|
Blog Archive
Year 1 installments Jan & Feb 2006 Our focus at the moment is on the CV system and respiratory system, so we have had some bodies out to look at the anatomy, some sessions with patients, lectures etc. I have been taught how to take blood pressure the old fashioned way with a stethoscope and a sphyg -“ none of this electronic stuff and also to find 6 different pulses - which is harder than it sounds believe me, I spent hours trying to find the one at the back of my knee (it must be buried pretty deep as some peoples' are really easy) - I know you are all dying to have a go so for the enthusiastic ones among you, it is slap bang in the middle behind the knee just about where the crease of skin is when you bend it. I have now been taught a full cardiac and respiratory system examination so I have been practising my skills on anyone who stays still for long enough - particularly differentiating between different heart valve sounds and backflow of blood is quite hard and it seems to take a while for different sounds to be heard when I am listening to someones chest but I'm sure it'll get better with practice. We concluded the CV system and the respiratory system and moved straight into the metabolism module, which was another 3 weeks. We then had an exam on these systems - which I passed! This allowed us all to move forward into our current Brain & Behaviour module. March 2006 We are now zooming towards Easter at record pace, I frequently feel that my feet haven't touched the ground some days. We have finished our Brain & Behaviour module, which was taught by a wide range of different people including both clinicians and scientists which provides an interesting mix of expertise. I am now attempting to pull all of the material together in my own brain so that I don't have a huge pile of learning to do after Easter. Studying the Brain & Behaviour module has been very enjoyable it has included the usual mix of PBL sessions, lectures and learning landscape sessions. I was glad to see the use of medical imaging in addition to the usual collection of anatomy learning aids, as I think it is advantageous to become familiar with imaging from an early stage. It has also been enjoyable as it fits in really well with my interest in neurosurgery which has been ongoing for a period of time now. It has been great to actually have a reason to be reading the neuroscience, neurology and neurosurgical texts that I have previously had to read as an addition to the core course content. My involvement in extra-curricular activities continues, I have a meeting regarding the Trauma Conference next week, and the students that I am involved with through SAMDA are doing well, and we will all be attending a clinicians evening next week where several of the Barts London doctors and surgeons will be making presentations about their area of work, so I am looking forward to it just as much as the students! So I have one more week after this current week, during which we will start our next system which is Locomotor, before having a much needed 2 week break for Easter, and then we'll return for the final push towards the end of year exams! End of Year 1 Update During the course of the last week, I have finished my exams, it is hard to believe that the first year of medical school has come to an end already - time flies when you're having fun! The last couple of months (since the return to London from the Easter break) have been possibly the busiest of my life. It seems that we all manage to drag ourselves over one hurdle to be faced with the prospect of the next with little recovery time - my stamina has certainly increased! After completing the Brain and Behaviour and Locomotor modules followed by probably the hardest exam so far, we proceeded straight on with the Human Development module, and had an exam on that within a few weeks of the other. During this time Medicine in Society was also coming to an end, and we had our final presentations to organise, and the handing in of all of the work from the entire year. It has actually been quite difficult just trying to work out where best to put my energy, and it has to come down to what is worth the most marks rather than where my enthusiasm lies. After the Human Development exam, I started a 2 week placement in the Renal Unit at the Royal London Hospital. This was one of the 2 SSMs (Student Selected Modules) that I have completed this year. There are a whole range of modules, and some people had less challenging ones requiring only a few hours of input for each week which proved to be advantageous as they had lots of free time to do revision, whilst the clinical SSM students were on the wards. Despite this price I had to pay I am grateful for the opportunity as it provided me with a brilliant overview of renal medicine and transplantation. I was able to attend clinics, ward rounds and theatre which was great as it enabled me to interact with lots of different people including all grades of doctor (both medic and surgeon), nurses, HCAs, dieticians, pharmacists specialising in renal medicine, transplant co-ordinators - the list goes on! The ward rounds were really interesting to be a part of as many of these people were present and watching how they all interacted with each other was great. The SSM also gave me a feel for the clinical years - although I realise now how exhausting they will be in terms of the attendance, reading up on everything at home, revising and trying to have a life! In amongst this hectic time period I have done my very best to maintain my extra clinical work. I have managed to attend most of the Neurosurgery clinics which has probably kept my focus for the exams actually, as it serves as a reminder as to what medicine is really about. I was also reflecting on everything I have been taught and picked up whilst in the clinics this year, and it has been so useful - I hope I can continue it next year. I also was lucky enough to spend an evening shadowing the HEMS (Helicopter Emergency Medical Service) team in their Fast Response Car, which is something I have been aiming to do since I got here - I am fascinated by pre-hospital care and trauma, and it was an amazing experience. The team of people involved in the whole operation is amazing - from the people in the call centre where the 999 calls are routed through who actually pick out suitable incidents for HEMS to attend, to the doctor and paramedic who