Saturday, May 26, 2012

Orthopaedic Clinic.

A bit hard to believe but I've only got 2 more weeks of Orthopaedics left. It definitely flew by despite not being a very "intense" placement. Actually it was extremely slack...but it still went by very quickly as I'm still having fun and having a good time. With this particular specialty at my school, students aren't placed in Orthopaedics for very long. Through the regular rotations through the school we only get about 1 week of Orthopaedics so consultants/registrars don't get to know you very well. With me, because I had self-designed my placement to be in Orthopaedics for 6 weeks...consultants find it weird that I've been around for a lot longer than most people. Every week I attend early morning meetings to discuss about cases and I can tell that the consultants are starting to expect me in meetings and I'm becoming a familiar sight. They are all acknowledging my presence and are talking to me, which is a bit of a surprise as I haven't really followed any of them to clinics/theatre so in general the only time they see me is when I attend their meetings (once a week). 

Essentially I go to clinic twice a week, and we would see quite a lot of patients in a half-day clinic. When I first started out on my first week, I essentially just sat in clinic and observed. The week after, I was allowed to go take full patient histories and then present them to my supervisor in front of the patient, but I would watch my supervisor perform examinations on the joints. Third week: full patient history + joint examination on my own, then present to my supervisor in front of the patient. Fourth week (now): take a full patient history, full joint examination, differential diagnosis + formulate a management plan. I think my supervisor is doing a really good job in terms of allowing me to progress and allow me to do a bit more with every week. Finally getting things to do and a bit of responsibility, which is nice. It also makes the clinic a bit more enjoyable as sitting through a whole clinic and not doing anything gets fairly boring, especially in such a specialized clinic (lower limbs). Patients generally come in with the same complaints so when we get new patients, I get to at least get up and walk around and do a bit of talking/interaction with patients in a side room, while my supervisor sees a follow-up patient. I actually think it helps the clinic move a bit faster as we are seeing two patients at a time at some points and when I present my patient, it obviously takes less time than doing a history on the spot and my supervisor is starting to trust my examination findings so he only needs to quickly check instead of going through all the motions.

I think I'm actually learning a lot as my history taking skills and examination skills can always be improved on so with all this practice, I believe I have improved a lot. Taking a pain history is quite easy now and it is something I don't really need to think about anymore and I hardly miss any questions out as I'm seeing so many patients and getting lots of practice in. This is definitely giving me a bit of a head start compared to other students as other students use their "self-design" placement as a holiday by applying to do a project in "sign language" or something really random. With my placement, it is almost like a regular rotational placement that we get placed in and I'm doing a lot of clinical things which is obviously helping me improve and giving me a lot of opportunities to practice and formulate management plans (which aren't really taught to is something we have to learn on placements).

Overall, really enjoying my time in clinics (can't believe I am enjoying clinics) and they go by fairly quickly as well. My supervisor asks me questions from time to time so he keeps me thinking and he teaches and shows me a lot of x-rays throughout clinic as well. Like I said about my last O&G placement, supervisors definitely matter and they can make a huge difference in your placement. Can't believe only 2 more weeks left...I could do another month of this! Starting to become a routine and I'm starting to feel a bit more comfortable. Best bit is that I'm not in every single day from 9-5, so I get to work on a project/audit at the same time so it keeps my week interesting/varied. Plus I'm getting some free time to enjoy the odd sunny weather here in the UK. Loving it.

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