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Care of the Medical Patient – Week Three

Wow , two weeks left of this block. Scary

Monday

Bank holiday

Tuesday

We decided to not attempt the ward round before teaching at 11:30am today. It was the day after a bank holiday, and you just know it was going to be chaos. That did mean however we were roaming the hospital car park for 40 minutes trying to find a space. We were in one car park when I witnessed a doctor scale a grass bank in their 4X4 and park neatly ontop of the bank.

My KA and I were not even going to attempt that.

We eventually got a space and were only 2 minutes late which in medical student speak, is bang on time. We had an hour on palliative care and then had a free afternoon which Klaudio and I were determined to fill.

We ended up in Respiratory clinic as we had not had that much exposure to lung related things thanks to COVID-19 (closest I have been to a Resp ward was on the day we got taken out of placement and were sent away within two minutes). I really enjoyed the clinic and it was good to see other areas of medicine and look at x-rays in clinical context.

The consultant also wrote with a fountain pen which I have not seen being used in forever. I’ve tried to get back to using a fountain pen but alas, has not happened due to having weird handwriting and a lack of patience with them!

I felt good. We ended up leaving at 6pm but you know what, it was a productive afternoon, I learnt a lot, and thats all I can ask for.

Monday was also the debut of my bumblebee scrubs – of which I love to pieces.

Wednesday

Our first day without anything pre-scheduled for a while. We headed up to our other ward Beauxbatons (can you get the theme I am going with here) which we normally steer clear from. However, today was changeover day and we were hoping to get some new F1’s to adopt us.

And we landed a JACKPOT. i walked into the doctor’s office and 70% recognized the FY1 sitting there. She started talking and yep , it was B who I did Revue with !! (It’s hard to confirm identities under masks).

The rest of the doctors began filing in and we knew this ward was now going to be one we could rely on. Klaudio and I joined in on the ward rounds which were super quick as there were various welcome meetings to get to. We had a patient who was scared and worried about dying. The ward round moved on but I couldn’t leave them like that. I grasped their hand and said that it was going to be ok and that they were not going home to die. They smiled and seemed to relax a bit. I believe they had dementia so just that little hand hold meant a lot to them.

After the ward round ended we tried to get some bloods but if veins were opposing magnets to needles, this patient certainly had them. They were more than willing to be a human pin cushion but that isn’t what we want for patients. So the standard two tries later and we left it to the doctors. It was so frustrating as these veins were incredible…

In the afternoon we tried to get into another clinic. This time ENT. I seem to have an affinity to this speciality, but that is purely because of my medical history. I was excited and we hung around for half an hour because we were early, then time for the clinic arrived but no consultant. We checked the notes to make sure there were face to face of which there were but still no consultant.

We waited half an hour before deciding to call it a day. It was frustrating but what can you do. The HCA’s were lovely at updating us but I felt sorry for the patients who were hanging around with the possibility of their appointment being cancelled.

We treated ourselves to ice cream for our patience:

I only have two weeks left to make the most of this ice cream bar ….

Thursday

Wow, it was so hard waking up today. Despite having Monday off, we are both shattered and feel like we have done a whole week already. it was time for our ILS course which is Intermediate Life Saving.

Basically, we had covered a lot of this already, but it was a step-up from just carrying out an A-E approach to MANAGING a crash call.

I really enjoyed this day. I LOVE simulations and it gives me a chance to practise what I have learnt and feel just that little bit of a professional. Thankfully, only one five minute lecture for the whole morning and we were off learning how to manage airways and ventilate an unconscious patient.

We then got to learn how to use the defib, how CPR felt in real life (my arms are still not right typing this out on a sunday) and how difficult a one handed jaw thrust and mask holding is. We also got some free snacks which I am always more than up for.

Klaudio and I had our OSLERS in the afternoon which step up this year. We get assessed based on final level. I wanted to get off on a good foot, but I did keep in the back of my head that I am literally 3 weeks into the so called “learn management” year so not to hate myself if it goes badly.

I got a patient with a good history, but I was hit with the classic chatty patient. My history was 15 minutes long which was frustrating. It’s just a skill I really need to hone down. As much as I am interested in the patient, I just need the information I need out of them before I find out what their great uncles on their dads side employment was….

It was an unusual presentation. Though arrhythmias are meant to be our bread and butter by now, this particular one I had not seen before in a clinical context. It was hard coming up with the management and I defiantly stumbled my way through this.

I think I did ok. Results are still to come in, and they don’t matter with regard to the degree but the Type A personality of mine want’s to do well, naturally.

Friday

End of the week at last. I think Klaudio and I only managed to drag ourselves out of bed due to it being the end of the week and we are going back to Hogwarts ward.

We got told a consultant who loves to grill us would be there today so we were a tad nervous but it ended up being our favourite consultant AND a doctor we had already worked with on another ward. So shaping up to be a good morning !

We have also discovered that although we cant get onto the PC’s (because even though we have logins, we get get onto the system) we have access to the printer. We took FULL advantage of this and photocopied the ward notes (IE – handover sheets) so we could follow along on the ward round but of course made sure to dispose of them before we left.

The ward round was brilliant. The male bay ended up being the weirdest round as all the patients were up in their chairs having a good old chat between them with some even moving around to chat perched on the end of beds. There were some BRILLIANT murmurs including the classic one you expect to hear on wards and some sweet patients.

