Week 1 - Anaesthetics.

Interesting week here in England. Had a snow storm the day before my first day of placement. A lot of my friends got a snow day, but I haven't heard from my hospital so I ended up leaving later than usual for the central hospital. Because of all the snow - it was actually a very pleasant drive as there were hardly any cars. What is usually a 30-40 minute drive, ended up taking me 10 minutes. I was thinking to myself that I was such a genius to drive as the roads were clear (bit slushy)...until I got to the hospital. The parking lot wasn't cleared and it was packed with snow/ice/slush. Made it a bit daunting to park my car. When I got out of my car, I stepped in about 2" of snow...well there goes my black shoes. Tippy toed my way into the hospital only to overhear people saying that there will be more snowfall in the afternoon. "Shit." was probably the only thing that came into my mind. And then I thought to myself: "How am I going to go home...what an idiot. Shouldn't have driven."

Anyways I made it for my induction and most of us managed to get in. A few people got snowed in as they live on a hill and couldn't make their way. We got our logbooks which has various skills that we need to be signed off on by the end of 4 weeks in anaesthetics/critical care. Such things include putting in cannulas, inserting a laryngeal mask airway (LMA), intubating, drawing up antibiotics, etc. I was quite motivated to get my logbook done as quickly as possible so I walked into the theatre I was assigned to - ready for action. I was then greeted by a consultant anaesthetist, who seemed a bit annoyed. I was quickly told to leave and come back in an hour. Almost felt like I smacked into a brick wall. It kind of threw me off and I got nervous again as the consultant didn't seem too friendly. I went to get some food and returned an hour later and was promptly told to go find a patient in the ward and get a patient history from him. In my head I was getting annoyed as I wanted to work on my logbook, not go and speak to patients. By the time I returned to theatre the consultant had relaxed and apologized to me for being a bit rude earlier. I really appreciated the apology and the consultant gave me a few tasks to do such as mixing and drawing up antibiotics. I was then taught how to insert a LMA and how to hold an oxygen mask to the patient's face. It was really good and exciting. I also got a lot of teaching about regional and local anaesthetics during surgery which was an added bonus. Because of the snowfall, some patients cancelled and we ended up having a short theatre list. I was out of the hospital by 3pm and luckily the snow had just stopped, so I made a run for it before my car gets snowed in. Thankfully made it home with my car (to the surprise of many). Also had the feeling of: "not so dumb after all!"

I would say I had a really good first day as I got a few things signed off and was ready to go for day 2. Unfortunately, it was a bit of a mess as there was teaching going on and the lists were starting later than usual (and I made the effort to go in for 8am when lists weren't starting until 11am). Then I realized that this is something everyone has to accept - as a student and as a doctor. Not everything will go to plan and you just need to adapt and find something productive to do. There were a few theatres running so I decided to go for a wander. Funny enough I ended up scrubbing in for a few procedures and assisting. Yay...but obviously deviating away from my placement goal: to learn anaesthetics! It was a nice bonus and certainly better than sitting in the coffee room for 3 hours. I at least did something productive and I felt like I was helpful. Later in the day I met up with a different anaesthetic consultant and I got a bit of teaching (not as much as I had hoped) and unfortunately did not get a single thing signed off. Great - here's hoping next day will be better. Next day...same thing. I tried to hint to another consultant anaesthetist that I would like to get involved as I had put on my gloves and stood at the top of the bed ready to lend a hand. Instead, I was ignored. I asked if I could insert a few cannulas and was told that it would be too difficult. By now, I had lost a lot of motivation and ended up just standing around for the whole day. I don't think this is really the anaesthetists fault as they are all very nice people and love teaching. I learned loads, it was just a bit more annoying that I couldn't do anything practical. Just another thing as a student you have to accept - sometimes you can't get in on everything. Unlike my group mates, I haven't been kicked out of theatres due to too many students. I've been lucky that I've still been able to stick around and observe and get some teaching. I've also been in orthopaedic theatres so the orthopaedic surgeons were also teaching me about their procedures, which I found really interesting. Essentially other than the first day, this was the story of my week. Just not getting any opportunities to do practical skills.

