5 Down 1 to Go.

Yesterday was the last day of my Orthogeriatric placement. Was a bit bummed out as I've gotten to know the junior doctors quite well and I enjoyed my placement (despite it being only 2 weeks). By being on the Geriatric ward, you realize all the ethical problems and how cost of care can be so high for these patients. For example - hip fractures cost the NHS 1.7 million pounds per year. The problem is that when these patients turn up, they don't just get an operation and then get discharged after a few days. Older people require a bit more care as they tend to suffer from other medical conditions such as vascular disease (MI, stroke, etc), diabetes, etc. Along with needing to continue treating their co-morbidities, these patients are more susceptible to hospital acquired infections (eg. pneumonia) so essentially it becomes a vicious cycle for these patients. Majority of the patients on the ward stay in hospital for a month which is quite a long time. Care 24/7 for 4+ weeks...the costs do add up.

I was probably most involved with ward rounds in this placement than any other placement I've had so far. I was quite keen to actually help out as I know I do get bored quite easily if I just stand around. I got to write in the patient notes and you just feel a slight bit more responsible while on placement. It sounds a bit sad, but it's quite satisfying signing off on something. I mean as a medical student, we never really get to sign off on anything so it's nice being able to sign off the notes you made in the patient notes during ward round. You also feel a sense of contribution as well, which is a nice bonus. Also good practice for the future as well - will be doing lots of paperwork in the near future...

I think the main problem about being on a geriatric ward is that the turnover rate is quite low so the ward round usually consists of a quick check-up and if there are any new concerns/changes. This made me find this week a slight bit more dull than my first week. The only thing is that now I know the patients, but there isn't anything new to see. Their improvement is also quite slow so I must admit this week's ward round was a bit less interesting.

I mean overall it was nice to be back on a proper medical ward and doing "medical things" as I've spent the whole year in very specific specialties. There was a lot of general medicine and it made me realize how much I have already forgotten (quite scary especially when exams are just around the corner too!). All in all these 2 weeks helped me get my sanity back and I managed to grab some motivation back - well enough to take me through to exams. Now I've got 2 weeks off before my next and final placement - Neurology. Neuro will be tough but I'm quite lucky that I've had an attachment in Stroke medicine last year so I shouldn't be too lost on the ward.

2 weeks to dig my head into my books and do some proper revision. Procrastination mode - on. Need to focus!

Psychiatry - Weeks 3 + 4.

So I'm finally past the halfway point for Psychiatry and to be fair, it isn't that bad. I mean nothing can get any worse than my GP attachment. Anyways...I finally went to the ward and spoke to a bunch of patients. I spent a week in the Substance Misuse Unit and it was really interesting. It was interesting to speak to the patients and to hear about how they have abused drugs/alcohol. It was shocking to hear that most of these patients have started using drugs since the age of 12! I had one patient who told me: "Any drug you can think of, I've tried it."

There was one particular male patient who stuck out for me. He is a 50 year old male (who looked 80 years old) and he was trying to detox off of methadone. He has tried almost every drug you can think of and at the age of 13 had already experimented with LSD. He was actually quite pleasant to talk to and it was interesting to hear about his forensic history. It was crazy to hear that he has been convicted many times and have served several prison sentences. What stuck out for me was his memory. Due to the many many many years of drug abuse, his memory is horrendous. His short-term memory was fairly poor and when doing the Mini Mental State Examination (MMSE), he scored 16 which is very low and abnormal. I'm not kidding - I spoke to him for almost an hour to get his history/why he is in hospital and then left for 20 minutes and came back to do the MMSE. When I came back to do the test, he had already forgotten who I am and thought I was a social worker! It was definitely a bit of a curve ball as I knew his memory wasn't great, but I didn't think he would already forget who I am after speaking to him for an hour and only had left for 20 minutes. Furthermore, because the patient had been injecting for so long, his legs are completely wasted. He has ulcers all over his leg which won't heal as he has poor blood supply to his legs and has suffered with DVTs. When you look at him, he looks unwell, tired, not with it, etc. Apparently on admission he looked like a ghost who was completely out of it. It makes you realize how bad drugs can affect a person. He looks so much older than what he really is and I actually double checked his date of birth with him to confirm that he was only 50! It was incredibly hard to believe.

