Learning outcome number 1: Learn all of medicine!

My task this year, to learn medicine, all of it. The medical school would say I am exaggerating but this is what it feels like to be a medical student. It’s so difficult to know how much we need to know and in what detail, learning outcomes are supposed to be a guide and can therefore seem vague and textbooks vary so wildly that you start to believe that maybe Wikipedia does have all the answers (note to self, it doesn’t!). This is a universal problem for medical students but it’s especially true of the Care of the Medical patient block which I am just finishing.

In third year, our speciality placement blocks are just 6 weeks long. I’m sure I’m not alone when I say medical students are often quite organised people and are good at compartmentalising their learning. So far this has worked in my favour, Paediatric block, focus on children’s health, then for Obstetrics and Gynaecology focus on women’s health. This theory doesn’t work in Care of the medical patient…which bits of medicine, or just all of it in just 6 weeks? I started the block wanting to see and learn everything medicine had to offer but after trying to sort out a timetable and plan of action going forward quickly realised this was unrealistic and impossible!

Thankfully at UHCW our block lead had taken the time to give us a timetable to guide our learning with some gaps in that we could choose to fill (or not!). Every week we are assigned to clinics from different specialities to give us a flavour of the sort of patients those doctors see. I particularly enjoyed a haematology clinic where I learnt lots about haematological disorders (such as blood cancer) as well as loads about interpreting blood tests. I also got the opportunity to attend a Fast track clinic for suspected Lung cancer, this clinic has patients referred from GP with symptoms that could be indicative of lung cancer. Attending this clinic reinforced the symptoms and signs all doctors should be aware of to identify a lung malignancy and how you would investigate it. One day a week we are also assigned to a different speciality ward. Tied in joint first are my days on the Gastro ward and on the Stroke ward. The Gastro day saw us attend an epic 5 hour long ward round seeing patients with liver and pancreatic disease all over the hospital. On the stroke ward we got to take some interesting histories from some of the patients recovering from severe strokes which really helped me understand more about potential risk factors and warning signs for stroke, we also got the opportunity to examine patients and see neurological signs first hand.

As well as days and clinics in different medical specialities we are assigned to a care of the elderly (or geriatric) ward. Geriatric wards have bad reputation among medical students. Common beliefs are that all the patients have dementia or are confused so no one can give a good history, or that patients aren’t medically unwell so there’s no point in examining them. Having spent 6 weeks on the geriatric ward there is some truth to these beliefs but it doesn’t mean there is nothing to learn as a medical student. On the geriatric ward you learn more about co-morbid disease than anywhere else in the hospital, you learn how a person’s psychological state and their social situation impacts on their health and how this needs to managed by a whole team of people and not just a doctor with prescription pad.

So, I haven’t learnt the whole of medicine in 6 weeks but I’ve learnt a lot about being a doctor that can’t be specified in any learning outcome.

Joanne

Luke Pemberton : 30 Jun 2017 10:22 |  Tags: Joanne Mbchb Student Warwick Wms |  Comments (0) |  Close comments |  Report a problem

End of the Obstetrics and Gynaecology Block

It’s hard to believe that we’ve come to the end of our fourth specialist clinical placement. This is officially our halfway point for Phase III, which means that we’ve got four more six-week blocks to go. It’s such a cliché, but time really is flying past. Seeing all of the first-year students celebrating the end of their exams recently has brought home the uncomfortable realisation that my cohort was in the exact same position already two years ago, and it’s become even more difficult to believe that a new cohort is starting in just a couple of months! Thankfully I can rest comfortably in the knowledge that I will never, but never repeat my first-year exams again.

Obstetrics and Gynaecology is really quite a diverse speciality – much more than I realised before starting. Obviously the focus is largely on women’s health (but not entirely…) but the clinical requirements on the doctors are really varied. It’s one of the only specialities I’ve come across which is a healthy mix between clinics, ward work, hands-on medicine and more than a little bit of surgery all in one role. Depending on the day of the week, doctors may find themselves performing hysteroscopies/colposcopies (visualising the vagina or uterus with a specialised camera), doing ward rounds, conducting caesarean sections, running clinics (either obstetric or gynaecological) and likely all of the above.