So I went home and thought what I can do about this as I have a log book that I need to complete. I think next week I will approach with a different mindset and make it clear first thing to the consultant that I am very keen on helping out and trying out some practical skills. Sometimes being subtle and polite doesn't work so I'll just have to be brazen and go for it. Fingers crossed that I will get to do a bit more next week!

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 - 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!

Just Need to Ask.

As you have all realized, I am not enjoying my GP placement as I haven't really gotten to do anything hands-on. Learning is minimal and I essentially just sit the day away. Last week, I requested to sit in with a GP who has a special interest in MSK. Finally got a schedule I could smile about. I was placed in a surgery where majority of the patients came in with MSK complaints. Then my next day was placed in the hospital (oh how much I miss the hospital environment) to shadow a physiotherapist.

Because I am so sick of sitting around, I finally opened my mouth and asked if I could do joint examinations.  The GP was more than happy to allow me to examine and started introducing me as the "Student doctor with a special interest in muscles and bones." Clinic for once actually went by quickly and was fairly enjoyable. Then I decided to ask the physio on my next day if I could participate and get involved. She was also more than happy to allow me. The physio had a special interest in upper limbs while I am interested in lower limbs. It was good for me as I am obviously missing quite a bit of knowledge about upper limbs. I learned loads about the common injuries and presentations you see in upper limbs. I also got to work on my upper limb examination skills which involved a bit of neuro; therefore, it was a really good refresher.  It was also fun to talk to someone who knows the orthopaedic consultants in the hospital and just learn more about the other sub-specialties in orthopaedics.  I got to know about the spinal unit and the shoulder consultants and what they would usually see.

It was also cool to see what would count as an urgent referral as we had one patient who we believe to have cauda equina syndrome. Cauda Equina is essentially where your spinal cord goes further down your spinal column than most people. Most people's spinal cord terminate at L1/L2; therefore, when you do a lumbar puncture, you make sure you go below that to avoid the risk of paralysis. The patient presented with urinary retention symptoms and decreased anal tone.  He also complained of changed sensation in his genitalia region.  It was evident that he also had bi-lateral leg weakness. His symptoms fit cauda equina syndrome so we had to urgently refer him to get an MRI scan. It was also interesting because the patient was claustrophobic and he made it very clear he does not want an MRI scan. We told him that the hospital has a wider scanner so it won't be as tight, but the patient was still adamant that he doesn't want to go through a closed scanner. He allowed us to refer, but he told us that he will refuse to go in on the day. We told him there is medication that he can take before he goes in to keep him calm that he can get from his GP. I don't know why but I felt like he is still adamant that he isn't going to get the scan done and will not go get the medication from his GP. Cauda Equina Syndrome can be quite serious and need to be treated so it was a bit frustrating to see someone refusing a simple scan which can rule out cauda equina.

Then I got a bit of a reality check near the end of physio clinic. I have suffered from a shoulder injury for 5 years now, and never really bothered to take myself to see a doctor. It's a thing about medics: "Medics either go see a doctor too early, or go too late." In my case: I just never go. A shoulder patient came in who obviously needs a shoulder replacement due to OA in the shoulder. The patient had very limited range of movement and you could hear his shoulder grinding as he was abducting his arm. He explained to us that it has completely hindered his lifestyle as he can't even reach up to get things from the cupboard and it is quite painful. He then mentioned that when he was young (my age) he had a few shoulder injuries and reckons that due to those injuries - he now has pretty bad OA of his shoulder. Once the patient left, I told the physio about my shoulder and she sternly told me to go see a GP and get a referral to either physio or orthopaedics as  I am susceptible to early OA if I don't get it sorted out. Even worse, it could hinder my ability to do orthopaedics in the future as it requires a lot of strength and lifting.

To be honest, the physio is right. I've left my shoulder long enough and it is obviously not getting better. Hate being on the other side of the table as the patient.

Empathy.

Empathy is probably one of the most popular answers to medical interview questions such as "skills required to be a doctor." Empathy is essentially the skill to be able to feel another person's feelings. To be entirely honest...it seems like it is a skill that you LOSE, not gain as your career progresses. As a medical student, I treat the patients with a lot of respect and take the time to listen to them and try to empathize and sympathize with them. It is definitely not an easy task. There are countless amount of times where I found myself fake sympathizing/empathizing with patients as I sometimes find it very difficult to place myself in his or her shoes. And some of you may think why you "lose" your empathy skill as you progress through your career. Obviously this is a generalization and there are definitely lots of consultants out there who are really good at empathizing with patients; however, there are some where you start questioning their bedside manners.