I was helping a lovely patient put her socks on after the consultant took them off and she asked if I was a doctor or a nurse. I was shocked. No one had ever asked that before. They just assume I am a nurse and call me so. I giggled and said I was TRAINING to be a doctor. She said ” oh that’s nice, I never know what to call you lot”. I said orange badges mean students and how nurses have uniforms etc but said I was really grateful for her asking.

I don’t mind being called a nurse. They do such amazing work and I admire the way they can handle all bodily fluids. I am a whimp and even the sight of flem sends me retching. I suppose it’s just annoying but not too much of a fuss with patients. They are ill afterall.

I made sure her toes were cosy and carried on with the ward round. The team were so lovely and we felt so included and were sharing the giggles and teaching.

We then ended up in the last bed which was in a side room. The TV was on in the background and we checked on the patient and had a discussion about his care.

However, something was distracting me. On the TV behind the consultant was BBC news. Prince Phillip had pictures being shown in a weird montage that was slow and fady. I remember thinking he was either dead or it was his birthday. I couldn’t see the writing though and the news reporter was only wearing a black jacket and not all in black.

However, it soon went to breaking news, and I was able to read he had died. We all knew it was coming but it’s so sad with him being weeks off 100. This day was getting more packed by the minute.

In the afternoon our amazing consultant spent a good half an hour (probably more) teaching us about Aortic Stenosis and my brain was on fire. This was incredible. However, he did assume we were second years so wasn’t teaching us management. It was a good 15 minutes in before I got an opportunity to correct him. I wish we had different badges or lanyards to denote year groups like other medical schools instead of resulting to my technique:

That afternoon I went to get my second jab at the place where it all started, UHCW !! I was excited to go and turns out the BBC are filming at UH for the new series of Hospital (my favourite programme):

All my sign offs completed !
These bump devices were used to maintain social distancing

And that was the end of a looonnngg week. Im thankful I left my jab till last thing on the Friday as the side effects came out of NOWHERE. I was knocked out for the majority of Saturday sleeping all day bar a couple of hours. My joints ached, I had the headache of a lifetime and was shattered. However, one sleep later and I was good to go.

What a week.

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Medicine Block – Week Three

So, you know I said last block I would have a shorter blog? Well, the timing of that sentence wasn’t quite right. This week was the week when I returned to being an actual full time medical student.

Monday

Thankfully just some tutorials today that started at 10am, BLISS! These tutorials are meant to help us pitch our own work right and if you are lucky, complete the work for you. We had a full day of workshops so it was just sat in a virtually empty lecture theatre all day.

There’s not really much to write about apart from the fact it was BOILING outside, this was of course, the week of the heatwave. However, to end the day off in the right direction, Kaludio and I took a trip to the infamous Gelliot Ice cream bar. Yes, it is amazing as it sounds:

Berry sorbet and bubblegum ice-cream

Tuesday

Tuesday brought a bit of a weird half day and a first for us. When learning clinical skills in the last block we had an afternoon of teaching and then a couple of weeks later (when you have normally forgotten everything), you are assessed. This time round it worked a bit differently. We were sent online learning modules and I self-taught myself ECG’s (OK, I basically knew that already) but NG tubes were something I really was not expecting to learn on my own and go and be assessed on the next day. (NG Tubes are feeding tubes passed through the nose, down the back of the throat and into the stomach. They are not pleasant to have inserted but can be the difference between life and death in serious cases).

Nasogastric (NG) Tube Placement - Oxford Medical Education

Thankfully the nurses running the TDOCS were lovely and supported us through each one so it was the highest mar I have ever received for a TDOC (lets ignore the fact everyone got a perfect score).

We had nothing for the rest of the day so I decided to get some tests done of my own. I had been “prescribed” and X-ray before lockdown for my hip and it was starting to hurt again so I took myself down to get it done. It was weird sitting there as a patient in the surgical gowns, especially when you are trying to get something to stay shut at the back which isn’t designed to stay shut at the back.

Did you wear a gown if you didn’t take a picture to prove it?

After I thought I had my outpatients appointment for my ears but after an hour of sitting in the sun I suddenly realised I had not only got the wrong day, but the wrong week. Nice one Abbie.

Wednesday

Nice normal day back on the ward today. Well, I say normal but this was a heatwave and our scrubs really do not allow the body to breath so within 5 minutes of getting onto the ward I felt soaked through. The ward temperature was nearly 30 degrees Celsius and we were just melting on the ward round.

Kaludio and myself managed to duck into the air-conditioned equipment room to gain some body regulation at one point and walking out of there to the ward felt like we were getting off the plane in Spain. I couldn’t understand how patients were sat there with blankets on. We also had the nicest consultant that day, they were teaching us around the ward round and at the end offered to do our sign off’s for the block. RESULT. He also insisted that we should not be in the wards but outside enjoying the sun, something which our F1 agreed on.

We stayed to put some cannulas in the patients that morning as most were going to need IV fluids to prevent Acute Kidney Injuries developing in the next couple of days. I had a patient who’s veins were just beautiful so my job was easy. The ward was also treated to ice-poles which was just the best thing to ever happen:

we were beat to the blue ones but red is a good substitute !

