My Audit Project: Start to Finish.

May 2012 - I started on my first audit project which was in Orthopaedics. I technically started planning this audit project with my supervisor back in January 2012. When we first discussed this project, the project was just intended to be a good learning experience for me and I pretty much saw it as something to keep me occupied during my Orthopaedics placement. I don't think any of us really thought of going far with this project. It was essentially a "we'll see how it goes" kind of thing. Admittedly, I didn't take the project that seriously either. I spent maybe an hour here and there in medical records. Our sample group size wasn't very big either so I wasn't exactly pressured to spend hours and hours to collect all the data. To be fair the audit project took about 3 weeks to complete (as in gather all the data, come up with numbers, and type up a rough report to hand in). As you can probably see now, I didn't take it very seriously. As I started getting results and numbers from the audit, my supervisor began encouraging me to think about submitting it to national/international conferences as he believes people might be interested in our results. I remember actually laughing off what he said and told myself: "That'll be the day!". Eventually he started to sound a lot more serious about it and continuously encouraged me to submit an abstract to conferences.

Because I had typed up a report (albeit quite roughly), I at least have a base for an abstract. An abstract is essentially a 250-300 word summary of your project. It would include an introduction, aim, methods, results, and a conclusion. I took a sentence or two from each of my sections in my report and put them together and there we go: I've got my 250-300 word abstract ready for submission. I submitted an abstract to 1 national and 1 international conference. As I submitted it, I still told myself: "Why would anyone want to select MY project? It'll be a joke." 3 months after submitting my abstract, I heard back from the conferences. I was accepted to do a poster presentation at a pretty "prestigious" (apparently) national conference. I couldn't believe it. I was over the moon. I mean I never expected to get anything from this project. Like I earlier said, it was a bit of a "keep me busy" project that I didn't take seriously. You can imagine I wasn't very confident about it and really truly didn't think I'll get anything from it. I even told my supervisor in the unlikely event of me getting anything out of this project, it will be a massive bonus. I heard back about the national presentation in December 2012 and in about 2 months I had to churn out a poster. Where do I even start?!

I have never done a poster before. I mean I presented my project a few months earlier at a local audit meeting so I had a powerpoint presentation of my poster, but not an actual POSTER. I asked around and was given a template. To be honest, I was still very lost. Because it was my holiday when I had to work on my poster, I pretty much sat myself down in front of my computer and spent the whole day making the poster. I used powerpoint to make the poster and after many hours of continuous work, I had my first draft for my poster. I remember sitting back and looking at my computer screen with a large grin. I can finally see my project "come to life". All that work, I can finally see it. After many drafts and sending my drafts to my supervisor, I believe I had my final draft. 2 weeks before my conference, I made some last minute changes to the images and minor adjustments and sent it for printing.

"Your poster is ready to pick up." - the graphics team had called. It was my day off and I quickly rushed out to go see my poster. When I saw the poster I just could not believe it. My work in true physical form. I obviously took a minute to be a bit of a narcissist and admire my work. I couldn't help but feel a sense of pride and joy. Just looking back at the long journey, I just could not believe it.

Then it was time to go to the 3 day conference. Poster rolled up and secured in a tube. No one has seen it other than me so my supervisor and other surgeons who helped haven't seen it. We all met up and went to the venue to register and put up the poster. Just walking into the venue and seeing everyone there (250+ people) and 95% of them were Registrars or Consultants in Orthopaedics, it was actually quite intimidating. It didn't help that I looked BY FAR the youngest in the meeting and 1 of the handful of women there as obviously Orthopaedics is quite male dominated. When I took the poster out to put up, while my supervisor and other doctors stood around, it was nice to see my name as the first author and the title of my project standing out among the other posters in the hall. I got a pat on the back and was congratulated. It has finally happened. My first national poster presentation. Throughout the day I was introduced to many consultants from around England and met some pretty famous ones who I have only heard about. It was such a great and new experience. When it was finally time to leave, I left my poster with my supervisor.

A few days ago I received an email from admin in Orthopaedics saying that I should go visit the Orthopaedics Department. I kind of dismissed it and didn't pop around until yesterday. As I walked down the hall in the department, there it was - my poster. It was displayed up on the wall, which registrars and consultants like to call: "The Hall of Fame". I stopped in front of my poster to be a bit of a narcissist again and admire my work.  

What this project has taught me is that if you work hard, "the sky's the limit". The opportunities are infinite - you just need to go look for it and grasp onto it when it passes by.

So what's next for me? Because my project was a lot more successful than we all thought, I am now hoping to submit a more polished report for publication. I mean these projects are quite fun, and a good experience so I am in the midst of planning with another consultant to do another project with a much larger sample group and on a different topic. After going to the conference, I am very motivated to keep doing projects and working hard. Who knows where my projects will take me next? America? Canada? Asia?

"The sky's the limit."

O&G Labour Week Part 2.

Tiring second half of the week. No joke. Again I underestimated/didn't give labour week enough credit. I thought it was going to be complete crap...but this week has proven me wrong. I wouldn't say obstetrics is my cup of tea, BUT it has certainly earned a lot more respect from me. The midwives are so hard working and enthusiastic despite their ridiculously long shifts. I think the most frustrating part about obstetrics is that it is either very busy or very quiet. When it is busy, time passes by extremely quickly...but when it is quiet - holy smokes...it is painful as all you do is just sit around and zone out.

