Coming to the End of Year Three

Starting the Care of the Medical Patient block felt like staring into the great unknown – how could we possibly cover all of this information in just six weeks?! – but it’s actually been great, if hard work. I’ve seen so much – it feels like all of medicine compressed into one six-week period and it’s hard to believe it’s almost over. It feels like a whirlwind tour!

Despite the time constraints of the block, however, our tutors have put a lot of thought into our timetable and, whilst it’s very broad in its focus, sometimes it feels like we’re jumping around a lot. I guess this is what being an F1 on A&E feels like! For instance, it’s not rare at all to spend the morning on an endocrine ward, have haematology teaching at lunchtime and then spend the afternoon in a neurology clinic! But thankfully we have developed a very strong base on core medicine in the second year – our hard work in Core Clinical Education is paying off – and so this block is allowing us to build on that.

I spent some time last week in an oncology clinic. I’d somehow never been to one before and it was really interesting. All of the patients were follow-up patients, so I was not present for any new diagnosis or any situations in which bad news was broken – but of course that’s not all that medicine is about. We spoke a lot about follow-ups and ongoing treatment and how different upper-GI cancers can present. I got to hear about a really uncommon presentation over the phone (as my consultant was also on call) and we saw the patient’s scans on the internal imaging system. The patient’s superior vena cava had been almost completely occluded by an undetected growth just under the sternum, which was detected incidentally after imaging for a different problem – this is apparently very rare and everyone got very excited by this. How interesting to see!

One of the other timetabled sessions last week gave us the opportunity to follow the Diabetes Specialist Nurses around the hospital. As med students and future junior doctors we don’t interact much with Specialist Nurses on a day-to-day basis (at least at the hospital where I am, they tend to move between wards), so this was a great opportunity to see healthcare from the shoes of people whose roles were slightly different to ours. We went on a massive, great ward round around the entire hospital, seeing diabetic patients and making sure that they were all supported in their needs. Some were newly diagnosed and some had lived with the condition for years, but the Specialist Nurses gave them excellent support; I was really amazed how well-versed they were and the strength of the rapport they had built up with their patients across the entire hospital.

We’ve not got much time left but I feel like we’ve got loads out of this block. And even though we had CCE in the second half of year two, all of the knowledge from that 30-week chunk has created a very strong base for this block. I’m really glad we did it as we did. And when this block ends, so will our third year! I just cannot believe that we’re almost fourth-years. This sounds so terrifyingly old. In the meantime, I’ll just concentrate on enjoying my summer vacation.

John

Luke Pemberton : 27 Jul 2017 16:49 |  Tags: John Mbchb Patients Student Warwick Wms |  Comments (0) |  Close comments |  Report a problem

Scrubbed up…

It’s now Specialist placement 5, the last block of year 3, and for me it’s my care of the surgical patient block. Despite all those years watching Grey’s Anatomy I’m not particularly interested in surgery and have spent most of my time in theatres so far thinking about lunch or how much my feet hurt! At the start of the surgical block I was definitely less than enthused and thinking more about my upcoming holiday in august than the anatomy of the abdominal wall, but I must say I have been pleasantly surprised!

I’m based at George Elliot, which is a small district hospital. Over the 6 weeks we rotate round 3 different surgical specialities: Urology, Colorectal and Breast Surgery. I’ve been with urology for my first 2 weeks, learning about different types of disease that can affect the prostate, bladder or kidneys that may require surgical intervention rather than medical intervention from the nephrologists. Clinics in urology are really varied; there is some overlap with gynaecology in women suffering from incontinence due to pelvic floor damage and there are lots of patients referred through the fast track system for worrying symptoms such as blood in the urine. Learning about the different investigations for these patients was something we covered last year but this year there is more focus on learning about the surgical management options, and how you decide which is best. Being able to get scrubbed up in surgeries means you can get much closer to the action and see the anatomical structures, and really appreciate the complexity of some of the operations. One operation to remove a patients kidney that had a tumour, lasted 6 hours, watching the surgeons avoid major blood vessels and control bleeding as they dissected the large tumour was fascinating. In contrast, another operation I observed was to remove a bladder tumour, which took less than half an hour-but to the patient these are both major, life saving operations.