We finished our jobs at 12pm so we decided that Ice Cream was also needed – cue Ice Cream trip #2 of the week:

Lemon Crunch and Bubblegum

Thursday

So very close to the end of the week. I am so tired, I don’t get how I was pulling the ridiculous hours I was during Speciality block AND keeping up with three presentations a week off the list.

However, today was significantly cooler as we had an incredible thunderstorm the night before which just lit up the entire nights sky. We had the ALERT course we were originally meant to do back in March. It was good as it made you aware of why we do the A-E assessment but it wasn’t until the afternoon that I realized just how far I had come along. We got free food and drink throughout the day (que me panicking as I watched my calorie budget drop due to the sandwich I ate which was nearly 1/3 of my daily count).

In the afternoon we were ran simulations of a deteriorating patient where we had to conduct an A-E assessment. My first one was a bit shaky but my second one I just got praise and advised to be a bit more flexible with my diagnosis as I can be a bit narrow sighted.

I felt like I could have been an F1 in A&E and that evening I went home with the biggest confidence boost I have ever had. I was finally beginning to feel like this was going to happen, I was going to be a half competent doctor one day.

We didn’t get the full plugged in version but it was helpful to remember things by just placing our hands on the body.

Thursday was also the day the whole A level thing kicked off but I will dedicate another post to that as it deserves more than a paragraph.

Friday

END OF THE WEEK

I made an agreement with the rest of my car share to have a half day as we were pretty tired. Oh what dreams we make.

You quickly find out that when you plan to have a half day, you end up having the longest days ever on placement.

We rocked up to the ward round and were asked to prep the notes for the two newcomers. I toddled off and wrote up basic history and recent investigation tests and once I was finished I toddled back to the nurses station. Whilst I was gone the F1, CT1 and PA had all arrived and asked me to present the case back to them.

The consultant turned up and God did my anxiety rocket. I had to re-present the patient back to her and discuss some points (tip for future Abbie – trends are as important as numbers) for treatment. The consultant then went, go and sort her out then. I stood there. What do you mean?

Well, go and have a chat – take some bloods so we can check how she is doing, document it and I’ll catch up with you in a bit. I stood there flummoxed but equally excited. I got to play F1 for an hour.

I know I have a problem with my anxiety levels but boy I did not realise the extent of them until this time.

I interviewed the patient, did their bloods, got everything ready for sign off (turns out I could put my own signature on them as they “never check the signatures”) and presented back in time for the regular ward round. It was a straight forward case but god was it a rush. I felt like a capable human for once in my life.

We stayed and did some more cannulas and bloods before lunch (one of which we had to get the reg to do as it was so difficult) but we were hinted at the possibilty of NG tubes after lunch.

Coming back we had two patients who needed NG tube insertion. Klaudio did the first who had lost capacity so was difficult, but we later found out he had managed to nail his first NG tube!

Mine, well mine was slightly more difficult. The patient had mobility issues and some movement issues, so it was more difficult to place the tube. They also kept giving and removing consent and there was a big decision to make if they had capacity or not. We tried to find this out but it was proving very difficult.

After two attempts (both consented for by the patient) we gave up as it was not sitting properly and I didn’t want to cause any more distress. IT was left as a weekend job as it was not getting done on the Friday. We ended up playing a weird medication quiz as our F1 wrote up the drug chart for another patient with our ward pharmacist adding the sound effects and it was just an hilarious way to end off the week.

It hit half five however, and my hip began to signal it was time to go home. I got back at 6:15pm and was exhausted. I’ve been suffering with hip pain for a while but hopefully that X-ray will show something that I can fix !

It’s weeks like these you have to hold on to as you will end up with weeks when everything just goes to pot and you give up. I really did feel like I was going to be a doctor after the end of this week. Let’s hope Covid doesn’t screw up more than it has done already.

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Medicine Block : Week1

THE BEE IS BACK!

Wow, it’s been a while hasn’t it. I’m not sure how this blog is going to work from now on forward because the medical degree I was once on, has changed dramatically.

I am now only in placement for two days a week. Later on this month I will also be starting GP so that adds an extra day but there isn’t going to be a lot to type about.

Lockdown has been hard and there has been times when I never thought we would never get back into placement. However, Warwick has been great at, keeping us busy and we have been completing our third your research project in replacement of our placement blocks. They have also been brilliant with communication and keeping us updated with what is going on but doing that project was a nightmare.

I appreciate a research project is nothing compared to some med schools which have piled on the work for their students but I was so glad to click submit.

We all had to do systematic reviews which I desperately did not want to do. I had my project planned out and I was really excited about it. I also had an incredible supervisor, so when I got that email I was devastated. There were worse things going on in the world then though.

Anyway, long story short my third year project is complete and I am hugely thankful it is over. I’ll write another post about it soon but for now, let’s just stick with the medicine.

Day one of two

That was such a depressing title to write. That is how it is going to be though. We arrived Wednesday morning, donned the classic blue mask on entrance and signed in. We were only 20 minutes into the day and the mask was beginning to annoy me, guess I am going to have to get used to it again.

We also ended trekking back and forth over the whole hospital to pick up our scrubs. Warwick had said scrubs would be provided as we have to wash all clothes at 60 degrees and the fact is, my primark clothes just are not going to cut it. We received three pairs of some dark blue scrubs which are actually really nice! Problem is for me is that I am a tad too big for the medium top ( I like slightly baggy clothes) and the large is too big. End of the tale is that I am now attending placement in a tent.