I really don't blame the consultants for not empathizing with patients. After doing your job for 30-something years, you might not be as interested in it as you were 30 years ago. Some consultants have extremely busy schedules and it is a shame they don't take the time to empathize with patients. With an aging population, we now see a lot of elderly patients on the wards with chronic conditions. These patients might be in for their 10th surgery on their hip, for example. Sometimes it is unfortunate that surgeons/doctors don't acknowledge these things. Yeah you need to fix a patient's hip, but after having so many surgeries, it is obviously going to affect the patient psychologically and socially. I know there are some doctors who believe in holistic medicine. These doctors would tend to all the needs of the patient: psychological, physical, and social. I feel like the patients who have these sort of doctors feel like they are cared for and sometimes I guess it is pretty frustrating to be tossed between 5 different teams in a hospital as consultants won't know you as well.

Then we start to asking the question: are doctors too specialized? I mean just under orthopaedics, we've got consultants who specialize in only hip replacements, or hand surgery, etc. With such specialized doctors, we start to realize that these doctors start to lose knowledge about other systems in the body. In hospital for hip replacement but have a breathing problem so the orthopod has to refer you to the respiratory team. Are we becoming too one dimensional? It's definitely a tough argument. By having such specialized doctors/surgeons, we get people who are excellent at their field. If we have a bunch of doctors who knows a bit of everything...well we get doctors who are just good at everything and not excellent in anything. It's a tough argument, but to be honest, I would much prefer having a very specialized doctor as I would know for sure that he or she is fantastic at treating a certain condition or performing certain surgical procedures. If my life is at risks...I would obviously want the best and only the best.

Hmm...think I got a bit off topic there. Anyways empathy. It is a shame that some doctors lose this skill and overlook a patient's social/psychological well-being. But like I said earlier...I really don't blame them. I hope I will still be good at empathizing with patients 30 years down the line, but I know it will be something I will have to keep reminding myself to do. What's the point of being rude to patients? You gain nothing. Might as well be nice and listen to them and make their stay at the hospital better. Easy to say...hard to do.

Expectations.

Everyone has his or her own expectations for certain things. In my case: I had my own expectations for this placement (Obs & Gynae). Before I even started this new year and embarked on my specialty placements, I had already made up my mind about some of the specialties. And I have once again been proven wrong and again shouldn't be making judgments before even starting a specialty. You would think I would learn by now not to judge so early. Before I started O&G I constantly told myself that it is going to be my worst placement ever and I will truly hate it. I was not looking forward to it. I even marked it on my calendar as: "Ugh." To make things short, I had extremely low expectations for O&G. And you know what, sometimes I like being proven wrong. Don't get me wrong I have respect for the specialty, it just never clicked with me. You get this whole: "Awkwardddd women's health...it's going to be weeeirdddd!". I think in general anything that deals with bits downstairs is a whole taboo subject.

So I went back to my archives and read up on my blog post that I typed up before starting the specialty:

"My next placement is Obstetric and Gynaecology. I'm actually really scared for this as I don't really know what to expect as well. Should be interesting as I'll definitely be able to go to theatre (YES!); however, it'll be dealing with quite a sensitive subject so I'll definitely need to change from being playful in Paeds to professional for this specialty. Hopefully I'll be able to compose myself and try to enjoy this specialty as much as I can. First I'll need to go to a week of lectures before commencing my placement. I much rather having lectures first before going to placement as at least I'll have some basic knowledge prior to going to the hospital so I won't look like an idiot in front of the doctors. I also hope I'll have a really nice/easy going/chill supervisor. My last supervisor on paediatrics was very easy-going, which made the placement much more enjoyable. Crossing my fingers that I'll be just as lucky this time with Obs+Gyn. Another 7 weeks of Obs+Gyn and then Easter Holiday! I can't wait for holiday. To be honest...I kinda need one now!"