Also during the 2 weeks I went to the regular ward and spoke to a few inpatients. It wasn't particularly interesting, but I realized that some of the patients don't know why they are in hospital and refuse to accept that they are in hospital for a mental illness. On top of that, I realized that in psychiatry, you have to build good rapport with the patient to get just a decent history as there are a lot of personal questions that you need to ask. In a psychiatric history, you have to ask about their childhood and about their personal life such as relationships and any possible attempts of suicide/self harm. Some of the things you need to ask are quite touchy and personal and I find that quite difficult. At the end of the day I think as a medical student you just need to find a way to word personal questions and be prepared to get an awkward answer or no answer at all.

So at the moment, the placement is starting to pick up, but as usual, once things start getting productive - it means it is coming to the end of my attachment. 2 more weeks left and then onwards to Care of the Elderly (which I'm actually quite excited about as by chance I am placed in Orthogeriatrics).

Psychiatry - Slow Start.

I don't know why, but I'm quite prone to having slow starts on placements. So I've had my first week in psychiatry and to be honest...I've stepped onto the "wards" for about 5 minutes and then left. I don't know if I should be happy about the placement or a bit annoyed. We've got a lot of free time on the placement and seeing how exams are coming up - it gives us a great opportunity to revise. But at the same time...when I did go on the ward and ask if there's anyone I can see or anything I can do - the staff said that there's nothing to do here and told me to go get a cup of coffee. For the rest of the week - I spent my time in half-day clinics with my consultant. Luckily he is very chill and really good at teaching (if asked to teach). The nice bit is that there is a mutual understanding between the two of us. He has established that I do not want to do psychiatry and fairly indifferent about it. He said he will leave me alone BUT will teach if I have any questions or want any teaching. On top of that, he clearly listed out my learning objectives and what he does expect for me to have completed by the end of the attachment - which was pretty easy/fair. I know what my consultant expects and I don't see it being a struggle. He's also extremely nice which is a nice bonus.

I haven't really met any patients with full blown mental illness. All the patients I have seen were follow up patients who have their symptoms under control and doing fairly okay. Somehow due to my luck, I managed to miss the two new patients I was supposed to see in the week so I can see how patients present to the psychiatric team. For the first new patient, I only managed to stay for half the consultation as I had a doctor's appointment. Then in the next clinic, I ended up being 30 minutes late and missed the new patient as I got lost. Was really annoyed with it as apparently that patient was very interesting.

To be honest though, I don't mind this placement! I'm actually enjoying it as it is fairly easy and not very stressful. My schedule is very flexible and essentially to get good at psychiatry is to just speak to a lot of people (which I haven't exactly done as I'm having an extremely slow week). Despite having a slow week, I am learning a lot as everything is new so that's a bonus. So far all the consultants I've met are also very nice and chill, but they claim they should be chilled out as they know stress is a factor for suicide...

Hopefully next week will go a bit better and hopefully I'll be a bit more productive!

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.

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!

O&G Ward Week.

You can hardly call this my "Ward Week" as I probably spent more time in clinics than on the ward. This week also marks my last timetabled week of my placement and I have been seriously trying my best to enjoy every day of it as there is a bit more flexibility with my week.

Spent Monday morning in Gynae clinic. I managed to see a lot of prolapses such as cystoceles (proplapse of the bladder). Luckily the consultant has gotten to know me as I've been in a few of his clinics with him so I got to do a vaginal examination on almost every patient. It was interesting to feel a prolapse as it is definitely very different and then feel the difference when a shelf/pessary is inserted as a temporary treatment for the prolapse. Patients with cystoceles tend to classically present with a "dragging" feeling down below which becomes quite uncomfortable as the day progresses. There is also a "heavy" feeling, which again gets worse as the day progresses especially when stood up for a long time. Some of these patients also present with urinary symptoms such as urinary frequency and hesitancy. I think by coincidence these patients also present with some form of urinary incontinence as well. Usually elderly women would not be offered a surgical repair where stitches will be placed to reinforce the anterior wall of the vagina (where the bladder prolapses through) as these patients are usually unsuitable to go under anaesthesia.  By the looks of it, most of the women are fine with the pessary and it seems to sort out their problems quite well.