We headed up to our assigned ward and introduced ourselves. It’s a world away from UH where I once was. We were put to work straight away writing in the notes, preparing for the ward round whilst waiting for the consultant to turn up for the ward round. Due to the type of block we were in, I’ve never actually been on a ward round before so this was a first.

They are kind of useful, I like seeing how the team functions and how the consultant develops treatment plans but there isn’t a huge amount of learning. Especially when the consultant is in pain or in a rush so they don’t get time to explain things. I only point this out because I wasn’t expecting to have teaching, but when we finished the consultant apologized to us for not teaching and explaining things. I nearly fell over, this is normal?

We then helped the docs on the ward with their duties. Halfway through a new doctor joined us, and I am talking new. Finally, we had someone else that was just as lost as we were! He was lovely and spent the majority of the morning trying to get IT to work – classic NHS.

We got split up between the two docs and the PA (Physicians Associate) on the ward. This is probably going to sound bad but , I didn’t realize just how advanced PA’s are and what they can do. Our PA was practically running the ward and I am looking forward to having more interaction with PA’s. I got to spend the morning helping make radiography requests before running off to lunch.

In the afternoon I got to attempt my very first ABG. I missed the artery and normally you “rummage” around slightly to get the vessel but with it being an ABG and not a venous blood sample, I was nervous as I knew the structures running around that area so the SHO ended up taking over. I still felt some source of accomplishment though!

Kaludio and I also got to try and take some blood off one of our patients. They were an ex-midwife so we were happily chatting away to them whilst we were trying to get some samples finding out abut their time in the NHS. Unfortunately, three med student attempts and two PA attempts later and none of us were able to obtain a sample, so we ended up leaving it there.

Overall, it was a pretty good day. I felt like I had accomplished something and I was excited to get back in on the Thursday, albeit at the slightly later time of 8:30am.

Day Two

We trudge in for a slightly later start but surprisingly, a “harder to get out of bed” start. I practically dragged myself to get ready, thankfully due to the scrubs, very little effort needs to be used when getting ready in the morning.

We headed back to the ward and ended up awkwardly killing time waiting for the ward round to start. We had a different consultant today and actually it’s interesting to see the differences in everyone’s medical practise and how they run ward rounds.

It was slightly long as we had seen all the patients the day before but it meant we could listen on more closely for management plans and how they differed day to day especially when it related to scans we had requested the day before.

That day we had a particularly hard hitting patient to see and although I can’t say much else, it was a first for me and I ended up just staying with the patient whilst the ward round moved on. We sat and had a chat which I hoped helped them for as long as I could get away with not following the ward round.

We heard of an MDT meeting that afternoon so we stayed on the ward to help out with any bloods we could do and then ran off for lunch. We got to the MDT meeting and got to listen in to discussions about GI cancer which included a couple of patients we were familiar with. It was good to sit there as although most of the discussions were over our head, we got to examine scans which was helpful as I need to get it out of my head that you look at CT/MRI from the head down. It’s actually a bad thing I have got this in my head as all the organs are in the wrong places in my head and it takes me twice as long to interpret a scan as anyone else.

At the end we managed to catch a consultant and headed to their clinic. These are very different to pre-Covid-19 as there are now no patients physically in the room. We sit and listen on a phone to discussions which still is helpful, but I am worried about how the lack of opportunity to do patient examinations how impact our progression as doctors. We still have our normal OSCE’s come January and with significantly less patient contact both on the wards and through consultant/ GP clinics, I can’t see how we will be expected to be as prepared as previous years,

Anyway, we learnt some lab examinations needed to make diagnosis of IBD and treatment options for those struggling. It’s a common presentation and a lot of the time, people are having to have cameras put into their GI tracts to find out what the problem is.

It was a useful clinic and we finished at a nice round 5pm and headed home.

Friday

This is the only entry for the remainder of year 2 about academic days. We only had our CBL today which should have marked the end of our teaching for second year. Normally, I would be stressed up to my eyeballs with exam revision ready for September so, it felt strange to hit this milestone so early.

We also had a discussion about getting back in the med school after the case concluded. I personally can’t wait as I knew I had 5 days of no face to face contact ahead of me. I understand why some of my course mates don’t want to come in due to fears over mixing the virus but when we are in a clinical environment for learning, I struggle to see how sitting in a classroom would make any difference. That’s probably just me though. There was also a comment about travel efficiency which ok, yes it does seem overkill to get us to come in for something that can be done online but it’s the human interaction that you then loose.

Academic days aren’t just for lectures and CBL but for some of us it’s the only time we get to see others who are in different rotations or are at different trusts, and it’s that I really miss about not having a physical learning environment. I got a little miffed about this comment as it’s a 10 minute drive to the MTC for most people and compared to the utter solitude and lack of seeing people you want to see outside a clinical environment (without risking mixing in pubs or restaurants), I think a 10 minute drive is a small thing.

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Second Year … Second Thoughts

No, I am not quitting Med School ( I worked way too hard in first year to do that). It is the 8th of September 2019 and it is also the night before the second year.

I am excited to be here. There were stages last year where I thought I would never see the day. I was convinced I would fail and be kicked out. It caused a lot of problems for me, this constant worry but I made it through!

