AMU, every day there are new patients to figure out.

Another area we have been assigned to is the Medical decisions unit (MDU), where patients are referred in by their GP for tests or treatment only available in hospital. These patients are usually not acutely unwell or unstable but they have presented with a problem that could be serious. For example if a patient presents to their GP with central chest pain that came on after eating a large meal, the GP simply doesn’t have the tests available in the community to rule in or rule out a heart attack even if it sounds like heartburn, that patient needs to come to hospital for further tests but they don’t necessarily need to come in an ambulance and wait for several hours in A&E. In MDU the tests can be done quickly and so patients can either be reassured confidently or brought in for further treatment. MDU is one of my favourite places to be as a medical student and it is great practice for finals. You can take a fresh history and examine the new patients and decide what your differential diagnosis is and what tests you want to do and then present it to one of the junior doctors who will agree (or disagree!) with you and who can organise the appropriate tests. Over the course of your shift you can chase up the results and actually find out if you were right and can decide on the management with the juniors and consultants. It’s a great chance to present cases to seniors and get feedback on your clinical reasoning skills and management.

Aside from getting to grips with the acute block I have also made a revision planner for finals, having the next 20 weeks before my first exam planned out and stuck to my study wall is terrifying! Hopefully when I start my A&E shifts next week that will provide a welcome distraction from my revision planner and the countdown to finals!

Luke Pemberton : 01 Sep 2017 12:29 |  Tags: Joanne Mbchb Student Warwick Wms |  Comments (0) |  Close comments |  Report a problem

Care of the Surgical Patient – and the Beginning of Year Four

When I first became a medical student, being a fourth-year student seemed such a distant place to be. Before getting there, we had lectures to sit through, ward rounds to attend, and – who can forget? – exams to pass. I used to look in awe at the fourth-years I knew and think, “Wow – they must know so much. I wonder how I’ll ever learn enough to make it into the fourth year.” Well, odd as it may seem, last week we started our fourth year – it’s a bit anti-climactic, however, as it’s really a continuation of what we’ve been doing in the third year. Nevertheless, it’s hard to believe that I’m in that position now. I certainly don’t feel as confident and knowledgeable as those fourth-years seemed to me, way back when. But maybe I just don’t realise how much I’ve actually learned in the intervening three years. I’ll have to wait and see how I do on finals!

Along with our fourth year of medical school, we have also just started our sixth Specialist Clinical Placement block – this one is the CSP block (Care of the Surgical Patient). I’m thrilled about it for a couple of reasons. First, my clinical partner and I are at the largest of our teaching hospitals. I am taking full advantage of the huge variety of cases and the opportunities for teaching that are sometimes present at smaller hospitals but are definitely routinely present at ours. There’s just so much going on here. Second, I’m teamed up with a vascular-surgery team for most of this block. In previous blocks, I’ve spent time in orthopaedic surgery, colorectal surgery, urological surgery, gynaelogical surgery and loads of other disciplines, but I’ve never actually spent time watching operations on blood vessels, so this is an area entirely new to me.

So far, it’s been really interesting. I thought a lot of vascular surgery was occupied with conducting bypass operations, but there’s so much more to it than that! A lot of the patients we’re treating are elderly people who have diabetes and/or a smoking history, as these are two of the many risk factors for peripheral vascular disease. The issues that the surgery team deal with are much more varied than I expected: there are lots of bypass operations, some toe/limb amputations, a lot of wound debridement (removing dead tissue from wounds that have not healed fully) and lots of other things that you probably wouldn’t discuss over the dinner table with your mother – unless she is a vascular surgeon. Let’s just say there’s more gangrene than I expected.

And of course, although we’ve had our fair share of shadowing operations (I even got to make a stitch the other day!), there’s much more to the CSP block than just time spent in theatre. We have post-take ward rounds, clinics and lots and lots of teaching around surgery-related topics. We’ve had anaesthetics sessions, suturing workshops, teaching on wound dressing and care, and many other topics. I wasn’t too keen on a career in surgery before coming into this block, but who knows? There’s still time to change my mind!