Being a student in this rotation has allowed us to see all of these and more. Our education department have done a great job of ensuring that we rotate throughout a few groups of learning opportunity: we have a labour week, a theatre week and a special-interests week, and we run through this cycle twice. I’ve probably enjoyed the theatre week the most of the three. It just amazes me to see open surgery (known as laparotomy, as opposed to keyhole surgery, which is otherwise known as laparoscopy). There is so much going on with the anatomy under the surface, and the doctors spend so much time concentrating on this and making sure that everything goes right; and then at the end when they patch everything up, all that’s left is a tiny little incision with invisible stitches which you can barely see. It’s such an amazing concept that it all tidies up so nicely and seeing it happen blows my mind every time.

This week in the theatre we’ve seen lots of gynaecological procedures, primarily dealing with ovarian and uterine disorders. We’ve seen the drainage and removal of several cysts (I’m not going to lie; it’s not for the weak-stomached among us), a couple of hysterectomies and a couple of removals of ectopic pregnancies. As is logical, we’ve seen women of all ages and all stages in life. Every woman is asked to provide her consent to our presence before we go into theatre and if she doesn’t want us there, then we observe her wishes. It’s been such a useful block and I’ve really got a lot out of it – I hope the remaining blocks are as good as this one has been.

John

Luke Pemberton : 19 Jun 2017 16:51 |  Tags: John Mbchb Student Warwick Wms |  Comments (0) |  Close comments |  Report a problem

Education, education, education!

You would have thought having gone through an undergraduate degree and then a PhD prior to coming back to medical school I would have had my fill of education but apparently not! Along with another student, I got involved in organising an optional course for third year students in medical education. Attending the course and then organising it this year has been a great experience and I’ve learnt so much about medical education and teaching theories and techniques. It’s helped me understand the different approaches the medical school use in our curriculum-combining lectures with more structured groupwork and then student led case based learning.

Before medical school I had some experience of teaching junior students in the laboratories I used to work in and at medical school I have taken part in OSCE teaching and student seminars, initiatives run by second year students in year 2 for students in first year. There are lots of opportunities to teach if this is something you are passionate about and its certainly something I would like to remain involved in as part of my future career. My enthusiasm for teaching and medical education has been encouraged by the medical school after I was asked to present my work on the medical education course at a regional conference. Myself and other students involved in student led medical education projects presented our work as part of a workshop, engaging with the audience and taking questions about our work. I also got to present my work at the local Warwick medical education conference. At both these events I got to learn so much about the challenges medical education faces and the new developments that are been made to continue improving medical education and training high quality and happy doctors.

Learning more about medical education theories certainly makes you assess your own learning from a new perspective! Having survived my speciality block 3 in Obstetrics and Gynaecology I have now moved onto my fourth block, which for me is Care of the Medical Patient. As the blocks fly by exams seem to be creeping ever closer and a sense of panic is starting to set in amongst myself and my fellow students.

Along with 3 other students I am placed at UHCW (the big hospital in Coventry) for my Care of the medical patient block. This block is designed to give us a broad overview of different medical specialities and allow us to fill in gaps we have from second year. There are a few things that I didn’t experience during core clinical education, so I’m hoping I can see more gastroenterology as I’ve made it this far through medical school without seeing many gastro patients! I would also like to see some procedures like endoscopy and bronchoscopy which I’ve never seen before. I think it’s much easier to explain a procedure to a patient if you have seen it done yourself and as this is a task that we can be asked to do as part of our clinical exams, I want to make sure I know what I’m talking about!

Watch this space to see if my enthusiasm for medical education theory can be translated into my own learning and practice!

Joanne

Luke Pemberton : 15 Jun 2017 15:44 |  Tags: Joanne Mbchb Student Warwick Wms |  Comments (1) |  Close comments |  Report a problem

Obstetrics and Gynaecology continued…

We’re about halfway through our fourth specialist rotation of the year and the pace is still, shall we say, energetic. Things are going well but it takes a lot of effort to keep our noses to the grindstone at times! We look on with envy at the students in the year below us who had the last week off, bringing back fond memories of 2016! (We haven’t had a break yet.) Anyway, we are still on our Obstetrics and Gynaecology rotation right now and it’s been really interesting to see all of the issues that clinicians in this speciality confront on a regular basis.