Second-year brings a lot of milestones for us. We pass the halfway mark in January (ish) and we also start to become clinical med students. This means we spend more time in the hospital and less time in the lecture theatre, we start to attend GP’s and we learn how to take blood and insert cannulas etc. Not a lot then.

Even though I am excited about what we have to learn clinical skills wise this year. I am really nervous about the upcoming changes to our education. After January, we have no timetable, no routine and it’s up to us to freestyle. Not having that routine and having to change how I learn means that it will take me longer to adjust than most, but I have been chatting with my medic family about it so I can have some heads up about what to expect. I suppose it will give me the freedom to learn how I want to learn, which I have been craving all year but I know I’ll be worried I haven’t covered everything.

I also have the situation this year where I can’t move into where I am living this year until next week. I am going to be a resident tutor this year meaning I look after the Freshers in their accommodation. However, due to the building works not being finished (surprise surprise) I am having to live out my suitcase until next week. YAY. Apparently, the first two weeks of second year are hard too, if you see me rocking in a corner, it’s ok, just leave me be, :D.

However, in two weeks time, the newbies will arrive. This brings about the slightly more positive thing about second year. I am a mother to two first years and I have also arranged with Matt to do a student seminar with him. I love teaching and we’ve established we are a bit of a team because he knows my weak block inside out and I love Block Three with all my heart. I also have tonnes of resources from all my revision so it will be nice to put them into use. It is going to feel strange not being the youngest year in the medical school, and even more strange that there will be 400 students in the MTC. Im used to 4 as of lately :D. However, one of the people I remember from helping out at interviews has got in (in fact they are Matt’s medic kid) so it will be nice to (hopefully) see a few more faces!.

We also have medic revue (of which I can’t wait for), doctors and nurses (of which I have already booked the time off and prepared for the hangover the next day) and medic family dinner. We also have a bit of an easier time with lectures because…. well we don’t have as many 😀

This year I am being a bit stricter with myself with regards to the amount of work I do. I burnt out, I did too much. I did not see the point in taking time off but now, I know it is not just a nice thing to do. It should come before Medicine (first-years take note of that). It is also the first year I can be at home for my birthday so I am hoping to go home for the weekend. I am also learning to drive so I can bring my car up to campus and not have to rely on the slow Coventry public transport network.

So … yup. Second year is finally here. There’s no stopping it. Just got to give it my all!

Abbie

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Surviving the First year of Medical School

Textbooks

You do not need to buy any textbooks going into first year, especially not detailed cell biology ones. You just are not going to need them. You will figure out over the first few weeks what you do and don’t need. The only one I can really recommend for first year is Greys anatomy and a good physiology and pharmacology textbook.  It’s easy to think that coming in with a library of textbooks will make your life easier but the harsh reality of it is that you will not use half of them. Borrow them from the library at first, and then when you find you keep using the same one over and over, then consider purchasing it. However, you never need to buy brand new. Ask around as to who is selling one in your medical school or look on ebay. The BMA even have a free online library where you can access textbooks for free! They even have Greys Anatomy!

Lectures

Yes, they maybe recorded but try and go to them. I found I engaged more when I went to lectures and it also gives you the chance to socialise! Med School can get very lonely if all you are doing is sitting in your room listening to lectures and doing work. It also means you can ask questions in the lecture without having to chase over emails. Lecturers will also respect you a lot more if you are showing engagement with the course and it’s always easier talking to someone you know rather than a voice on a screen. As a GEM student this may not always be possible as you are more likely to have conflicting demands but I would say to go to most of them. It also allows you to follow group work as you will be fully caught up on the lecture content. This was especially true for me as I did not go to the Block 2 teaching because I didn’t get on very well with the lecturers style ( I enjoy story time but when I am struggling to grasp the concept, I just want lectures that are to the point). I found that CBL became a nightmare, and I was at one point 17 lectures behind. So yup, go to lectures, see the recordings as backups rather than first time lecture content. (Recordings can also fail and lecturers have the right to refuse recording of their lecture especially if they are talking about patient details).

Free Time

Have some. This is really important. You can not learn everything on the course. It’s just impossible. To this day I still have no idea about altered voiding. All I know is that kidney stones can get caught at certain points and one of the drug classes is called “Anti-spasmodic”. You make the free time in your life. My lecture often said, plan your week with your free time first. In put that two hours climbing every other day, or 4 hours for date night, then put in your academic work. This stops medicine becoming all you are, and believe me, falling down that particular rabbit hole is not pretty. A question I get asked all the time is “How do you find the time to have a break”, the simple answer is you make it. Apart from sign in sessions, there is nothing to dictate how you study or when you study. I could have done zero work from September to Easter and no one would have known. This is not school where homework is checked, this brings a little freedom into how you use your time. Obviously, med school is tough and there will be times where you feel like you can’t have that time off and that is ok, but it is important that you do take this time off elsewhere. On the opposite end of the spectrum, you do need to be keeping up with your work. The lectures come thick and fast and its not often the content that is the problem, it’s the quantity of it ! Do little and often, you do not need to be up to 11pm each evening working and doing this is a recipe to burn out. Even if you just do a quick review of what you have done, make sure you do not fall too far behind !