I really can't blame myself for being scared as it is a sensitive subject, but in terms of changing my behaviour from playful to professional was something I was a bit unsure about as I'm naturally a "happy-go-lucky" so I was a bit nervous for that change. Thinking back through the last few weeks, I haven't had so much fun on placement. Even more fun than my paediatric placement. Yes I have to be professional and build a good rapport with patients to talk about more sensitive things, but I realized that if I'm having a good time, the rapport comes naturally and you as a person become a bit more easier to approach and get along with. In paeds I was told that it was "written all over me" that I was not enjoying my placement. For this placement, yes I went in knowing I'll hate it, but I really wanted to make sure that I didn't make it obvious that I'm not enjoying the attachment. Because I went in with such low expectations I was open for anything and had little expectations. This actually helped me be a bit more welcome to anything and I think a lot of the staff and my supervisor could see that. I was even told by the nurses that some of the patients thought I was a "breath of fresh air" as I was always smiling on the wards and just enjoying my time. A patient told me that most of the staff look bored, but I look interested and just trying to have fun. Because in my last placement in paeds I looked super bored, it was probably the main reason it took me a bit longer to get to know the staff and interact with the patients.

And I can't really call it luck anymore with getting a nice/easy going/chill supervisor. I've said it before, but at the end of the day, a consultant/supervisor is a person as well. Yes they too have expectations for me and I try to meet their expectations, but because they are also people, you can certainly have some good banter with them. I got to know my supervisor and probably saw my supervisor the most out of the rest of my group so I guess he got to know me better than the others. Definitely made the attachment more enjoyable as I could feel that my supervisor genuinely cared about my learning and it's also nice to get to know your supervisor as it'll keep my blood pressure and heart rate from shooting through the roof whenever I see him. In some placements I would purposely avoid my supervisor just to avoid getting told off/being quizzed. For this placement, I didn't mind bumping into my supervisor on the ward or even in the corridors. I think we also had a "mutual understanding". He knew what my personality is like and what sort of student I am so he didn't form unrealistic expectations for me so that put me at ease and allowed me to feel comfortable in the hospital.  Again it is a two-way process. I know when my supervisor didn't want to see me and I guess I'm fairly good at telling when I can be cracking jokes. I guess it is a skill I definitely cherish as like I said I'm a "happy-go-lucky" and a bit of a prankster/joker who is quite cheeky as well...so I definitely need to know where to draw my line with each person.

All in all, I think this attachment has worked out really well and essentially exceeded my expectations. I have definitely gained a heck lot more respect for the specialty and it has definitely changed my view on the specialty. It really ain't that bad at the end of the day. The doctors are also pretty cool people as well so it was good. The hospital was great as well and was really good at making sure medical students are learning and interacting. Following a doctor around is one thing, but being able to assist and do things is a whole other ball game that makes your attachment so much better. This could be the very last time I'll be doing O&G for the rest of my career, but hey if I do get a rotation in it in the future, I won't mind doing it again. Hate to say this, but this is easily the best placement I have ever had so far. Who would've thought I would be saying this 7 weeks later. I wish all my placements can be this good. Now I'm scared about my future attachments as this placement has set the bar so high. How can I go back to just following a doctor around? How can I go back to standing in theatre not scrubbed in and peering over the surgeon's shoulder? Will I get along with my next supervisor how I got along with my supervisor now? What are my expectations for my next placements now?

Thank you for proving me wrong and giving me the best 7 weeks of my medical degree. What a placement. Damn. Can't believe it is over. The one time I am dreading for the end of a placement. I guess one good thing about this is that I finally get a much needed 3 week holiday.

Side note: Will be on holiday for the next 3 weeks and I, most likely, will not be posting as I really need a break. Sorry! 

Long day - On-call.

So it is week 2 of my paediatric placement. Now I'm getting to know the doctors on the ward much better and they seem more keen to teach us. Even if they see something vaguely interesting, he or she will come and tell us to take a look. I was on-call on Wednesday and what a long day. Got in at 8:45am and didn't get home until 10pm. I was intending to leave at 8pm as I do have to drive back home as I do not stay in the hospital accommodation.  Day started off with a ward round (usual). Saw a few interesting patients, but nothing really out of the ordinary. Managed to see a Stevens-Johnson Syndrome. To be honest...it looks pretty horrible. Essentially Stevens Johnson is where you get really red eyes and blisters all around your mouth and oral mucosa. You can also get blisters elsewhere in your body...including your genitalia........yeah. Anyways it doesn't look pleasant and obviously the patient was in quite a bit of discomfort as he could not really eat any solid food. Then went to clinic after lunch where we saw pretty general stuff. Ear infections, constipation, diarrhoea, etc. Got to play with a few of the kids that came in/working on my "playing with children" skill.

