Dull.

If I could describe my GP placement with one word I would use the word: "Dull". Dull might even be an understatement. I have caught myself so many times zoning out during consultations. Again my frustrations are growing as I still cannot do anything in clinic. The most I can do is maybe do manual blood pressures. I guess the only thing I can take away so far from GP is the difficulty of immigrants. My practice sees a lot of immigrants and most of these people can't speak English.  You realize that it is very difficult to get a patient history and even more difficult when you have to talk to your patient through an interpreter.

We had one patient who was from Slovakia and could not speak very much English.  It was requested that an interpreter come, but he/she did not show up so the patient attempted to tell us her problem in broken English. Unfortunately, her problem was a mental health related problem so patient history is really important and there was no way we will get what is the problem as her English was not cutting it. We resorted to using the phone interpreter. I swear those things are not user friendly.  The interpreters aren't that great and it is really awkward having a phone in between the patient and you and the phone is on speakerphone so it is quite difficult to hear what the interpreter is saying.  Even weirder is that you lose a lot of rapport with the patient as both of you are trying to talk into a phone. Very confusing stuff.  After 45+ minutes (when it should've been 10 minutes), the GP gave up. It got far too complicated and too difficult to get a proper patient history. I felt like we wasted a lot of time and it obviously makes the clinic run quite behind. We asked the patient to bring an interpreter next time and you just can't help but feel a bit annoyed that you wasted 45 minutes only to get nothing accomplished.  The next few patients weren't too pleased either as clinic got quite delayed. When one patient sees that you spend 30+ minutes with one patient, they think they have the right to have 30 minutes as well and it's hard to cut people short and to keep them on topic about their medical problem/presenting complaint.  When you're running behind, the last thing you want to hear about is what the patient did on the weekend.

I have no problems admitting that GPs are extremely patient people and their job is certainly not easy.  I just feel like I would have a lot of difficulty maintaining my composure during consultations especially when it gets quite frustrating.  I do consider myself quite patient, but I guess not patient enough for GP and probably the main reason why I'm having a difficult time enjoying this placement.  Worst bit is that I still have another 5 weeks to go. Thankfully I am only in 3 days/week so my weeks won't be too long. I'll take it that I have 15 more practice days.  That doesn't sound too bad...I guess....

1 down, 6 More Weeks to Go.

What a shock to the brain. I've tried my best to prepare myself for my next attachment in General Practice....and actually had very little expectations. My main fear prior to starting my attachment was the prospect of just sitting in the corner of a clinic from 9-5pm and not really do anything practical/talk to any patients. I have never had a rotation in GP before so I am obviously out of my element. I have always been in a hospital and there are a lot of advantages of being in a hospital such as if you don't find your attachment particularly interesting/useful - you can always go to another ward/department and there will surely be someone who will be willing to teach. The problem with GP is that you are stuck in the same building and there is no where to run. I am a type of medical student who likes to venture off to find more interesting things if I find myself getting very bored. There is a sense of "freedom" in a hospital as you aren't bound to a single area for the whole day. It is seen to be acceptable for us to roam to other wards to learn about different things while we are in the hospital so no one would really notice you not being on your assigned ward (unless there is scheduled teaching). In terms of GP, it is VERY obvious if I do not turn up as I am the only student in the practice and the GPs who I am attached to can see on their own schedules that they should have me, the student, in clinic with them. Very difficult to escape.

So I had a short week...had 2 days of lecture and 2 days on placement + 1 day off. Despite only being in the GP practice for only 2 days...it still has managed to knock my motivation completely over. My last attachment in orthopaedics probably was the highlight of my degree and my motivation to work was at an all-time high. I could wake up for early morning meetings. I rarely found it boring. Just everything clicked. I was truly happy. I was hoping all the happiness and motivation I managed to build up in my orthopaedics attachment will get me through GP. Wrong. In 1 week....my motivation level is at an all-time low. I am not interested in doing anything. Can't wake up in the morning. Don't feel like doing any work. Do not feel like participating. According to my friends, I am in a horrible mood. I am actually really low at the moment. On my first day I walked in with a very open mind and told myself it will be a good change as I'll get to see various different type of conditions and get to relax a bit more.