Then I wandered onto the wards with one main goal in my mind: Take as many gynae patient histories as possible. Why so keen? This is because my assessment is taking place the following day. Essentially we are required to take a full patient history with an assessor sitting alongside. This assessment either makes or breaks me. If I fail, I would obviously have to resit the assessment which would go down on my records that I had 1 failed attempt. If I fail the second time, then I will have to repeat the entire 7 week placement all over again. I mean I'm having a good time on this placement, but if you asked me to do another 7 weeks, it might be a bit of an overkill. Anyways I took about 4 patient histories in the afternoon and had a good time talking to patients. It's nice to see patients enjoying talking to me as I guess for them it is better than sitting in silence and day dreaming as the hospital is pretty boring in general.

So I had my assessment...and oddly enough...I wasn't too nervous for it. Actually I was so calm it was worrying. I was struggling to take the assessment seriously as before I went in to take the patient history I was chatting away with my colleagues (well I did the talking...they just listened as they all looked very nervous). I kept telling myself to take this assessment seriously but I struggled. I was fairly annoyed with myself, but at the same time - if I'm in a good mood I tend to take better patient histories and form much better rapport with the patients, which is key for the assessment. Luckily, my patient wasn't too complicated (vaginal hysterectomy and anterior wall repair). I finished my history quite quickly and  I thought I did quite well. Didn't have any difficulties whatsoever. Huge contrast from my last placement (paediatrics) assessment. In my last placement I was properly pooping myself prior to my assessment and I was dead scared. I was much more confident for this gynae assessment - night and day in terms of confidence between my last placement assessment and this one. My assessor had no difficulties in passing me and even gave me an "above average" mark which I was quite chuffed about. I was quite proud of myself as I was only expecting a "meets expectation" as my supervisor is known to be quite strict with marking.

Since my next assessment isn't until next week, I knew I can relax for a bit and return to enjoying my placement. Oddly enough I thought I was going to be quite bored on the wards as there isn't much a medical student can do on the wards, but I was actually quite productive on the wards. The doctors were all really welcoming and actually allowed me to write in the medical notes and sign off on them (of course the doctors reviewed and counter-signed my notes). I also got to clerk in a few patients, which is always interesting. It's weird seeing how seriously some of the patients treat me. I mean at the end of the day I'm just a medical student, but these patients really take everything I say seriously and show a lot of respect. It's quite nice to not be treated as a joke and it definitely makes me feel much more responsible.

Because my next assessment is on obstetrics and I haven't had much exposure to it on the wards, I decided to spend my day on the obstetrics ward and practice my obstetrics examination skills. And jeez....I suck at obstetrics examination. I swear I cannot feel a thing. In our assessment I'm supposed to be able to tell the position of the baby, the engagement of the head, the lie, etc. I feel like my hands are dead stubborn as I swear the bum of the baby feels the same as the head! Yes I know one side is flat and the other is round like a ball, but at the same time I'm too scared to palpate deeply in fear of hurting the mother. I definitely need to get more confident in doing this examination or else I will fail my final assessment. Not looking good. I thought I could get away with just a full day of practice, but I definitely need to go back to the obstetrics ward next week to examine more pregnant women. I think I did leave a good impression with the midwives as they seemed keen to have me around and that I am welcomed to come back next week to practice some more.

1 more week until holiday...well not even. Technically only 2.5 more days of placement left as I have a half day next Thursday (and Monday is a bank holiday and I get Friday off).  Can't believe it's already been 7 weeks. I can still remember my very first lecture for O&G like it was just yesterday. This placement seriously went by way too fast...and I'm having such a good time. Argh.

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.