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Luke Pemberton : 31 Aug 2017 15:44 |  Tags: John Mbchb Patients Student Wards Warwick Wms |  Comments (0) |  Close comments |  Report a problem

End of third year…

If I close my eyes I can still picture the second year exam pass list, seeing my name there and relief flooding over me, it feels like only yesterday. Since then I’ve started and completed a research project (student selected component 2), had a refresher course of hospital life (advanced cases 2) and had five of my speciality clinical placements. So far I’ve completed 6 week blocks in General practice, Child health, Obstetrics and Gynaecology, Care of the Medical patient and Care of the Surgical patient. There are no exams in third year (phew!) so the main thing to worry about is making sure you have submitted all the correct forms and assessments for every block on your e-portfolio.

It’s been a busy year since we started our speciality placements in January and I’m really looking forward to a break, every block has had its good and bad points, but all have been enjoyable and interesting in different ways. In General practice it was a great confidence boost to be able to conduct entire consultations on our own for the first time. In both child health and O&G we were exposed to a lot of intense emotions from both the patients and staff, helping care for sick children is about reassuring and supporting parents as well as providing medical care for their child and in O&G caring for the same patient over the course of a long labour is stressful for everyone involved. Care of the medical patient wasn’t just about the theory, our consultant always made us think about the person behind the disease and the effect on their life. Care of the surgical patient has been about when not to operate just as much as any of the surgical procedures, something which surprised me!

Learning when to intervene or not is a huge part of medicine but I suppose in surgery it is vital to ensure that if an operation is performed it is for the right reasons. The last two weeks of my surgery block at George Elliot hospital have been with a Breast Surgeon. The breast clinic is a one-stop clinic, patients are examined and can also have a mammogram and ultrasound of the breast and get the results on the same day. This means lots of patients can be reassured and others can be referred quickly for further investigations. A lot of the results are then discussed at the breast surgery multidisciplinary team meeting where histo-pathologists, oncologists and surgeons, radiologists and nurses all decide together the best course of treatment for patients. In some cases it could be a simple benign lump that needs no further treatment, or in others it could involve deciding what type of surgery or systemic treatment is required for a cancer. It’s great to see how these complex decisions are made as a medical student, I’ve certainly learnt not to believe everything I watch in Greys Anatomy!

Following our break I come back to the acute medicine block. I’ll be working evenings and nights in A&E as part of the team. This will be followed by the Psychiatry and Musculoskeletal blocks. During this time I will also apply for my foundation doctor jobs (i.e. decide where I want to live!) and sit the situational judgement test, which plays a huge part in what job I will get. It’s going to be a busy autumn for me but what’s important now is that I have 2 weeks off, time to relax, ready to come back as a final year medical student.

Joanne

Luke Pemberton : 10 Aug 2017 15:27 |  Tags: Joanne Mbchb Student Warwick Wms |  Comments (0) |  Close comments |  Report a problem

Time flies…

Now that we've finished the Care of the Medical Patient block, our fifth six-week block in a row in 2017, we finally have a couple of weeks off to relax and re-charge our batteries. This is our official Summer Vacation. I worked for many years in the private sector before coming to medical school, but this thirty-week stretch in Phase III with only (three) bank holidays off is the longest I have ever done without a break in my professional life. I really hope that it's worth it in the end! I'm relaxing and not doing much and in between the lie-ins and catching up with old friends, I'm taking my time filling in the gaps in my notes from some of the earlier blocks. I'd rather do it now than spending time panicking over Christmas.

Slightly more alarming is the fact that we're now the oldest cohort at Warwick Medical School. When did this happen? It feels like we had our induction week just last month, but now we're just weeks away from yet another cohort starting. And the people who have been just one year ahead of us the whole way through the course have now got their degrees and are now actual, real-life F1s in hospitals up and down the country. It's wonderful, inspiring and more than a little daunting that this will almost certainly be us in a year's time. I have faith that we'll be fine, though. The environment for junior doctors to learn is very supportive, and the medical school has trained us well in what to expect.