I will certainly not dispute that GPs see a lot of different things, and actually props to them for being such patient people. Some of the patients who come through the doors really....erm....there are no words to describe it. GPs are given 10 minutes per patient...but some patients come through the door expecting to get 30 minutes and talk about everything and anything. I can obviously tell in between patients that GPs get frustrated and they have to put on a mask whenever another patient comes through the door. As a student (who is sitting in a corner), it's just painful. If the GP finds it frustrating and boring to constantly have to reassure and listen to life stories...think about the poor student sitting in the corner who can't do anything but sit and watch. There is only so much I can learn by sitting and listening. I learned from my last placement that you won't learn anything until someone pushes you into the deep end of the pool. I was very hesitant in my first week of orthopaedics to go see new patients on my own as I had never done that before...but very quickly I found it very useful and eventually became quite good with taking patient histories. I don't think you can learn communication skills by just observing. It is something you have to learn by experience and I think that by making your student sit in the corner and listen is not very productive/a good way for he/she to learn.

I personally think that medical students can actually be very useful if used correctly. At the moment I feel like an old piece of furniture which isn't being used. I literally just sit there and watch. I don't even get to interact with the patient. I just try my best to not fall asleep and smile. I don't want to look not interested in what GPs do so I have to put on a face. I was so bored in my morning clinic today that I was desperate enough to offer to get things for the GP or make him a cup of coffee/tea, but nope...was told everything is fine and to just sit there. I haven't been so frustrated with a placement in a long time. I mean paediatrics wasn't my most favourite placement....but at least I was in a hospital where I was given the freedom to walk around and go to other wards...go see other things. I feel trapped at the moment. How am I going to survive next week. I don't get how I'll stay sane by the end of this attachment. All I want to do now is just sleep the day away. Props to people who want to be a GP...don't think I have the patience/tolerance to be one. Need to desperately find a way this weekend to pick myself back up or else I won't be able to bring myself in to the practice on Monday.

Theatre Etiquette.

As promised I will discuss about surgical theatre etiquette. Theatre is a really good way to see anatomy and learn more about the management of certain conditions.  Again like the wards it's a really daunting place to be in. I actually found theatre a bit of a scary place as there's so much equipment in there, but once you have experienced it...it really isn't that bad. Your consultant finally invites you to go to theatre with him next day so here are some tips: Find the theatre list for the day you'll be going into theatre so you can get an idea what you'll be seeing - best place to go is the consultant's secretary. This will allow you to do a bit of reading up on relevant anatomy for the surgery. Also a great chance to read up on the condition that the surgery is treating. Most consultants like to ask questions during surgery so make sure you're ready. Nothing worse than being the student that seems like he/she didn't do any preparation whatsoever. Also theatre starts at different times so it is something you'll have to find out from the consultant/registrar/theatre staff/secretary. Make sure you turn up for the very beginning as this is when everyone introduces each other and go through a team briefing. So you get to the hospital - what do you do next?

Head on to theatre and sign in. Go get changed into scrubs and put on a theatre cap. Make sure you also change into theatre shoes which are usually clogs/the super fashionable crocs. Hopefully your hospital have some theatre shoes for you to borrow so make sure you ask at reception first. Take off all jewelery. At all times make sure your ID is visible. In general for theatre changing rooms it is best to bring your valuables with you or simply don't bring valuables to a theatre day. I always bring my money and my phone with me and depending on the hospital I also bring my bag with me to theatre as it's just a small messenger bag. Make sure you leave the bag in the prep room or ask theatre staff where you can put your bag.

So you get to the theatre and hopefully you'll know who is the consultant. Go introduce yourself or say "Hi". You'll be surprised how often they don't notice you even though you think they saw you. I guess sometimes they can't recognize you as you are in scrubs and have a theatre cap on. Get in on the team briefing and pay attention to the theatre list for the day. Also find out who is the anaesthetist. Ask the anaesthetist if you can observe the patient being put to sleep. It's quite interesting to watch.

Simple rules of theatre:

• Don't touch anything green/blue in the operating room especially on tables/trolleys
• If you're going to faint - don't faint on the patient - so go sit down - it happens to everyone
• When the surgeons are gowned up - don't make any contact with them as they are now sterile so that means good dodging skills and just stay out of their way until they have gotten to their place at the table

Usually there will be 3 people scrubbed in and working on the patient. It will usually be 1 consultant surgeon, 1 registrar, and 1 scrub nurse. It'll be fairly obvious who is who. Scrub nurse is the one who will be passing all the equipment to the surgeons. If it is open surgery (not laparoscopic) you'll probably need to get a pedestal to see over the shoulders of the surgeons but make sure you ask them first/let them know you're standing behind them so they don't bump into you...but obviously don't be right up behind them - give them some space to breathe and move around. If you wear a lanyard for your ID badge - then this would be a good time to tuck it into your shirt so it doesn't swing around.

If it is a laparoscopic surgery - there will be a tv screen for you to watch so you don't need to be standing as close to the surgeons. Just find a good spot to stand and for me, I never sit down as I think the theatre staff are more deserving of a chair than I am. 