So far, the block has been going well. Although the focus is heavily on female anatomy for obvious reasons, I’m also liking the fact that the Genito-Urinary Medicine clinics are for both sexes and cover lots of different presentations. Aside from a week with midwives and on a labour ward in our second year, we aren’t provided much exposure to the O&G side of medicine from a practical and real-life perspective until this clinical rotation. We have loads of lectures, but it’s all been very conceptual and didactic – and not very hands-on. But this all changes once we are in Phase III. At our hospital, the education coordinators have been doing a great job of giving us extremely varied exposure to different clinics and theatre opportunities, and it’s been a good form of revision.

Most of the procedures we have seen have been relatively routine, including hysteroscopies (inspection of the uterus with a little camera at the end of a tube – very similar in concept to a colonoscopy), excisions of suspicious cervical tissue and even caesarean sections. It’s been like Block 5 (Reproduction and Child Health from year 1) come to life!

Theoretically, a woman can progress through an entire pregnancy in the UK and never need to see a doctor, provided that the pregnancy is low risk and that everything progresses normally and without issue. As I’ve learnt, normally patients are referred to specialists only if there are concerns about the mother’s or the baby’s health during the pregnancy, the delivery or the post-partum period. These are the cases that we tend to see these days – and this has taken a lot of getting used to for me, since midwives don’t really exist in my country of origin, in which almost all babies are delivered by doctors. Anyway, when women are referred to neonatal clinics staffed by registrars or consultants, they usually have a condition that requires additional monitoring and support (although sometimes it’s the baby who requires attention). I’ve seen lots of endocrine issues, some obstetric cholestasis, some social-care issues and even saw a baby with a very high chance of being born with Down Syndrome who required some extra monitoring. All in all, it’s been a fascinating glimpse into the variety of humanity and I’ve loved what I’ve seen so far.

John

Luke Pemberton : 30 May 2017 15:37 |  Tags: John Mbchb Patients Student Warwick Wms |  Comments (0) |  Close comments |  Report a problem

Obstetrics, Gynaecology and So Much More…

In our fourth clinical rotation, my clinical partner and I are focusing on obstetrics and gynaecology for the next six weeks. It’s a very interesting lead-in from the paediatrics block, although in some ways it might make more sense for us to have done this block first – paediatrics focuses on (among many other things) babies once they’re in the open air, whereas O&G looks at them from conception through birth. But of course we have already learned a lot about both topics anyway in previous years and this is just getting stuck in more deeply. Block 5 in our first year specifically focused on reproduction and child health, and Warwick’s spiral curriculum means that we are (as always) building on knowledge that we have already gained. Needless to say, I’ve spent a lot of time revising hormone axes and reproductive anatomy from year one!

So far, a lot of our time has been spent in clinics and in teaching, and we are seeing a lot. It’s good to spend some time seeing a variety of gynaecological presentations, especially because the sensitivity of the presentation means that our opportunities to learn from observation in real life have been limited in the past. We’ve seen a lot of textbooks and Power Point presentations. Gynaecological details can be very personal, but of course they are an important part of medicine and so it’s really helpful that we’re getting such exposure throughout this block.

We don’t just pay attention to gynaecological health, of course. Our block also focuses on obstetrics (the health of pregnancy and childbirth) and sexual health as well. Obstetrics is a fascinating part of medicine to me for many reasons. Foetal embryological development plays such an important role in our health throughout our lives. We saw some childbirth and midwifery in our second years, but that was five days in total – this is six weeks, complete with very well-defined learning outcomes and lots of focused teaching. And at the risk of sounding obvious, being born is literally the most common human condition – everyone goes through it. The maternal-health aspect fascinates me as well – when I hear about some of the conditions that some women present with, it makes me grateful that we live in an age of modern medicine. Even one hundred years ago, lots of these conditions could have been a death sentence.

As mentioned above, we also look at sexual health and have spent some time in genito-urinary medicine (GUM) clinics. This is an area that I’ve been interested in for years – and maybe after qualification I will try to pursue it as a career. Dealing with presentations in this area is a fine art. Since it’s so personal, it’s necessary to be extremely sensitive and ensure that you have a patient’s trust at all times. But of course clinicians can’t be embarrassed or ashamed of discussing intimate details with patients. It’s all part of the (very interesting!) job. All of the people I’ve worked with so far have been models of professionalism, and I hope to be the same when in their position. I’m really looking forward to seeing more in this block!

John

Luke Pemberton : 16 May 2017 09:06 |  Tags: John Mbchb Student Warwick Wms |  Comments (0) |  Close comments |  Report a problem