When we start back, we'll be on the Care of the Surgical Patient block, which is intended to teach us as medical students everything we need to know for a firm basis in surgery and anaesthetics. I'm actually really excited - it's not a part of medicine I know much about from a practical standpoint. We've observed lots of operations and procedures but our (minimal) involvement up to this point has been on an ad hoc basis from consultants who kindly ask us to scrub in; this is rare. I hope in this block we will get a much better, hands-on view of what surgery actually entails. I believe that every foundation doctor is required to do at least one surgical rotation (although don't quote me) so this will be excellent practical backing.

For the rest of my break, however, I'm going to concentrate a little more heavily on the 'life' part of my work-life balance. This will be the last time before final exams that I get to relax and have a lie-in occasionally (or frequently)! I'd be lying, however, if I said that I wasn't revising a little bit at times. There is so much information to learn, and I cannot afford to forget any of it. But maybe I'll think more about it after I wake up from my nap!

John

Luke Pemberton : 08 Aug 2017 10:05 |  Tags: John Mbchb Student Warwick Wms |  Comments (0) |  Close comments |  Report a problem

Perks of the job…

Being a graduate entry medical student is pretty tough, hours are long and the work never really ends so feelings of guilt are always present, having said that studying medicine is a real privilege and there are some excellent perks…you just have to know where to look for them! One of the perks of being a medical student is the opportunity to go to conferences. There are always bursaries and prizes available for medical students to attend conferences. At the start of third year all students must complete a research project and lots of my colleagues have been able to present their work at conferences. Some around the UK, to exotic places like Newcastle, and others have gone a bit further afield to present at conferences in Canada! Presenting an oral or poster presentation at a conference not only looks great on your CV but is a great opportunity to network with other students and doctors who share your interests.

This year I’ve had the chance to present my work on a medical education course for students at a regional medical education conference. This was not only great practice at delivering oral presentations but I got to meet lots of people interested in medical education. Many of the attendees were clinicians who also worked in medical education, I was able to quiz them about their jobs and how they got into their roles over coffee. I was also able to get to know senior members of the medical school better and understand what it’s like to work in management roles within a large medical school. The most recent conference I had the opportunity to attend was the International Congress for the Royal College of Psychiatrists which took place in Edinburgh. Although I wasn’t presenting at this conference I was able to attend fully funded as I had successfully applied for a fellowship from the RCPSYCH that supports students interested in psychiatry for 3 years, and as part of this you can go to the annual conference for the duration of your award! Being able to attend such a large conference was really exciting but also quite daunting. I took the opportunity to attend sessions on topics that I’m particularly interested in such as perinatal mental health, getting into research and improving medical education and recruitment to psychiatry. In between sessions I met lots of other medical students as well as psychiatry trainees in a special refreshment area reserved for Students and Trainees- a very friendly and welcoming place to enjoy the free conference food!  I was introduced to the Chair of the Psychiatry Trainees committee and learnt about opportunities to get involved in this in the future. I also made contacts with people in Warwickshire who I could get additional clinical experience with in sub specialities like Forensic psychiatry.

I’m looking forward to attending the conference again in the future and been able to present some of my work that my fellowship is supporting me with as part of my elective project. The medical student elective is another major perk of medicine-6 weeks to go and experience medicine in any part of the world! Our elective takes place after final exams in March/April and I’m hoping to go to Ethiopia and conduct a research project in perinatal mental health. We had to submit our proposals for approval last week so fingers crossed it will all be approved and I’ll be off to Africa! Medicine isn’t all that bad after all!

Joanne

Luke Pemberton : 31 Jul 2017 13:48 |  Tags: Joanne Mbchb Student Warwick Wms |  Comments (0) |  Close comments |  Report a problem