The problem with surgeries is that it can range from 30 minutes to 8 hours. You'll find that your back and feet will be hating you during long surgeries. Also make sure when you're standing for a long time just to keep your legs moving so you don't faint. Sometimes with long procedures I will go take a walk around the operating room just to get my legs moving again and give my back a stretch. No matter how much you love surgery (and take it from me - I really do LOVE surgery) - it will get boring especially when you're not scrubbed in and just observing. If nothing interesting is happening go talk to the anaesthetist. Ask he/she about the machines and what they are doing. The thing with surgeries as well is finding the right time to ask questions. There will be times where the room goes dead quiet as the surgeons are concentrating - obviously horrible time to ask a question. You'll be able to tell when they don't need to focus as much as usually they'll start talking about really random things like plans for the weekend...you'll be surprised what sort of things surgeons talk about during surgery. Some surgeons even have music playing in the background so don't be shocked when you walk in and there is music playing. I think the best one was when I was waiting outside a day surgery theatre and the doors to the operating room opened and all you can hear was music blasting out...almost seemed like a night club in there!

Hopefully your consultant will be good at teaching and he'll show you the relevant anatomy IF it is easy to see. Not all the time the anatomy is easy to see, but don't be disappointed if you don't really see much. Most surgeries that I have observed - I usually don't see very much so don't think this is your fault. Especially now, surgeons are trying to make incisions smaller to reduce the recovery time...but again as long as your consultant knows he/she has a student around - most are quite good at moving over and letting you do a quick lean in to take a closer look - again make sure you don't touch the patient/surgeons.

When the surgery is done - go make yourself useful and help the theatre staff with moving the patient. Put on a pair of non-sterile gloves and grab hold of one side of the bed sheets (other than the head as the anaesthetist will be there). It'll be made clear which way the patient will be going and usually the clue is probably the empty bed right next to the operating bed with a slide board underneath. The anaesthetist will always count you down to moving so some will say "On 3" or "Ready Steady *Move/Shift*" - either way it'll be obvious.

If the previous surgery was long - you might want to stick yourself onto the consultant/registrar as they usually will disappear to the coffee room. Go make yourself a drink or get some water - staying hydrated is key for surgery. Sometimes it is quite frustrating as you could wait for an hour before the next surgery. I always hate coffee room breaks - not because I hate waiting around...it's because sometimes the consultant needs to quickly pop up to the ward and you're left alone in the coffee room. Just keep your eye on someone who is from your theatre as they tend to leave without telling you. Well based on personal experience - I always get left behind so I always got to stay near the registrar/consultant/theatre staff just so I wont miss the next surgery. Another way is before breaking off to the coffee room - ask a theatre staff how long a break do you have or what time does the next surgery start - then at least if you lose everyone - you'll still know what time to get back.

Hopefully this gives you a better idea what to expect when going to theatre for the first time. Hey maybe you'll be lucky and get to scrub in. But don't be disheartened if you don't scrub in as I didn't get to scrub in til this year (3rd year of medical school - been on surgical placements ever since 1st year). So just enjoy your time in theatre and hopefully you'll see lots of cool things. Also a great place to witness some good teamwork and communication skills as well. If you're unsure about anything just ask a theatre staff.

Ward Etiquette.

My last post was for non-medical students so here is one for medical students. Going onto the wards is quite an exciting thing if it is your first time, but there are a few "unwritten" rules that medical students should know about. Either you learn about em by hearing it from an upper year...or learn by experience (eg. being told off by a nurse). So I'll save some of you from any embarrassment/telling off by doing a quick post on ward etiquette.

Hopefully your medical school will make the hospital aware that you'll be coming to their department for your clinical attachment, BUT there will times where the ward/hospital will not be expecting you. First rule is to turn up to your placement ON TIME - even better: show up a bit earlier. Nothing more frustrating than expecting a student and them either not showing up or showing up late. It is important to leave a good impression. Nurses are quite good at passing on feedback to doctors/consultants. Last thing you want to be known is as a disrespectful student. These nurses can actually make your life very difficult.

Next must-do is to dress appropriately. You guys probably won't believe me but I have had colleagues who show up to placement in a hoodie. Yes it is cold outside, but before showing up on the ward where all the patients are...take off your hoodie and look presentable before you go into the ward/hospital. Some of the staff/patients won't know you have just arrived and no one wants to be seen by a poorly dressed student. I'm pretty sure if you were a patient, you wouldn't want to see a doctor who is in a hoodie/not looking presentable. I've also had friends who have been told to get off the ward because their shirts were not ironed. For girls, heard of female medical students getting kicked off the wards for showing too much cleavage and for short skirts. General rule is that if you bend over you shouldn't be able to see anything in the mirror. Skirts should be below the knees. I save myself from the hassle and wear trousers instead of skirts...plus it isn't very glorious when you're in a skirt and you have to help move a patient or lift things (which I do a lot of as I feel bad watching nurses struggle).