Ask For Help

There is no time for heroes here. If you are struggling, ask for help. A friendly second year or even a more experienced first year (don’t forget as a grad entry student you will be amongst those with PhD’s in topics you maybe struggling on). Medicine is a team “sport”. Universities that encourage competition I believe are doing nothing to help their students, you will never be turned away for asking about a patient in a hospital (yes you may just get a grumpy response) but you will never be left when a patient is concerned, so why abandon your course mates now (Doctors correct me if I am wrong on this !)? We formed a team over revision in our med school and people who had been studying alone actually came and sat with us towards the end and wished they had joined us sooner. This does not just cover academic means either. If you are struggling with anything else, talk to people. As I have said before on here, I spent a lot of time in my senior tutors office, even if it was going in there and letting her know what was going on before laughing over the fact a patient complained more about my sweaty hands than the fact I had accidentally knocked their cannula, I knew someone else knew what was going on and this was helpful in itself.

The “Look at Me”

Do not, I repeat, do not start worrying about how other people are approaching the course. Find what works for you. ANKI is HUGE in med school, but it really does not work for me. I get bored and start doing less and less each day. Instead I preferred question banks, writing notes out and drawing pictures. That is fine because I was still learning the content. However, I did worry because everyone else was carrying out their revision differently to me, focusing on different areas, doing things at a different pace.  We all passed though so it goes to show however you do it, make sure it works for you. Ignore everyone else.

Do not sacrifice something you enjoy for studying

Waaay too many times this year I’ve said “I can’t, I have too much work to do”. This is not an excuse. Especially on a Friday night when you know you would rather be doing anything else than working. Go to events that you want to go to, just work it into your timetable. A good example of this is Freshers Week and med school events. I would go to all of these events. They are fun, and it is an amazing chance to just let your hair down and forget about medicine. Every medical school has a Revue, go to it. It’s an evening where we make a mockery of the med school to raise money and it always ends up being a huge laugh and the talking point for most people for the next week. Go to the things you want to go to, enjoy life outside of med school. You can always come home and do an hour of work, it will always be there, nights out can’t be repeated.

Don’t Try and Copy Every PowerPoint

I really would invest in a computer/tablet/ unlimited printer budget this year. It is so much easier and quicker to input any extra notes that lecturers give into a completed PowerPoint than trying to keep up with the PowerPoint AND everything the lecturer is saying. Some med schools will even test you on things that were said in the lecture but may not be on the PowerPoint, ESPECIALLY if they are recorded. This is very rare but they can technically do it because they did teach you on it (another reason to attend lectures). Some lectures aid more to this than others such as anatomy where you really do not have time to be drawing out structures but in subjects such as VLE and Soc Pop, you can probably get away with it a bit more. A hack for the printers is to print double sided with 9 slides to a page and to double check the lecture slides beforehand. A couple of times we have had lectures where animations were not used, and it was 275 slides of pictures which can be cut down to 60 slides with text.   

Engage With Your Course

Sounds pretty straight forward right? If there is extra teaching, go to it. If there are careers sessions, go to them. Guest speakers? Go. Sometimes you just need the extra motivation by seeing people in the position that you want to be in one day. My Student Seminars were my godsends through the year and I learnt a lot through them. I sometimes felt more comfortable going to my student sem teachers than my lecturers (because I’m weird like that) so this was a huge benefit for me. Our ECG teaching was largely solidified by the 3rd and 4th years and ABG’s were something I understood only in student seminars. If you can go to it, go.

Enjoy it !!

I found first year a pain and I was stressed the whole year through. Looking back, I wish I had given myself more time off and did not work as hard (you read that right). I was too stressed and this was affecting me and having a negative impact on my work and my mood. I wish I had gone to more parties, actually talked to people who I didn’t talk to before Easter because I would have found the group of people, I call my closest friends a lot sooner. I wish I had found a group to have a pint down the pub with sooner as this is something I loved doing in my undergraduate. I wish I had gone climbing sooner and just enjoyed being in first year instead of worrying about exams from the get go. So enjoy being the babies of the med school, enjoy your first time in the hospital and your first time seeing patients, worry about everything else after… 😊

Abbie

Ps. Learn to love coffee too !

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GOSH Summer School

Monday

On Monday I headed to GOSH for a 9:30 start of the summer school. I had been really looking forward to this for a while and I had the added bonus of a free ticket ! I managed to get there and of course you enter the awkward first moment of finding people to talk to. I ended up chatting with a soon to be doctor from Vienna ! People had actually come from afar to attend this event with people coming from Ireland and even New Zealand!

We had our first talk on general paediatrics delivered by Professor Caroline Fertleman. She arrived with her pink hair and talked us through her day to day job as a paediatric consultant. I was in awe and just her passion for the children she had seen and her interactions with the family was lovely to hear and you could tell she loved her job. This was actually a common theme throughout the rest of the summer school. It was clear these doctors would not rather be doing anything else, that is something I want from my future job.

We then had a quick break followed by a talk on the training pathways in paediatrics. The specialty that was originally the only one I wanted to pursue wasn’t actually covered by the paediatric route, instead I would have to specialise through the surgical training pathway. I guess that’s going to be a bit harder to make sure I get the paediatric exposure but I guess it’s worth it in the end!