respond to the calls. The abilities of the doctor and paramedic are immense and so wide ranging - obviously the knowledge they carry around with them but other things such as their focus in high pressure situations, the driving abilities necessary to manoeuvre a Fast Response Car safely but rapidly around central London, and the ability to interact with lots of different people at the scene of an incident. I learned so much from observing them for just one night, it was amazing. I realise that I have been incredibly privileged to have this experience so early on in my medical career, and it is one that I will not forget. The exams I sat were challenging, and certainly the year group as a whole has mixed opinions on them. One of the most stressful was the OSCE exam - this is a station based set up where the students move round and complete tasks - some of which are observed by an examiner such as performing an abdominal examination. Having passed my driving test when I was 17, I'd say that the OSCE is a comparable stress and pressure. Some people found it too much to cope with and got upset and emotional because of the pressure, which is understandable. It seems that it is all about being able to hold your nerve. So we have a short respite before the results are announced on Wednesday, we are all re-initiating our social lives, and getting used to going outside again! I spent this afternoon with some friends in Hyde Park doing nothing other than laying in the shade which was wonderful. Next weekend I return home to Yorkshire and my job in the pharmaceutical industry, which I am looking forward to. I know I will miss medicine, and the rush of the East End, but I think a change of scene will leave me all the more motivated for my return in September and the start of my second year here at Barts and The London.
Year 2 installments October 2006 - Back to work! After a long summer break (of 3 months) I have returned to medical school, and found myself propelled into life as a second year medic. I say "summer break" somewhat tentatively as I found myself along with many of the other graduates on the course returning to full time work in order to pay the bills. I was lucky enough to return to my previous work and life in North Yorkshire, and started full time work with a weekend in between finishing med school and re-starting up north, so this provided a geographical challenge to start with. The move did however go smoothly mainly due to input from my long suffering parents and my housemate in North Yorkshire. I had an enjoyable summer - I found it quite scary how quickly I became settled back into my pre-medical life. I enjoyed catching up with everyone again, and reminded of how lucky I was to have a job in the middle of the rolling hills of the Yorkshire Dales. It was hard work (most jobs in the Pharmaceutical Industry are) but in a very different way to medical school. I had forgotten what it feels like to walk out of the office at the end of the day leaving work firmly behind. At medical school there is always something I could be doing, when I get home after a day of lectures and work in the library, there is always a pile of books to read on my desk. Even when I'm watching a rare hour of TV I seem to be half reading something medically related. I enjoy both lives though, so I'm lucky to be in this situation. I have only been back here in London for 4 weeks and yet it feels like forever. We have started with the cardio respiratory module, and believe it or not I am already revising for my first exam (in 2 weeks time). I have been desperate to get back into attending Neurosurgery clinics but unfortunately my timetable seems to clash on every level which is pretty frustrating really. I have attended my first day of my Medicine in Society module. Last year I was attached to a General Practice in East London. This year I am attached to a medium secure Forensic Psychiatry unit in Hackney. Obviously this is totally different to my placement last year. I openly admit that I know fairly little about psychiatry so I am avidly reading various books in an attempt to increase my general knowledge before the next session. As my love of Emergency Medicine and Pre-hospital care continued over the summer I returned to London due to my involvement in the organisation in the annual Trauma Conference at Barts and The London, which seemed to run smoothly and was enjoyed by all involved. This year I came back vowing to get more involved in Emergency Medicine, and last week I made significant progress. After a lot of chasing around I managed to make contact with the London Ambulance Service and spent a 2 nights shadowing their Rapid Response vehicles. The Rapid Response vehicles are different from ambulances in several ways. Firstly they only have one occupant - a highly trained paramedic who is also the driver. They respond primarily to category A emergencies (for example myocardial infarctions) in a shorter time period than the ambulances do. I have discovered that this presents an excellent opportunity for people like me, as it is effectively one on one teaching, a variety of emergency calls, an opportunity to become involved and feel part of the team, and contact with a wide range of other emergency service personnel. The downside (as I discovered last week) is that the shifts are 12 hours long - I did 7pm until 7am. I have to say at this point that I was offered the opportunity to leave early but I was determined to complete the shift as they all do every night. The long night time shift though is a small price to pay for brilliant medical experience (in my opinion anyway - many would disagree) so I am determined to try and keep this going as an ongoing contact. Several close friends and family have implied that I might be slightly crackers for wanting to do this on a regular basis, but I am struggling to understand why people wouldn't, especially as several of the patients I have seen in just 2 shifts are directly relevant to the course material we have already covered since the start of this academic year. It is a brilliant opportunity and I don't intend to waste it. Other than that I have attended a constant stream of lectures, PBL (Problem Based Learning) sessions and anatomy classes. I have managed to start attending the gym on a regular basis (we shall see how long it lasts for) and I am just about managing to cram in a few hours sleep in between going out and