I will always remember this key point: "You will never get kicked out of medical school for not showing up to one day of placement, BUT you can get kicked out for showing up to placement hungover/drunk". If you had a night-out the day before and you're hungover/still drunk...take a sick day. The quote just stated...says it all.

Nothing frustrates me more than seeing my colleagues disrespect the staff. I'm usually quite a modest student, but I like to think I am quite successful with getting along with staff/consultants. My friends always ask me how I become so friendly with consultants/why doctors/staff treat me like a friend. Simple: Respect them first. It is quite annoying to see some students being very arrogant. I was on a placement with another student and he thinks he is the best thing to have graced the hospital. When a consultant asks him to get something...he goes and tells the nurse to get it for him. He treats the nurses like slaves and at the end of the day - you are just a medical student. I have stated it in many many posts that we are probably the LEAST important thing in the entire hospital. I have had a professor talk to us about "knowing our place in the hospital". You cannot go wrong by assuming that you are less important than the janitor. And ever since that day - I go onto the wards and respect every single member of staff. Nurses are your saving grace. If they like you - they will make your life so much easier. Best bit is that they sometimes remind you of things and bail you out if a consultant is being a bit "uncooperative/unfriendly". A way to show your respect to the nurses? Everyone loves a cup of tea. I have lost count the number of teas I have made for the nurses. In my last Obs and Gynae placement...I made 2 pots of tea for all the midwives every 2 hours. They made my life so easy and they passed on very good feedback to my supervisor as well.

When talking to patients - first ask the nurses if the patient is a good patient to talk to. Always introduce yourself before going to talk to the patient. Put yourself on the same level as the patient so go get a visitor chair and sit down. Don't sit on the patient's bed. When asking for the name of the patient always ask them how would they like to be addressed. Some of the more elderly patients usually would like to be addressed as Mr/Mrs, etc. Smile when you talk to the patient and just act professionally. When you leave - make sure you take your chair with you and put things back where you found them. I personally like to ask the patient if there's anything they would like me to get/do for them. It's the little things that makes a difference. Usually their tables are too far away or they need something to drink. If they want something to drink, make sure you ask a nurse first before fetching something just in case.

Finally - the most daunting bit: interacting with the consultant. Some like to make your life very difficult. I like to think it is because the consultant didn't want students and was forced to have them...or he/she is overly bored. My good friend said dealing with consultants is a skill on its own. I like to give myself 2 weeks to get a feel of what the consultant is like. Is he/she friendly? Is he/she talkative? Is he/she interested in teaching? One way to put yourself in the good books of a consultant is obviously the things I have listed above and just smile and be relaxed. Don't be arrogant. And DO NOT correct a consultant...no matter how tempting it is...it is a bad idea to correct a person who has been in the job for 20+ years. It is fairly embarrassing to get corrected by a student. Unless the care of the patient is at risk - I usually keep my mouth shut. If there is really any discrepancy - go look it up on the internet/textbook or ask the registrar/SHO. At the end of the day - the consultant is still a person. It's like dealing with teachers back at school. Yes they teach...but they still have a life. No one wants to talk about medicine 24/7. If you manage to figure out that the consultant is fairly relaxed - chat about regular stuff. People always find it amazing that 90% of my conversations with consultants are random banter. Make yourself enjoyable to be around. Put yourself in their shoes. Be considerate.

Anyways basic ward etiquette. Seems like common sense - but you will be surprised how many students forget about these basic things. Assume you are back in school and the medical staff are your teachers. Address them properly. Address the consultant by their last name unless they make it known that they want to be known by their first name. I have yet to call any of my consultants/supervisor by their first name. I tend to address registrars by their first name as that's how they introduce themselves to me. Can't go wrong by being polite and respectful. It is a pain but I think it is fair.

How to Make the Most of Shadowing.

Right so I'm in the mood for a tips post so today I will be discussing how to make the most of a shadowing opportunity. This is mainly aimed to those who aren't in medical school yet.