I don't have any younger siblings so I personally am not really used to playing with young children. I am still quite apprehensive about playing with kids as I don't really know what to do with them. I mean I think I'm good at making faces as so far I have been able to make the kids laugh by making faces. In terms of toys....I try and just pick up whatever  I see and hand it to them...which they quickly put to the side/throw it to the side. Had a few quizzical looks from babies...which is quite adorable...and pretty funny. Sometimes they just look so confused even you get confused yourself! So clinic lasted for about 3 hours and I did get my bum grilled to a burnt toast by the consultant. Non-stop questions. I asked my consultant a question and he proceeded to ask my question back to me! I'm sure I gave him several blank looks. I'm alright with being put on the spot to answer questions, but it still gets my heart rate up. Luckily the consultant is very relaxed and nice so I knew he only asked to help me learn instead of trying to make me feel dumb....not like any consultant would have that sort of intention (sarcasm). Nice thing about being quizzed is that you do remember things much better. I did learn quite a few things.

Then the ward went dead. There was nothing to do. I literally was wandering around in circles looking for patients to talk to or something to do, but most of the patients I saw in the morning have been discharged. I sat around at the nurse's/doctor's station and swiveled in my chair. Then my registrar who is on-call with me...started getting several bleeps. Literally 5 patients walked in at the same time right after dinner. So I got to work clerking the patients in and helping the registrar out with some stuff. Did learn how to take blood from a baby. A pretty pain-staking process. You essentially prick the heel of the baby with a device and you let the blood drip out and catch it in the bottle....you can imagine this can take awhile depending on how fast the blood drips out/how cooperative the baby is.

As earlier stated...I was planning to leave at 8pm, but because suddenly all the patients decided to show up at the same time...I ended up getting held back. I didn't want to leave midway through clerking so I told myself I can leave after clerking and presenting the cases to the registrar. At around 9pm I was finally finished and made my way home. Got home...showered...and then passed out on my bed. And up again next day for 9am. As you can guess....I had a lot of difficulty waking up. Plus the prospect of needing to drive for about an hour was not helping. Either way....thankfully this week kind of picked up and I am starting to get much more teaching from the doctors and I'm starting to get along with the doctors. Starting to feel like I'm a part of the team. It's a nice feeling.

Paediatrics - Week 1

Wow this week was LONG. First started the week with a whole day of introductory lectures from 9-5. Then on Tuesday it was the start of our placement and the start of long drives early in the morning. Got to the peripheral hospital and the minute I stepped into the Children's Unit, I knew something wasn't right. In first year I had a placement in Paediatrics and you could hear children screaming/crying from outside in the hallway. This time...it was dead quiet. There were no doctors to be seen. We met in the doctor's room and soon all the doctors arrived and did a handover. The reason for the quietness of the ward? We only had 3 patients on the ward and another patient was coming in later in the day. I mean the doctors are all really nice though. All of them are also really keen in teaching as well. They did mention that the lack of patients is common so we do have to be proactive.

We are expected to do 7 on-calls in our entire attachment (7 weeks). So it would make out to be 1 on-call per week. I did my on-call on Friday which meant I was in from 9am-10pm. What a long day. However, I managed to clerk in several patients and I was definitely learning. Also in the middle of the week I got to do baby checks. This is where the doctor would check over a newborn baby making sure he/she is healthy and ready to go home. Some of the babies were so cute; however, after all the baby checks, I feared crying babies. Every time I hear a baby cry, I flinch a bit. Also the funny bit is that almost every baby we checked, the baby decided to leave a present for us in his/her nappy. Lovely. Guess that's what you get in paediatrics. Cute babies and stinky diapers.