Obs&Gynae - Initial Thoughts

So I have completed my first week of placement for Obstetrics and Gynaecology. Initial impressions? Fairly interesting. It's nice to see adult patients again. When I took my first patient history on this attachment, it was weird being able to speak directly to the patient and receiving specific information. Also in Obstetrics (pregnant women), you can't really call these people 'patients' as most of them are healthy and essentially are only in hospital to give birth. It's quite a nice change of environment from seeing ill children. In Gynaecology, one has to be quite professional as this specialty deals with quite sensitive things. You have to ask personal questions and you really need to gain the trust of your patients in order to get such personal/sensitive information.  Again a huge contrast from Paediatrics as I have to put on a "fun" attitude when approaching children; however, with gynaecological patients, I have to be composed and essentially act professionally. It is a nice change and I haven't found the transition too difficult...yet. We'll see in the next few weeks.

Again I am in a peripheral hospital, but this hospital isn't actually that far away. For me, it is actually closer than the central hospital so I'm not complaining. It's great to be in a hospital which has a good reputation for teaching. They pride themselves in teaching and on day 1 it was very noticeable. The supervisor and secretary was very organized and were expecting us. We felt very welcomed and we received our schedule for the next 6 weeks! I was not expecting a schedule as in my previous attachment everything was done ad hoc and we received little guidance. Huge difference for this attachment and it was definitely a change I welcomed. It was nice knowing what you will be doing in the next few weeks and I could actually plan my life as I will know when I will be free and I can prepare ahead of time for clinics/teaching.

On top of that, I have come to realize how patient some people are. I went onto the wards to help out and was given the task of clerking in 2 new patients. These 2 patients have not seen anyone yet, so I was excited to go talk to them. The first patient I saw was having severe pain and to my surprise, she had been waiting to be seen for 4.5 hours! Talk about patience! I would've left ages ago and I found it quite ridiculous someone in so much pain has been waiting for so long! After taking the patient history, I realized this patient was in a lot of pain and a doctor had to see her soon. In addition to that, the patient was not impressed with the care so far (not surprised) so I quickly went to go get a senior doctor. It was found that she had surgery a week ago and the stitches were infected and some of it has come away. This patient was promptly admitted to the ward and was finally given stronger pain killers and a surgeon was called to review the case.

Then I went to go talk to my next patient...who actually arrived earlier than the last patient I saw. She had been waiting for 5 hours and I felt really bad for her. She had come to A+E the day before and due to the long wait she left and decided to come to the ward the next day. Because the ward was fairly busy, no one has really seen her and again I was the first person to see her. This could of easily been the longest history I had ever taken. After introducing myself I asked the standard question: "What brings you to hospital today?". This patient went on and on with a very extensive history of her presenting complaint and I was overwhelmed with information. She did not stop talking for a good 10-15 minutes and I was completely lost. I slowly had to work my way back through her history to get a more clear idea what was wrong and this clerking felt like it took ages. It didn't help that this lady's first language was not English so I had to word my questions differently and I had to try and figure out some of her medical conditions as she didn't know the names. It was the few times I actually struggled taking a patient history and this is the first time where there was a bit of a language barrier between the patient and I. It was a good challenge and it was new experience. It definitely taught me to be patient and to take things one by one. Luckily the patient was patient with me as we worked our way through the problem and her history and after 40 minutes I finally got through the history. Mind you...it usually takes me 10-15 minutes to get a full patient history.  After presenting the history to a doctor I  had to leave so unfortunately I could not follow up with the patient.  When I came in the next day she wasn't on the ward list so I assume she didn't need to be admitted to hospital, which I guess is good news.

All in all...interesting week. It was an introductory week so it was quite light and I took things slowly as I found my bearings around the hospital. Next week is my theatre week so lots of surgeries! I can't wait!

Highlight of my Placement.

It is now the end of week 4 of my placement. 3 more weeks to go. To be honest...these last few weeks have been going by quite quickly. Even the doctors on the ward agree that these last few weeks have blown by. Now 4 weeks in....I'm really feeling a part of the team. We are all starting to get to know each other better so there's a lot more banter going on and joking around, which I really enjoy.  Despite this, there are still a lot of up and downs during this placement. There are days where there's a lot going on, and then there are days where you start asking yourself why did you even come in.