Let's point out the obvious issues of shadowing doctors when you aren't in medical school yet:

• You can't do any clinical skills
• Don't have much knowledge in medicine 
• Daunting environment - very unfamiliar/disorientating 
• Never really spoken to a patient before

Common problems that you share with medical students:

• You get ignored
• Can't do very much (depends on the placement/consultant)

So with the common problem of getting ignored...there isn't much you can do about it other than finding someone who won't mind having students around/is a good teacher. Not being able to do much is a universal problem. Fair enough some patients don't want to be handled by a student and there has been several times where I have found myself sitting in a corner like an old piece of furniture. It's just something we all have to accept.

Right so as a prospective medical student you want to get some experience and see what it is really like to be a doctor so you ask to shadow a doctor/consultant. So how do you make the most of it? Because you won't have much knowledge about the specialty, the best thing you can do is observe the key skills that a doctor needs. The main skills you'll notice are:

• Communication skills
• Empathy
• Teamwork

Communication is probably the most important skill to have as a doctor. The profession involves a lot of talking to patients, but also the need to listen to the patients as well. Watch how the doctor talks to a patient. Listen to how he/she asks a question. Usually doctors start a consultation with open ended questions to allow a patient to elaborate why they are in clinic. Watch the rapport that the doctor establishes with the patient. The best way to get info from a patient is to get them to trust you so the first few seconds of a consultation is key. Don't dig your head too deep into the medicine. Just focus on the interaction between the doctor and the patient. Some of the consultants who I have been attached to describe it as an art form. Communication is literally needed everywhere. Communication is key in theatre, clinics, and on the wards. If you're fortunate enough to go onto the wards, take some time and talk to the patients. I took my first patient history 1 month into medical school and hardly knew any medicine at that time. Take a social history which involves asking the patient about how his/her medical condition has affected them. Try to find a patient with a chronic disease such as heart conditions. Find out how their condition has changed their lifestyle. This is a good way to practice your communication skills and creating good rapport with the patient. Plus most patients on the wards are really bored so most will welcome a nice lil chat.

Empathy...I've made a post about this not too long ago. Again another important skill and something you'll sometimes see. Talking and listening to a patient is one thing, but watch to see if the consultant shows a bit of empathy. Sometimes patients have a tough time with their medical condition and SOME consultants do take the time to empathize.

Being a doctor involves a lot of teamwork. It is certainly not a one-man job. In clinic, you'll probably have a nurse helping out. Just watch how the doctor and the nurse interact and how they have to be on the same page. Essentially the nurse keeps the clinic running smoothly and on time. You'll probably see more teamwork in the operating theatre. There is always about 6-8 people in an operating theatre so again stressing the importance of communication skills and teamwork skills. Sometimes the consultant may invite you to a MDT meeting (multidisciplinary team meeting). There will be microbiologists, radiologists, surgeons, physicians, nurses, etc all sitting in one meeting to discuss complex cases. Not only do you have to get along with people in your own specialty, but you'll have to get along with people in other specialties. So essentially the care of a patient isn't just in one person's hands...but in many many other people's hands. If you can, take the time to appreciate this as when I first started out in medicine I didn't expect THAT many people to be involved in a patient's care. It was actually surprising and quite amazing how people manage to stay organized and not mix things up (but it does happen from time to time).

Oh and if you really don't know what's going on...best thing to do is just smile and look interested. No one wants a grumpy/tired/not interested student around them. If a doctor sees that you're interested then he/she will be more willing to teach. I've tested this so this is based on first hand experience. Recently in my last orthopaedic attachment...I was falling asleep in clinic (due to jet lag) and my consultant hardly said anything to me or really taught me anything. He just left me alone. Next clinic...got over my jet lag...more keen...leaning forward and looking interested - learned loads. My consultant taught me so much and he seemed to enjoy my company as I was interacting with the patients and with him as well.

Another tip is that if you find yourself on the wards and no one to follow - go find the junior doctors. They know what it is like to be a student as it is still fresh in their minds and they'll probably be able to sympathize and show you some interesting things suited for your level. I've encountered prospective medical students in the hospital before and don't be shy and just ask for help. For me, I'll always be happy to help unless I'm busy. Same goes with junior doctors/doctors of any level. As long as they aren't doing something really important/look really busy, just introduce yourself and ask em if they can show you around/teach. Just make sure they know you're not a medical student and just want to get a taste of what it is like to be a doctor. Some might even get a break and sit down with you and tell you what their day is usually like.

Good luck and I hope this post helped!

Difficulty of Going Backwards.