As well as spending time in clinic and in theatres with the surgeons and anaesthetists we have also spent time with the junior members of the team while they are on call. The surgical senior house officer (not an FY1 but not a registrar yet) carries a bleep and sees all new patients that come into A&E or are referred by GP’s who may need to see a surgeon. This was a great opportunity for my clinical partner and I to take the history, examine the patient, come up with our differential diagnosis and decide what investigations we would want. The SHO was brilliant and gave us really useful feedback and helped us understand things we might have missed and importantly asked us to justify our investigations, something we have to do in our exams!

So 2 weeks in and I fairly sure I still won’t ever be a surgeon but so far I’ve learnt lots, which is always good with the prospect of 4th year approaching, and as an added bonus I haven’t fainted in theatres (yet)-win win!

Joanne

Luke Pemberton : 21 Jul 2017 12:24 |  Tags: Joanne Mbchb Student Warwick Wms |  Comments (0) |  Close comments |  Report a problem

The Broad Church of the CMP Block

It’s hard to believe, but we have passed the halfway point in our Specialist Clinical Placement (SCP) blocks, although I wouldn’t yet say that the end is in sight yet! Our fifth, and current, block is called “Care of the Medical Patient” (CMP) and is the block with the broadest focus yet. The purpose of this block seems to be to cover the general-medicine topics that we don’t see in a lot of our other blocks. For instance, we’ve already had blocks covering musculoskeletal health, paediatrics and obstetrics & gynaecology, all of which are very focused in nature. This block is much broader in approach, and the hospital where we are working has done a very good job of distributing us very widely across multiple disciplines.

What I’m really liking about this block is that we are exposed to a lot of topics in more detail than we ever were in Core Clinical Education (the latter two-thirds of Phase II). It’s great, and I’m really glad that (finally) so much of my work in Phase II seems to be bearing fruit. For instance, we are getting focused haematology teaching for the first time – so we are learning about lymphomas and leukaemias, factor deficiencies and all sorts of stuff that we briefly skimmed over last year. And the best part is that now we get to go to clinics and see patients in the flesh who live with these conditions. I learn best when there is an actual human being with whom I can associate a particular condition. It just helps tremendously when I can picture a patient in my mind to recall presentation, examination and treatment. As a case in point, I feel much more comfortable with lymphomas and leukaemias than I did before starting this block.

For my first placement in the first CCE block of Phase II, I spent about ten weeks on a respiratory ward at a local hospital. At this point, I had been a medical student for about fifteen months. It seems so very long ago now! This was probably my favourite placement, and I really felt at home in this learning environment. I was lucky enough to spend another day in a respiratory ward again just this past week, and it reminded me of how much I liked it. The presentations were fairly common (exacerbations of COPD, advanced pneumonia, bronchial carcinoma, etc.) but it was great to come back to a respiratory setting with a lot more experience under my belt. I felt much more comfortable working with the doctors and nurses and also felt much more comfortable understanding which investigations were being done and way. I hope to see more respiratory medicine in the future.

I have also spent some time observing neurology clinics for the first time; this was another area in which I had read a great deal but had seen hardly any patients. Now I can confidently say that I have seen and can hopefully recognise cases of myasthenia gravis, epilepsy, early-stage Parkinson’s disease, multiple sclerosis and many other common neurological conditions. Attending neurology clinics definitely brought more than one flashback to Block 3 of Year 1 (Brain and Behaviour), especially the direct and indirect pathways for movement regulation and how they can become inhibited. Thankfully I didn’t have to worry much about the various tracts that go up and down the spinal cord – that’s a headache for another day!

John

Luke Pemberton : 21 Jul 2017 12:10 |  Tags: John Mbchb Student Warwick Wms |  Comments (0) |  Close comments |  Report a problem

Fly on the wall

As a medical student, I spend a lot of my time hovering awkwardly behind consultants and other doctors as they see patients on the ward. In clinics, myself and my clinical partner are also squeezed into the room, often sat across from the patient, it feels like a follow up appointment in the form of a panel interview! I am always so grateful to patients and their relatives who are happy to put up with a committee of people on ward rounds and very crowded clinic rooms all so we can learn. I have been even more grateful over the last few weeks during my care of the medical patient block to patients and their families who have allowed me to sit in on clinics where doctors are regularly breaking bad news: the oncology clinics.