about with friends. I should also mention that I have moved out of the student accommodation I was living in last year and into a flat with a non-medic. I wanted to try and separate "work" and "home" a bit more this year. I found it quite hard living with all medics last year as you are always aware of how much work everyone else is doing and it starts to feel very competitive after a while. Some of my flatmates from last year have moved into house shares together though, so I am in regular contact with them all which is great. I think part of the problem also is that I have done a degree and the whole student house thing once before so I felt like I needed a more grown-up atmosphere, which I have luckily found, and I am enjoying the luxury of an uninterrupted sleep through the night. The conundrum I will leave you with for now is when is a medical student too young/inexperienced to intubate a patient? I understand the role of the procedure in the wider context of the care of critically ill patients, and I would take the responsible attitude necessary. I ask the question as a result of two very different responses I have received during the last week from two very different Healthcare Professionals. I asked when they thought a medical student would be ready to intubate a patient and the first responded in a very positive manner and said that it is more or less irrelevant when someone does the procedure as long as they have been taught the theory, had a practice on a mannequin, observed one being carried out and then has an experienced clinician by their side when they attempt it for real. If you can drive a car you can intubate a patient was the summary response. After having this conversation I approached another person and asked if they would be willing to teach me on a model how to intubate a patient. The response I received was "why do you want to know how to do that? it's a little bit early isn't it?" - Obviously a less encouraging response and I was thinking about it on the way home on the tube. Is it wrong to want to be taught the skill in my second year? Why is it early - is putting it off for a year really going to make me better at intubating someone? The latter question seems almost ridiculous because as far as I am aware I'm not scheduled to have an intensive 2 weeks worth in intubation practice so how will waiting a year make a difference - are key skills going to diffuse their way into me? If it is an age thing then I probably should have been doing it last year or everyone who is younger than me is going to have to wait an extra 5 years after I have started intubating. I sometimes think that people in education put up boundaries that stop people learning without even realising it, and often smother enthusiasm and interest when it is staring them in the face. Thank goodness for all of the student friendly people I have met so far in my career who love nurturing interest and take pride in teaching people their skills.
LAS FRU (London
Ambulance Service Fast Response Unit) As 2006 draws to a close it seems appropriate to discuss the stresses and excitement of my first term in the second year. As discussed previously we started off the year with the cardioresp module, and I have to say that I worked my socks of during those first 6 weeks. I enjoyed the content of the course, and found it easy to sit with my books late into the evening. I sat the exam feeling confident, and managed to secure a good mark – which is psychologically a good start to the year. I don’t think I was the only one who really got into the first module, a lot of people seemed to really push themselves. Unfortunately we all hit a bit of dead end (no pun intended) when we finished the cardioresp module exam on a Friday, and then had to throw ourselves into the next module (metabolism) on the Monday morning. Everyone seemed to be in need of a break – even just a couple of extra days but we didn’t get it so I felt like I was wading through treacle for the rest of term. I was exhausted and I didn’t really settle into the metabolism module. I did (as I always do) put a lot of hours into the preparation for the exam, but it didn’t seem to go in as easily as the cardioresp module. By the end of term I felt a bit disappointed by the experience but I still can’t really figure out why so many of us just lost the drive halfway through the term. I’m reflecting on this whilst munching on the Christmas chocolates somewhere between Christmas and New Year, and promising myself that I will give my all next term. I am well motivated for the next module as it is Brain & Behaviour, and I do have a special interest in neurology and neurosurgery. I’ve had a look at the timetable and it seems pretty packed – I don’t think I’ll have time to worry about the impending exam. Regarding the LAS (London Ambulance Service), I am delighted to say that this is an ongoing time commitment for me. I am shadowing one of the FRUs (Fast Response Units) on average once a fortnight as a 12 hour night shift. Most of my shifts are spent with the same individual, which is great as we get on well, and already he has taught me so much. He also seems to be coping well with the constant stream of questions that I keep asking, as well as the added stress of having a medical student out and about with him. I am very grateful for the ongoing opportunity that the LAS is providing me with. I intend to continue this after Christmas, as I find it fascinating, it is brilliant to see how the LAS works with other services such as the police and the fire service. HEMS are also involved in some of the trauma jobs, so it is a brilliant opportunity for me to observe all of these different professionals in action together. I have witnessed many different jobs now, a few examples include road traffic collisions, a stabbing, seizures, assaults, chest pain, a range of respiratory problems (such as COPD exacerbations) and antepartum haemorrhages. These all provide me with lots of additional knowledge from the underlying physiological causes to the principles of incident management. I have also become increasingly involved in Barts City Lifesavers, I have attended several training sessions now, and I am becoming involved with teaching CPR skills to members of the public, and employees in large city companies. I really enjoying the teaching element, and I look forward to becoming increasingly involved in the charity in the coming year.