Wednesday could have been easily the highlight day of my entire placement. This day also came at a perfect time as it's halfway into the placement and it really gave me a good boost. Every one noticed that I was in a very good mood on Wednesday and actually had a bit of spark in me. Found out that there was some paediatric surgery going on in the morning and I decided I needed a change of scenery. Heard the consultant surgeon apparently looks fairly stern (cue heart sinking) and no one could pronounce his name. Got changed into greens (oh I missed them soooooo much) and heard that surgery is delayed as the patient hasn't arrived yet. Sat in the coffee room and there was only one doctor in there (who looked kind of stern) and I figured he was the surgeon I will be following in the morning. It was fairly awkward in the room as we just sat in silence and watched a tv show. Few minutes later he got up and I shortly followed behind him and hope it didn't seem like I was stalking him. Saw the surgical list before going in and to my delight I found out he is a Paediatric Orthopaedic Surgeon.  Pretty sure I was smiling like an idiot at the list. Walked into the anaesthetic room and we did introductions and after the consultant introduced himself, I knew immediately he's a really nice guy. He asked me to help him out with setting up equipment and he seemed really keen to get me involved. Slowly my mood was picking up and I was really getting excited. He then allowed me to scrub in for one his surgeries (in grown toe nail). It was a really quick surgery but when a consultant asks you to scrub in, it makes you feel involved and you start to feel more included/less useless. You feel like you're actually helping. It's a hard feeling to describe.  Like during placement, especially early on, you feel unwanted and useless so when a doctor asks you to help even in a tiny little task, you get this good feeling/sense of satisfaction.

Anyways during a break in between surgeries, the consultant and I had a chat and he noticed that I seemed quite keen about surgery. It was cool having a casual chat with the surgeon and I told him I'm interested in orthopaedics. We had a really good talk about the specialty and then he told me to go to the Trauma list in the afternoon. Saw a fracture reduction + internal fixation and it was easily the bloodiest surgery I have ever seen, yet oddly enough, the one I enjoyed the most...ever. Even a few times I questioned myself as I caught myself smiling during surgery. I was really interested and I found the surgery pretty cool. There was a surgical trainee who was observing and he talked me through the surgery. The surgery was fairly complicated, but I was genuinely absorbing everything the trainee was saying. I was following along without difficulty and I just had this good feeling inside me. I think the hardest part about the surgery was wearing the lead aprons for 2.5 hours as there was a mobile xray machine in the room. Xrays were periodically taken to make sure the plate was in the right position and if the screws were placed properly. My back was killing me by the end of surgery (as I've been in surgery all day and almost all the procedures I had to wear a lead apron). But the aching legs and back was totally worth it. I could easily say it has been the best time I've had in surgery. The morning procedures were fairly simple, yet I still really enjoyed my time. It's quite weird.

"Be back by 4pm" said the registrar when I stopped by the ward to grab my bag for lunch. It was now 5:30pm and I was still in surgery watching the surgeon close up. He made stitching seem so effortless and simple, but I guess if you've been doing it for 20 something years, it'll become second nature.  I was in no hurry to leave theatre. To be honest, I didn't want to leave. My bleep went off twice and I knew I should get going. The consultant and I had a chat after surgery and he said throughout the surgery he noticed me looking very interested/keen. I don't think I have ever really heard any doctor tell me I look keen. To be honest, most of the time I probably look like I'm not even there. The consultant also said he was fairly impressed that I didn't get sick as he agreed it was a very bloody/gruesome surgery.  He asked when will I join him again in theatre or pop by his clinic as he said he wouldn't mind me around, especially if I'm interested in the specialty. Again I got this weird feeling of actually being wanted. Usually consultants don't want to deal with students, but this consultant seemed interested/keen to teach me.

Dragged my feet back to the ward and everyone was commenting how I look alive for once and happy. To be fair, I was very happy. I was definitely motivated. I can't wait to go back to theatre next week/hopefully I'll be able to escape to theatre. What a great day. Will never forget the last surgery of the day.