We then had a talk from a general paediatric surgeon (Mr Simon Blackburn) about his work in paediatrics. We were told about the surgeries he had carried out and how he had undergone his training. He had also undertaken a masters degree in surgical education which is something I didn’t know was on offer. I do want to gain a masters degree one day and perhaps a PhD but I know research is not one of my strengths so I guess we will see where my training goes. This was the first time out of many for the three days where my mind wandered over to a specialty that was not neurosurgery. I’ve been pretty much set on this specialty since day one of med school so to suddenly think about another pathway was a surprise to me! The delicate surgeries used to correct birth defects in the gastrointestinal system was intriguing and it was the method of fixing the defects that captured my imagination.

In the afternoon we had breakout sessions. We had been randomly assigned to groups as I was put in the “design a research study one”. I was dreading it slightly but the group I was with worked really well together. Our facilitator was Prof Paul Winyard and he took us through designing a study and the tings you need to consider when trying to secure funding. This small exercise boosted my confidence approaching research projects now that I know a little more about them. We all came together in the afternoon to present our ideas. Other groups had different projects such as designing an App for Junior Doctors where they can access help when needed (and even without internet connection, a common problem in hospitals). I liked the idea of a coffee button that you press when you need to chat to someone. There were other projects such as tackling health problems in the community, running an outreach day with the appearance of Dr Ranj and how to improve doctor- patient interactions in consultations with paediatric patients. The presentations were part of a competition and my group ended up winning! We won a textbook for our efforts which was published by GOSH.

After we had a Q&A session with GOSH Young Peoples Forum. This was an organisation set up where patients of GOSH and their siblings could put their ideas forward about how the hospital was run. Members of the YPF have also sat on meetings for picking the new chief executive of GOSH. They have also been invited to give their opinions on new GOSH wards and what should be included on them. It was nice to be able to talk to the YPF as this was a opportunity to ask them what they wanted their future doctors to have in terms of qualities. There were two GOSH patients and a sibling of a GOSH patient so we were able to find out what it was like having a sibling at GOSH. I think the one thing that I got from the session was to involve the siblings in the child’s care as much as possible. The sibling mentioned about wanting to be trained so they could administer care to their younger sibling and they were not able to be trained until GOSH had actually offered them the chance. Offering the siblings a chance to get involved in the care of their brother or sister would be a good way to make sure all the family feel listened to and valued. It would also give the sibling more involvement and make them feel included in the treatment as much as the parents and patient.

That came to the end of day one. I was exhausted and it showed as I managed to get on the wrong train home and ended up having to travel a further 40 minutes to get back to where I needed to be.

Tuesday

Managed to make myself late today because the trains were all delayed due to signal cables being stolen further up the line from where I was. At half nine I was sprinting through London to try and get to GOSH as soon as I could. I arrived during a talk but I go there in time to hear the one thing which has changed my entire outlook on my career and myself. Dr Sharma was giving a talk on his career pathway and how he felt he wasn’t the correct personality type to pursue the career he did , until he found paediatrics. He said that you shouldn’t ever change yourself to suit the job you are going for, instead be bold and be the person to be different. I think this was the thing I took away most from this summer school. I had been constantly doubting that I was the correct person for surgery, I am quirky, excitable and loud. Not really something you see in surgeons but this small thought during the middle of a speech made me realise that actually, there’s no reason why I cant still pursue surgery, there’s nothing in the job description about personality wise. I later found out that Dr Sharma is actually the medical director at GOSH.

After Dr Sharma we had a talk from Prof, Paolo De Coppi about regenerative medicine in children. He was part of the team that performed the first Stem Cell Trachea transplant on Ciaran Finn-Lynch in March 2010. (https://www.gosh.nhs.uk/news/latest-press-releases/2012-press-release-archive/first-child-receive-stem-cell-trachea-transplant-doing-well-after-two-years)

This was incredible as in the next decade , Stem Cell transplants will probably replace any transplant we use from living/deceased donors. The trachea was derived from a donor in Italy and stripped of any cells down to the collagen. Ciaran’s Stem Cells were then isolated and applied to the tracheal skeleton. Ciaran is still doing well today and does not require any anti-rejection drugs, he even attended the GOSH award ceremony with the team for their work.

We then had lectures regarding how to strengthen our CV’s . This was useful as being a first/second year medical student as I still have time to work on mine. One common theme that kept recurring was taking an F3 year. This would be a break between becoming a fully qualified doctor and starting specialty training. There was also an added emphasis on taking breaks away from training to pursue other opportunities such as going over to other countries to become exposed to their healthcare systems and different consultants (as well as taking a quick 10 minutes to soak up some sun).

In the afternoon we had a careers fair. This proved to be incredibly useful as I got to chat with some of the specialties that had caught my eye. One of these was PICU / CATS. Paediatric Intensive Care wasn’t anything I had originally thought about, but it has become a specialty that has got me re-thinking my career pathway. Dr Andrew Jones was running that stall and it was interesting to hear about what he does day to day. He also informed us about CATS which is the Children’s Acute Transport Service. This is a service designed to take critically ill children to PICU units at hospitals where they are currently in a hospital without one. It is a specialised ambulance that can cater for critically ill children during transfers from one hospital to another meaning children can receive the best possible care at every stage of their journey. Dr Jones happened to be on a 48 hour on call during the fair so was multi-tasking to say the least! He was very open and honest when we asked why he chose PICU over NICU and I could see how retaining what you want from your career was important when choosing specialties.