LAS FRU Plans are already being discussed for the 2007 Trauma Conference, and I am once again involved in the organisation. I am jointly responsible (with one of my colleagues, who also happens to be a close friend of mine) for the content of the conference. This relates to the lecture content, and the practical stations, and will require the two of us to approach the relevant individuals and plan their input with them. I thoroughly enjoyed my involvement in the conference last year, and I’m looking forward to making it even more exciting this year. I continue to attend Neurosurgery outpatients (I missed the first few as my timetable seems to constantly clash but I managed it towards the end of term) and I very much enjoy the experience. I recognise names and faces now, and it is good to see the continuity of care. I am very lucky to have the opportunity, and I always leave the clinic feeling motivated with something I need to go and look up in a text book, which (in my opinion) is just how teaching and learning should be. I hope to continue this in the New Year, as it will also fit in very well with the Brain & Behaviour module. My Medicine in Society placement at the medium secure psychiatric unit continues, and I find it very challenging. Prior to starting the placement I did not have any experience in psychiatry other than via my previous job in the pharmaceutical industry in a medical information capacity. It has been a relatively steep learning curve, which at times has been quite difficult. This is because there are lots of different Medicine in Society placements available to the second years, ranging from paediatrics to palliative care, whereas in the first year we were all attached to a General Practitioner. This (I imagine) makes it more difficult to set specific learning objectives – resulting in them being more generalised. This makes it difficult as we have had very little psychiatry teaching (only 1 hour so far) despite us being expected to participate in ward rounds and case presentations. I enjoy a challenge, and I do my very best to borrow relevant texts from the library to support my learning, but it is frustrating when I don’t really know which information I should be attempting to learn. I have also become involved in the Ethics and Law Society, (I hold a position on the committee) which is primarily due my interest in the area, I admittedly know relatively little about these areas of medicine, and I thought that it would be a great opportunity to increase my general knowledge. We plan to have several lectures from various different people, each with a unique example of a medical legal / ethical issue. I found out much to my delight at the end of term that my 2 SSMs (student selected modules) are exciting and just what I had hoped for. This year I have to complete 2 SSMs, each is a 2 week period of time, during which students study an area of special interest, not necessarily related to the content of the second year course. The medical school offers a number of these run by various doctors and lecturers, and we have to apply for them by ranking our top selections. There is obviously an element of competition for the most popular options but random selection is used to ensure fairness. I have both of mine coming up before Easter. The first is Cystic Fibrosis, which I’m looking forward to, and the second is Pre-hospital care which is incredibly exciting for me as it is a fascinating area of medicine and utilises the LAS (London Ambulance Service), the A&E department at The Royal London Hospital and HEMS (Helicopter Emergency Medical Service). Finally, I’ll just say a quick word about aims and ambitions for the coming year (as life would be boring without these). I’d love to get more experience of pre-hospital care – my SSM will provide a fantastic initiation, but I’m keen to learn as much as possible about this amazing area of medicine. I’ve done a small amount of research so far, and I’m aware that exciting services exist in areas such as costal regions (air sea rescue) and in mountainous areas (mountain rescue) especially in Scotland. Rural medicine is also demanding more of a pre-hospital care element, and in Scotland I believe they have the only government funded air ambulance service due to the isolated locations of some of the patients. I would love the opportunity to shadow one of these services for a short period of time over the summer break. That is all for now – if anything incredibly exciting happens in the near future you’ll be the first to know! If not I’ll update in a couple months.
|
||||