The Key is to be Proactive

Have been in placements for about 10 weeks now and I have had many ups and downs as you have read in my previous posts. After looking back at my placements, I've realized that my best experiences had been when I am being proactive. Being active in learning and stepping out from my consultant's shadow. In my first placement in the summer, I put a lot of effort into taking patient histories and doing loads of physical examinations (cardio, resp, and abdo). 2nd placement...did a lot of ward rounds - definitely seen a lot. For comparison sake - first placement I took about 10 patient histories and have done 4 cardiac exams, 3 respiratory exams, and 3 abdo exams. 2nd placement: 1 patient history, 1 shortened peripheral nerve exam. Poor showing in the 2nd placement. Yesterday, I did a group revision session on cardiac, resp, and abdo examinations. I knew how to do those examinations quite well and knew what I was looking for and can easily explain positive findings. The minute we got into neuro and musculoskeletal (MSK) exams...I died a little inside. I didn't know what was going on. Okay well MSK was easy to follow as I'm quite familiar with joints and those tests...but neuro was painful. I obviously didn't know how to do these exams as well as the cardio, resp, and abdo exams and it just felt horrible how lopsided my learning has been. Thinking back - it was because I was really proactive in my first placement. I had put a lot of effort into seeing patients and doing examinations. These last 2 placements - I've been...how should we put it...lazy.

You might ask: why suddenly the realization? Yesterday I was in clinic in the afternoon and my consultant told me to go take patient histories of the new patients in clinic and to come back and present the histories to him. While presenting, my consultant would ask questions dealing with the presenting complaint and about the differential diagnosis. It really made me think and be on the ball. When I didn't know something - he would teach me what to look for in a history and I realized: "I'm actually learning and remembering this." Once clinic was over - I actually had a good time. I felt independent and a lot more confident in my history taking skills as I got to present my histories and then got quizzed on it. I also realized that I was quite rough with my history taking with my first patient but by the time I saw my 3rd patient - it was easy and straight forward. It was a great feeling and a great confidence boost.

Now I'm sitting about - pondering - actually no...stressing about exams (OSCE + 2 written papers in December). There's no way I can pull off taking good histories and performing examinations without practice. I need to be proactive and do what I did in my first placement. Make a schedule and follow it. Be involved and just take a step away from my consultant and tell him that I need to practice. There isn't much point following him - I've got a good idea what the specialty is about already. I need to see more physical signs and conditions to start seeing patterns and recognizing things quicker. 4 more weeks of placements - I need to get back on the wards and talk to patients!

End of Placement 2.

...where did my 3 weeks go?!

Seriously. These last 3 weeks actually blew by. Crazy. Couldn't believe that today was my last day on my placement in the peripheral hospital. Next week I will be back in the local teaching hospitals so I guess YAY no more 45-50 minute drives! Thinking back - I quite enjoyed my placement in the peripheral hospital. There were only 20 medical students at the hospital so the doctors were all really keen to teach and the staff were all very friendly. If only the hospital wasn't so far away. I've been hearing stories how the local teaching hospitals are absolutely packed with students; hence, patients are pretty annoyed with us and the consultants don't have time to teach.

Anyways this week has been really good. Did the standard ward rounds and finished up my first essay assignment that I handed in today. Got loads of teaching from Dr Y so that was really good. Saw some pretty interesting physical signs this week. Saw really marked dyskinesia in a patient with Parkinsons Disease. Today we saw a really interesting case. Patient presented to hospital with left sided weakness as well as facial weakness. This patient had a previous history of stroke. On examination, it was found that the patient had heminiopia and reduced corneal reflex in both eyes. Patient could not show her teeth/smile and could not open her mouth very wide. Arms and legs were not that weak. Both limbs seemed fairly normal and there were no changes in sensation except in the face. So what do you think she has?

Well she was just admitted so investigations have to be done, but it is suspected that she has bilateral facial palsy which is apparently quite difficult to make out. In general her face was emotionless which lead us to think that she may have bilateral facial palsy, and both corneal reflexes were reduced. The team didn't think this is a stroke but probably a pathology in the brain.

I personally thought this case was quite fascinating. It was different and it definitely makes you think. Thought I would share this case with you all.