So I've had a week of lectures...which to be fair weren't too intense. They weren't 9-5 lectures so I can't really complain. Ever since January, I feel like I have made leaps and bounds in terms of progression in clinical experience. In paediatrics, I hardly did any clinical skills and was in a small group for my placement. I had a partner with me for all clinics and was never really on my own. Didn't really even see patients on my own either. Then we get to Obs and Gynae...slowly venturing out a bit and being a bit more independent. Still in a small group on my placement, BUT I didn't have a partner to go with to clinic/theatre. I was actually scared to be on my own as I have never really been to clinic on my own and you get all these thoughts of: "Ahh no one to bail me out when the consultant asks me a question." I actually really enjoyed going to clinics on my own as you get to chat with the consultant more and it isn't as daunting for patients to have two students watching/sitting in. I definitely started becoming more independent on placements and started being more proactive in guiding my learning.

Then my last placement in orthopaedics. It was the first time I ever attended a placement on my own. I have always been in a small group. Funny enough my first concern was: "Who the heck is going to eat lunch with me?!" I am definitely not a fan of eating on my own as it is painfully boring. I like to talk during my lunch as I eat quite quickly so talking helps me slow down. I can easily scoff down lunch in 5-10 minutes and I end up taking extremely short lunch breaks. Luckily, due to my half-days I was able to go home to eat so I didn't have to sit in a cafeteria eating on my own and staring off into space. When I did have to eat lunch at the hospital I was usually with my consultant/registrar so we all ate together. But yeah my independence was really tested in this placement as everything I did was all "me". No one to fall back on. No one to rely on. No one to catch your mistakes...other than the consultant. Went to see new patients on my own and do full examinations on my own..then presented to my supervisor. If you had asked me to do that in my paeds placement...I wouldn't be confident enough to do it. I guess that's one thing with being dropped in the deep end. Got to learn quick and deal with it quickly. To be honest it did help that my supervisor is probably one of the nicest people I have ever met so I knew if I made a mistake I wouldn't get a full blown telling off/humiliation. It was also nice that I actually got to do things during my placement such as see patients, do examinations, assist in surgery, etc.


Now...sitting in lectures on a very hard plastic seat (even the clinic chairs are more comfy) in a small tutorial room...painful. I was talking to my friends and they kept saying it was nice to have a relaxed week of just sitting around and doing nothing but listen. I actually struggled this week. I may not be the hardest working medical student...but I hate sitting around. Especially with my last 2 placements where I was actually being productive and learning loads on placement...I am actually a bit sick of sitting in lectures and listening to one person talk about the same subject for 2-3 hours. Also got my induction pack for my next placement (GP) and the first thing I read: "Patients should not be seen by medical students who are on their own. Medical students will be supervised at ALL times." I'm totally looking forward to GP now...so excited that I'm bouncing off the walls (sarcasm). I really really hope that the package is a bit outdated and my GP will let me go see patients on my own and do some examinations. It's weird getting so much independence and responsibilities...and suddenly being stripped from all of it and back to holding hands. If this is the case...wow this is going to be a shock to the system.

The End of Another Placement.

Seriously cannot believe it has been 6 weeks. It literally blew by. I didn't think it would as I wasn't particularly busy and I had quite a few day offs as well (bank holidays, etc). My friends said that you cannot find a happier medical student on placement than me. I will admit, the placement started off quite slow...but once it got going...I truly truly truly did not want it to end. It's the first specialty where I could see myself work in as a career. Before starting, I was a bit hesitant as ever since I knew I wanted to do medicine, I wanted to do orthopaedics. I had very high hopes for it. Obviously I was very excited to start the placement, but there was a bit of doubt in the back of my mind. These 6 weeks could either make or break this specialty for me. I was actually scared that I will end up not liking orthopaedics...and actually hating it.

Luckily, orthopaedic surgery is just like how I imagined it to be. I was genuinely happy. It's the first placement where I enjoyed everything about the specialty. I enjoyed the surgeries. I enjoyed being on the ward (which was minimal to be fair). And I can't believe I am saying this but I enjoyed clinic. Everything clicked for me. I never struggled waking up to go to this placement. I had 8am meetings to go to (where I had to wake up at 6am) and I never struggled. If this was any other specialty and was told to go to an 8am meeting...I can guarantee you I would struggle and would probably turn up late or maybe even miss it. I was actually motivated to work hard in this placement. I didn't work hard because my supervisor was strict/I was scared of him...I actually worked hard because I enjoyed the specialty. I felt no pressure to work hard...actually my supervisor kept telling me to take it easy and made it very free. It was all down to me. There were times where I wished I was in more.