Cancer biology was not my strongest subject during my biomedical science undergraduate degree but in medicine it’s not just the underlying cellular and molecular biology that’s important, we need to know all the clinical manifestations so we can diagnose cancer, when to refer and what investigations are needed. So, in this block I decided to make a concerted effort to try and improve my clinical knowledge of both the diagnosis and investigation of cancer and of oncology as a speciality.

One of the clinics I attended was a fast track clinic for suspected lung cancer. GP’s can refer patients with symptoms or signs indicative of lung cancer and they will be seen in hospital within 2 weeks. Patients attending this clinic have often had a chest X ray and in some cases a CT scan before they attend so the consultant can in either reassure the patient or show the patient where the problem is that they need additional information from, perhaps in the form of a biopsy or a different scan. What struck me most in this clinic was the number of patients who were told that they had a suspicious mass in their lung but decided not to have further investigations, many were elderly and were quite clear that they didn’t want to undergo any further procedures. Having these conversations requires a very sensitive and perceptive type of doctor and is a very different type of medicine to what medical students probably envisioned before medical school.

Attending the oncology clinics, patients already knew they had a diagnosis of cancer but often didn’t know what treatment if any was available. These appointments lasted up to an hour and the doctors were clear that the appointment lasted until the patient wanted to leave, they encouraged questions from the patient and their family, and took the time to explain things multiple times. They comforted patients and relatives as they cried at the prognosis and then did it all again for the next patient.

All the time I’m sat in the room, a fly on the wall, observing how the doctor handles the different consultations, learning how they manage these complex patients, but all the while I’m trying my best to not get emotional too and reminding myself that it is a real privilege to be invited into people’s lives to experience their best and their worst times.

Joanne

Luke Pemberton : 05 Jul 2017 11:47 |  Tags: Joanne Mbchb Student Warwick Wms |  Comments (0) |  Close comments |  Report a problem

Starting the Care of the Medical Patient Block

We have just started our fifth specialist clinical rotation of Phase III and it’s really hard to believe that the time is flying by so quickly (this seems to be a recurring theme). This block is called Care of the Medical Patient (CMP for short) and I think we’re lucky to be doing it at a very big and busy hospital with lots of learning opportunities. Whereas most of our blocks have focused on more focused topics (paediatrics, musculoskeletal health, and obstetrics and gynaecology), the flavour of this block is more on general medical topics than many other blocks. This means that we see lots of traditionally core-medicine topics in quick succession and have many varied learning opportunities.

In Phase II (the latter two-thirds of our second year), our curriculum introduced us to “Core Clinical Education”, the purpose of which, I gather, was to give us a grounding in core medicine and help us students become proto-clinicians without getting carried away by too-detailed topics. At this point, it seems like the CMP block is expanding on these themes. We are getting a lot of teaching on core topics and talking about conditions – their diagnosis and treatment – in far more detail than we ever did in the second year. We seem to be focusing a lot of dermatology, neurology, renal medicine (I actually love kidneys), cardiology, gastrointestinal medicine and respiratory medicine than we have so far in any other block, and I’m really enjoying it. I have always had a great time with the core-medicine subjects and could possibly see my career developing in this direction.

In addition to being assigned to a base ward for the block (my clinical partner and I are on an endocrinology ward, so we see lots of diabetes and thyroid problems), we are also expected to attend lots of clinics of all sorts of flavours and also rotate through other wards for exposure. It’s pretty full-on. So far, I have attending two renal-medicine clinics (did I mention I love kidneys? I love kidneys!), a lymphoma clinic and a diabetes clinic – and we’re just a week into the block. It has been absolutely fascinating to see physiology come to life: when we first learned about the structure and function of the kidneys in October 2014 (Block 1 of year 1), I found it really overwhelming. But I committed myself to learning more about them, and I’ve slowly developed a begrudging yet abiding love for all things renal. Needless to say, the clinics have been great.

In addition to wards and clinics, we also get a fair amount of teaching from consultants and registrars. This is usually very useful. Today we got the first haematology teaching since second year, and I found it fascinating. I think my coursemates all think I’m mad, but I love talking about things like Tissue Factor and the Extrinsic and Intrinsic Pathways. I am really looking forward to the rest of this block and seeing more of what CMP has to offer. Maybe I’ll see if there are any extra kidney clinics as well!

John

Luke Pemberton : 30 Jun 2017 10:26 |  Tags: John Mbchb Student Warwick Wms |  Comments (0) |  Close comments |  Report a problem