Found out my next placement will be in General Surgery..........................AGAIN. General Surgery is great, but I have had enough. I'm so sick of it. I've done general surgery in my 2 weeks of placements in first year and then general surgery for my first placement this year. I want to see something else NOT GI related...PLEASE. I'm really interested in surgery and it's just so frustrating to be constantly placed in the same specialty. I really want to see the other surgical specialties and it's annoying how the medical school doesn't take into consideration your previous placements and what specialties you have been on. Pretty sure the school will come up with something like "Life isn't fair." But come on.

But yeah all in all - great placement out in a peripheral hospital. Definitely the complete opposite to my initial impression and have learned not to listen to other students as these students said that the hospital I was just placed in was hostile and unfriendly. Complete opposite and my experience has been fantastic. Really enjoyed it and have learned so much. Hopefully this continues in my next placement.

Placement 2 - End of 1st Week

What a quick change. From sitting in lectures from 9am-5pm to being on my feet from 9am-5pm. Hands down: placement > lectures. There is just so much to learn and see on placements.

For my 2nd placement, I've been placed in the Stroke Unit. On the first day I realized that this is the first time I've been placed on a medical ward. For the last few hospital placements - they have ALL been in surgery. I was definitely preparing myself for the worst as I really do enjoy surgical attachments and I wasn't sure what to expect from a medicine attachment.  Also the fact that I was placed in the Stroke Unit was quite intimidating. In my mind Stroke = Neuro = intense. I was scared as heck on the first day and quite nervous, but also excited for the unknown.

The minute I stepped onto the ward, I was greeted by a really friendly receptionist who assured my partner and I that the doctors on this ward are really nice. We asked to see consultant X, but was then told that he no longer works at the hospital. What a great start to the day. We then muttered out another consultant name, Dr Y, and immediately the receptionist became very reassuring as she guaranteed us that we will be just fine with this consultant. Apparently he is very friendly and is a great teacher. I was starting to get excited. Right before going to the Dr Y's office we bumped into another consultant, Dr B. I must admit, I was surprised to learn that he was a consultant as he is quite young. He seemed really friendly...and perhaps a bit quite awkward. Then we met Dr Y. My first impression of him was: "What a boss." I know that sounded a bit weird but Dr Y seems to be a very confident/leader-like person. Very calm, and very approachable. He definitely looks serious, but we came to find out that he is a very patient man. Oddly enough, Dr Y quickly set out a schedule and several goals that he would like us to accomplish and what he aims to do with us. I believe this has been the first time where I've been sat down with a consultant and made goals and aims. I actually quite liked that as we are only 3rd year medics (1st year of clinical), so a little bit of guidance is quite nice as we don't really know what we should be doing in the hospital. He also arranged for some time to teach us about neurology/stroke. I was definitely liking the sound of this.

Anyways we then joined Dr B on ward rounds and pretty much got grilled to death by questions. I guess that's his way of teaching. Not exactly the method I would prefer to learn from as I do get quite nervous when put under pressure with a question, but Dr B is a really nice guy so I'm not too scared about answering a question wrong. He wouldn't put you down or look disappointed, he would simply acknowledge and explain the answer to his question. With this method of teaching, I guess things stick in my head for longer as you remember being grilled on that topic and stuff stands out a bit more.

Impressions of the ward? I'm really surprised at the range of ages on the ward. You would expect the whole ward to be elderly people, but to my surprise - there were quite a lot of middle aged patients. Made me realize that stroke isn't an elderly person's problem, but it can be a risk to anyone of any age.  The ward is also extremely friendly and relaxed. You don't feel pressured or watched on the ward. It's also nice that the nurses and junior doctors have welcomed us and do acknowledge our presence. Quite a difference from my last placement where I felt like an ignored object standing in the middle of a corridor looking really awkward and lost. Here, I feel a part of the ward.

I got to admit I have learned loads. I mean LOADS. Information overload. I have learned so much from both Dr B and Dr Y. They are really amazing at teaching. And it's really nice that they show us physical signs and teach us how to classify the signs as we do the ward rounds. I'm definitely looking forward to next week where we will learn more about stroke/neuro. From time to time, I do miss watching surgeries though, but it's good to finally experience a medicine attachment. Not a bad start I guess!