This was probably the most flexible and easy going placement I have had this year, but this is easily the one placement where I have learned the most. I had lots of fun, but also learned a lot of useful things. I am so lucky to have a supervisor who is really good with teaching and letting me progress. You all probably remember me having great praises for my last O&G placement and that it has set a very high bar. This orthopaedic placement just blew through that bar. I mean I knew it was going to be hard to have more fun and more responsibilities than my last placement, but wow this placement was fantastic. I have nothing but good things to say. I got to scrub in. I assisted in surgery. I learned how to suture and help close up. I saw patients in clinic on my own and got to examine them. I got to start and finish an audit project. I really could not ask for more. I don't even think I could do much more.

Today started out like any other day. Early meeting and then to morning clinic. Usual banter in the meeting...lots of good laughs and teasing. I took up my usual spot at the back of the room against the cabinet. Then off to clinic. Busy clinic as usual. Saw new patients on my own. Did the usual. I'm sure no one knew it was my last day because everything was going like it was just another day of my placement. Patient by patient...the note pile got smaller and smaller. Clinic was coming to an end. Next thing I knew my supervisor was signing my feedback form off. Had a bit of a chat about the placement and then a solid handshake. To be honest it was tough to leave. I wasn't sick of the placement yet. Just wasn't ready for it to end already. Every day when we finish and before I leave, I always crack a: "When am I seeing you next?" It was weird not to say that as I was heading for the door. I didn't even know what to say as I left. I think all I kept saying was "thank you" as I dragged my feet out the door. Even now...I'm absolutely gutted this placement is over. Feels like someone shot me out from cloud 9. Next week is going to be tough. Back to lectures. Back to reality. Then on to GP and being cooped up in a clinic from 9-5. No surgeries. Not in a hospital environment. Going to be out of my element. Hurts just to think about it. Should be a crime to enjoy a placement so much.  Genuinely loved this placement. Entered placement as one of the happiest medical student you can find to probably the most gutted one at the moment. What a contrast. Just shows you how much I enjoyed this placement.

Post #100 - A Look Back.

Post #100 for this blog. I obviously want to make a special post and let's take a trip back to the beginning of this blog.

August 6, 2009 - my first blog post. It was a big day for me as it was the day I received an unconditional offer from my university to study Medicine in the UK. Looking back, coming to study in the UK was a huge decision and definitely a path of a lot of unknowns. A new country. A new culture. A new chapter. Little did I know what a roller coaster ride it would be for the next 2.5 years. I faced many challenges (and still facing challenges) and have grown up a lot in the last 2.5 years. University was a new chapter to my life. Saw and learned so many new things. It has so far been the best few years of my life. I can easily say that Freshers week will always be a highlight as it was quite an experience getting to know so many new people in such a short amount of time. I've been in the same school for half my life so making new friends is something "new" and I was extremely nervous. Kind of laughing at myself now for being so nervous/scared as there was nothing to be scared about. Every one is on the same boat in terms of friends and people are just so friendly. A tip for those who will be starting this coming September: be EXCITED. There is nothing to be afraid of and don't let anything hold you back. Enjoy your time as a Fresher as it will blow by in a blink of an eye. 

When I first started this blog I was really unsure whether I will even be able to keep up with it. Slowly I've noticed that people are reading it and it really motivated me to keep posting. Whilst scrolling through my archives...I have noticed quite a change in frequency of posts. I think it's a fairly good representation of excitement through my years in medical school. Obviously if there is something exciting, I would post about it. Here's reality: the first 2 years of medical school is a bit of a shock. I think a lot of us come into medical school thinking like we would be like the TV show ER...or House and we would be immersed in doing clinical procedures and running around. WRONG. Well in my case I was stuck in a lecture theatre for 2 years learning about the basic sciences, which isn't the most exciting thing. It is obvious there were a lot of up and downs in the last 2 years. I lost sight of the final prize (becoming a doctor) several times throughout the last 2 years. You get to a certain point where you're like "get me on the wards!" and then there will be times where you ask yourself: "Why in the world am I studying Medicine?" Medical school is full of obstacles and it is emotionally, mentally, and physically tough. There are so many times where you're on the floor and you really need to dig deep to pick yourself back up. I realized this is a degree that you have to be committed to because there are times where you truly do question your desires of being a doctor. Then at last - I reached clinical years. 2 grueling years of being cooped up in a lecture theatre and finally I am able to do some practical things and talk to patients. But hold up...with my school we are quite lucky to have a bit of clinical experience in the first 2 years.