Day 3 - Because I only had 1 thing left to be signed off on my log book (instrumental delivery) I was literally running around and broadcasting to the midwives and doctors that I need to see an instrumental delivery. Essentially showed up early...again struggled with arriving for 7am, but tried my best. The midwives suspected that one of the rooms will need an instrumental delivery so they told me to keep an eye out. Literally sat and waited for the whole day for this woman to deliver. So a bit of background.

27 year old woman
Prima Gravida (first pregnancy)
Been in labour for 48 hours
Admitted to hospital with cervix dilatation approx 5cm and severe contraction pains
SROM (spontaneous rupture of membrane)
CTG revealed an episode of deceleration of fetal heart - spontaneously resolved - may need C-section if re-occur
FBS (fetal blood sample) taken x2 (both revealed normal blood results)


Plan: Midwife to review every 2 hours for any more CTG decelerations.

Essentially I had been hovering around this lady's room and keeping an hawk eye on the midwife responsible for this lady as I did not want to miss an instrumental delivery. Sat around in the midwife room for hours. Time was ticking and it was getting closer to the end of my shift (5pm)...then 4:50pm - midwife reports that the lady is fully dilated and has tried to push for awhile but the baby was not coming out - called on-call registrar. It was determined that this woman will need instrumental delivery. I obviously perked up and was relieved that I will finally get to observe an instrumental delivery and get my log book obstetrics section completed.

Lady was brought into theatre as there was a bit of cervix which could be pushed back and she was given spinal. Realized that we cannot use the KIWI so we had to use Forceps. I had never seen forceps before and when I saw them it looked pretty crude but it doesn't really do any damage to the baby. Forceps delivery is just crude. The registrar was pulling quite hard and we had to hold the lady back as she kept sliding down the bed as we pulled. The husband nearly passed out as well. After several attempts, the baby was delivered and it was fairly large so I was not surprised why it took a few pulling attempts. Unfortunately, due to the baby's large head and that the lady was quite small, she ended up with a 3rd degree tear. 3rd degree tear = torn perineum and a bit of anal sphincter. Essentially tears are not pretty...seen a few tears now and it's not nice. Essentially the surgeon has to stitch your perineum back together which is pretty much  a mess. It isn't pretty. I don't even get how does the surgeon figure out what to stitch. To me it was just a bunch of flesh torn apart. Certainly looks very difficult to repair and requires a lot of skill and experience. Amazing though. Once that was done it was almost 6pm but the extra hour got me my final signature for my log book.

Day 4 - because my log book was filled and it was a half day as I have a night shift on day 5...i turned up late and observed 2 caesarean sections. Fairly boring day.

Day 5 - 16 hour on-call night shift. Start at 5pm Friday, finish 9am Saturday. I really didn't know what to expect...I like to consider myself nocturnal as I work well in the middle of the night. Unfortunately it was a VERY quiet night and time was crawling. I didn't know what is the proper etiquette for night shifts...do I go sleep or do I stay awake with the midwives? The doctors disappeared midway through the night and I assume they went back to their office to sleep. So what do I do? Essentially I tried my best to stay awake and read 6 chapters of my O&G textbook. 4am - I was getting fed up. Bored to death. Nothing going on. 5am - told the midwives to bleep me if there's anything interesting/if they need to bleep the doctors to also please bleep me. I technically don't have a room but I reckoned the seminar room would be empty so I went to bum on the couch in there. Passed out for about 30 minutes and then my bleep went off. I was so tired...I looked at my bleep and was trying to get up...couldn't. 15 minutes later - woke up and sun was rising...obviously hardly knew where I was...very dazed. I could hardly open my eyes and zombie stumbled to the ward and the midwives said they were trying to bleep me and that there's a patient in theatre. Went to theatre to see the consultant repairing a 3rd degree tear. I'm pretty sure he knew why I was late...but he didn't say anything. Phew. 8:30am - doctor handover. I packed up, got changed back into clinical clothing, and then stumbled to my car. Managed to get home in one piece. But wow WHAT A TIRING/BORING NIGHT. Brutal. Never again - 16 hours. Doctors and midwives only do 12 hour shifts...why the heck do students have to do 16 hour shifts?! Trying to kill us?! At least give us a room or an office instead so we can rest.

All in all...labour week wasn't too shabby. Obviously Monday and Tuesday were my highlight days as I got to assist and scrub in for elective sections. Very good experience as I enjoy surgery so any opportunity to scrub in is an honour for me. Next week is my final "timetabled" week which is Ward Week; however, it is more like 50% ward, 50% clinic. My summative assessment is next Tuesday as well. It involves taking a full Gynaecological history and answering questions about investigations, management, and treatment. Quite nervous as I haven't had time to practice history taking as I haven't had my ward week. Next Monday = catch up time. Probably going to try my best to talk to as many patients as I can on the ward. Final stretch of placement: 2 more weeks. Ward week then "catch-up" week. I'm actually kinda sad that this attachment is ending. Having a blast. Unexpected. Wow.