I also managed to talk with Dr Bhate about Neurology and how to best get involved in research so show dedication to the field. He seemed receptive to the fact I already have a degree in neuroscience so I am hoping that will stand me in good stead with other clinicians. I also managed to sit down with Prof Paul Winyard about getting involved in research and what clinicans expect of their students. I was worried about the data manipulation side of research as this was something I just never really understood in my undergraduate. I think he sensed that I had little self-confidence and basically told me to get out there and just go for it. I must admit, sitting in a lecture hall knowing I was probably the only one who didn’t get straight A’s or A*’s for their A Levels , it was easily to feel like the underdog but the boost I got from Prof Winyard I think was needed.

We then had a Q&A session with the specialties and I believe the most memorable question was “ Is it as bad as Adam Kay says it is?”. This earned a laugh through the audience but we were told about how paediatrics was tough and that the days were long but , it’s the smiles of the kids and relief on parents faces that gets you though it.

We then had a presentation by GOSH arts which ended up being more of a group singing session. We were all stood up singing through this tune and for a bunch of people who have seen more of the inside of a hospital than the outside for the past couple of years, the harmonies were quite good. Despite feeling a bit embarrassed it was a really enjoyable session and it really hit home the power of non-medical treatment.

In the evening we had a small drinks party on the roof of GOSH with views all around London. It was nice just to talk to everyone from different medical schools exchanging OSCE horror stories and stories from the wards. I was also chatting final year students about their electives. I also found out about working Glastonbury as a medic and I got given the website so I am hoping to gather a group of us up next year ! I also ended up bumping into the guy who runs the media side of PGME GOSH and we were chatting about how despite the thousands of emails that got send out, only 44 people were there. I was saying about how emails can be easily missed but it might be better to have a student ambassador at each school pushing GOSH events, they seemed to like the idea! We ended up leaving at 8:45pm from the event that was meant to finish at 8:30pm but that’s a minor detail !

The view from GOSH

Wednesday

Final day. I didn’t want the course to end but I think we were all pretty shattered by Wednesday. Our first lecture was about DRIVE at GOSH which is the Digital Research and Informatics Virtual Environment. Apart from the slickest presentation I had ever seen, the tech they are developing at GOSH is incredible. It’s important to understand that as medical students in the 2020’s , we will be seeing an influx of technology into our daily working lives. One particular bit of software that caught my eye was their data collection as you could input the data you needed and then it would tell you what test to use depending on what data you selected. They were also developing programmes that linked with therapy for respiratory patients to games where they had to perform the therapy correctly. I am excited for what technology can bring to healthcare but I am also worried about how this will affect training. If an app can listen to heart sounds and correctly diagnose them, then why bother teaching medical students how to identify them. There’s also the question of data security as we have seen how the NHS is not impenetrable to attacks from hackers in the past however, I think the benefit for patients through this technology will be huge, we just need to know how safe it will be.

We then had a talk on Paediatric Ethics. Ethics is something that has grown on me a lot through this year and I am considering it for my SSC1 module next year. We were told about how GOSH ethics panel makes decisions based on ethical values and how they allow their patients in on the meetings in the children are well enough to attend. Although Charlie Guard and Alfie Evans were mentioned , we talked about how the ethics panel also decide on if it is ok to give an experimental treatment to a child, in the case we talked about the child actually sat in on the panel and was eventually allowed to undergo the experimental treatment.

Our penultimate lecture was looking at global health and how we can incorporate practising and teaching medicine abroad as part of our training. Again, it was highlighted that is it good to take time away from the conveyer belt of training and to do something with your career away from clinical practise. It was amazing to hear about the projects Dr Kingdon had worked on throughout her career in Africa educating nurses and future doctors as well as improving hospital standards in paediatrics.

Our final speaker was Anthony Bennett who was a former GOSH patient who had gone on to speak at national events about his journey and has now developed his own motivational speaking business. He took us along the treatment he had received as a patient at GOSH having survived 12 cardiac arrests from multiple infections after becoming ill on a school trip. We had a few laughs through the presentation as he spoke about his morphine hallucinations which actually turned out to be real visions ! Anthony spoke about listening to the dreamer voice rather than the “puller back voice” and I think we all left just that little more optimistic about the careers we have ahead of us. I managed to chat with Anthony at the end about how he got into his public speaking as it is something I would love to do with the view of educating pupils that just because something does not go right , does not mean you can’t reach your end goal.

And that was it ! Summer School over. It was an incredible experience and I feel like I have gotten so much more out of it than just how to become a paediatric doctor. I am so grateful to GOSH PGME for picking me as the winner of a free ticket ! GOSH seems just that little bit more realistic as a career goal now. I can see my personality reflected in the doctors I met and it was nice to chat to them with the traditional consultant/medical student barrier removed. I can’t wait to start second year now. I want to try and get as much exposure in paediatrics and neurosurgery as possible and possibly experience with anaesthetics as this is also something that has caught my eye as a specialty. There are a couple of GOSH conferences coming up that I would like to help out on to further see how research works within clinical settings and to hopefully talk with clinicians already where I want to be in the future.

Registration for 2020

https://courses.gosh.org/GOSH_SummerSchool