March 15, 2010 - first hospital attachment. It was a short clinical attachment and really just a taste test of what I'll be doing in the future. Only a few months ago I saw first year medical students starting with their first clinical attachment like I did back in 2010. Seeing these freshers really put things into perspective of how far you have come along. (And for once it was nice not being at the bottom of the ladder at the hospital). It really gave me a flashback to what it was like when I started my first clinical attachment. Patient histories were a struggle...I was not good at them at all. Hardly knew any medical sciences so I didn't really understand anything and tried my best to keep up. Couldn't do any clinical skills. Essentially just shadowed the doctors and tried to not get in the way. Went to observe a few surgeries and standing on a pedestal trying to peer over the consultant's shoulder. However, I do remember how much I enjoyed watching surgeries. It just clicked. Fast forward to 2012. Patient histories - easy. Interacting with patients - easy. Medical knowledge - growing every day. Clinical skills - taking bloods, inserting cannulas, inserting catheters...just the other day I put in an endotracheal tube on my own (supervised by the anaesthetist). Surgery - observe? Heck I'm scrubbing in now and even helping close up at the end! Medical school is a long and painful process...but when you take the time to stop and think back to when you started...you see how far you have come.

February 8, 2011 - immigration laws changing. I believe this is the first proper post where I've discussed in detail about being an international student and things we have to think about. From then on, I have dedicated 2 other posts (Tidbit for International Students and Life of an International Student) to give a bit more insight about the life of an INTERNATIONAL medical student. To be honest, being an international student isn't that much more different than a local British student. We go through the same course. We get treated the same. We learn the same things. We see the same things. The only difference is our accents, and our passports...and the fact we have to worry about Visas and immigration laws. But other than that, being an international student hasn't been that hard of a transition that I had initially thought. Before I started medical school, my biggest fear was the fact I was an international student and it might be a bit harder for me to make friends or get used to the culture. Again during Freshers week...everyone was just so friendly...I didn't feel different. I didn't feel that much of an outsider. There were a few times in the last 2.5 years where it was frustrating to be an international student due to the lack of support from the medical school, but you learn to manage. As an international student, you make a lot of sacrifice. You leave your family behind. You leave home behind (which can be thousands of miles away). You pay higher fees. But hey hopefully it will be worth it. Hopefully this is something I will not regret. At the end of the day...hopefully this will be all worth it. Homesickness is a huge thing for international students and a lot of my friends do struggle with this...including me. Every time this happens I just have to take a break and tell myself it will be worth it and think about all the obstacles I have already been through and how far I have come. What makes me wake up every morning is the end prospect from studying medicine. I am grateful to be in such a great field and the experiences I have had so far have been amazing. The future with immigration and working in the UK - not a straight path and one with many bumps, but the fact I have made so many sacrifices just gives me so much more motivation and determination to make it work. Work hard and hopefully have a bit of luck on my side when it comes to jobs.

August 7, 2009 - first tip post. Not exactly one of my best tip post, but hey we all got to start somewhere. Obviously this blog was to keep a track of my crazy life of being a medical student, but also to give some tips to future medical applicants. I try my best and over the last 2 years I have posted quite a few tip posts here and there. Applying to medical school is no easy process and I wished I got some tips. My school back in Canada was not very good with helping out students with applying abroad as they are not very familiar with the process. It was a difficult process as I had to do a lot of stuff myself and call up universities in the middle of the night (my time due to the time difference) to get some more information. Hopefully with my tip posts I am able to help future applicants with the process. Obviously I applied 3ish years ago so UKCAT info and tips are a bit off, but I'm sure the interview process is still the same. Now I'm trying to focus on giving tips on surviving medical school. Little tricks I have learned here and there. I remember my very first medical school lecture, one of my professors told all of us: "Life is not fair." And it is so true and particularly true with medical school. So here is a tip to all of you: Life is not fair. You cannot have your way with everything...unfortunately, BUT what you can do is make the best of every experience no matter how undesirable it is. There is always something to learn. Stay humble and treat those around you with the same respect you would expect in return. You will meet a lot of people throughout medical school and treat everyone well as you never know, you might see he or she again in the future. Consultants on placements - treat them with as much respect as you can as who knows, he or she may just be your future employer in a few years. Don't do anything you will regret, even outside of school hours as things can come back and bite you on the ass. Unfortunately as a medical student - we got to grow up very fast. We start medical school at around 18 or 19 years old...you will see patients of all ages and they expect professional behaviour despite your age. Also grow some thick skin - consultants can be very unforgiving. Do your best to not take it personal. At the end of the day their criticisms are for your own good.

June 2, 2012 - post #100. It has been quite a journey and I expect more ups and downs in the next 2 years. Being a doctor is starting to get real. Now going through my specialty placements, I'm starting to do more and more on placements. This post has made me look back and realize how much I have grown emotionally and mentally. Thank you to all you readers out there and keeping me going on this blog. I really appreciate it. Happy reading!