Paediatrics is definitely interesting, but the lack of patients in our hospital is really taking a toll on me as I do find myself standing around doing nothing. I also find myself getting bored quite often. Unfortunately there isn't much to talk about for this week. It has been overall quite dull. Not a lot of banter either on the ward. Guess not every placement will be fun. Hopefully next up will pick up. I mean at least I'm starting to get to know the doctors quite well and they are very welcoming. 6 more weeks. Yay....

Clinical Specialty Placements

So tomorrow I will be starting clinical specialty placements. I will be on Paediatrics for 6 weeks. I am kind of nervous for it as I don't know what to expect. I was placed in Paediatric Surgery in first year (which by the way is still my most memorable and fun time I have had on placement), but  I was only on the attachment for 1 week. I'm pretty sure it'll be a completely different ball game as obviously the consultants will expect much more knowledge. I have been placed in a peripheral hospital so hello to 1 hour drives each way. Should be interesting...hopefully the weather holds up to make my drive less stressful.

To best honest, I am alright with kids. I don't LOVE kids so I'm not uber excited to be surrounded by them. But who knows, in first year I was really inspired by my first attachment and saw some really interesting things. At one point I was thinking about maybe even specializing in Paediatric Surgery. Hopefully this will be a good experience and I will be able to learn loads as the hospital is much smaller so the doctors will have more time to teach.

9 am introductory lectures tomorrow until 4pm, then on Tuesday I'll be going to the peripheral hospital. Really hoping this will be a good attachment. More updates will come in the week!

Practice Makes Perfect.

I was signed off from placement on Monday so I haven't been doing anything particularly interesting other than revising for exams. Met up with a friend on Thursday to do some physical examination practice on patients at the hospital. As you may recall in my first attachment back in the summer (doesn't seem that long ago...time flies) I was drilling Cardio an Respiratory Examinations. Well exams are in 2.5 weeks so I got to get drilling on the rest of the examinations.

So we went and practised Abdominal, Shoulder, and Knee exams. Got that down pretty quickly. Never really had trouble with those examinations to be honest. Then we practised Cranial Nerves, peripheral neuro, and hand examinations. We did these with each other as these exams have quite a lot of steps. Before practising, I was hopeless at Cranial Nerve exams. I was not slick at all and obviously needed some serious practice. After a few attempts, I have finally gotten it down and was starting to get slicker at it. Did the same with the other examinations and I could definitely see an improvement. I was starting to feel much more confident with my examination skills and a bit more confident for my OSCE exam. Have arranged another physical examination practice session for Monday so hopefully I'll continue to improve and get better at these things.

Today I finally reached the last system to revise (Gastrointestinal). It surely doesn't feel like the last unit as my binder is still full of notes and it just doesn't seem real that exams are so soon. It's really weird. Most of my friends and I agree that exams don't seem near and the panic still hasn't set in. Generally been feeling quite unmotivated so I constantly have to remind myself how close exams are which results in mini panic attacks/a kick up the ass. I guess it kind of works as I've been revising furiously for these last few days and really pushing to get ahead of my revision schedule to give myself an extra half week of revision for anything I'm unsure of. At the moment I have scheduled in 1 extra week prior to exams for random revision/going over sample questions. Hopefully if I work hard enough I can make it 1.5 weeks of extra revision time to actually properly learn Microbiology. I swear Microbiology is my new nemesis. It used to be histology, but because we don't do that as much anymore...Microbiology has quickly taken Histology's crown of being my nemesis. There are so many things to remember! And all the stains for the different bacteria. Mental.

Pharmacology comes close behind. Drug treatments for Cardiovascular disease and respiratory are fairly straight forward. The minute you get to Dermatology...oh wow. You start feeling like a walking BNF (British National Formulary - it is a book of drugs)...but more like a BNF written with fading ink. Put some new drugs into my brain...the old drugs fall out. Dermatology...endless amount of drugs. So many names as well! Half of them I can't really spell! I can picture myself writing drug names in my exam and writing the first few-ish letters and then squiggling the rest and making sure it looks like the drug I'm thinking of. Thank goodness spelling doesn't count in our exams! As long as the word is recognizable they will take it.

My Oxford Handbook of Clinical Medicine is also finally getting beat up. It had been in mint condition for 2 years and FINALLY it is getting used...and I am seriously using it to death. Also random note - think I might be getting tennis elbow as my desk isn't great to write on as it is fairly deep. That means my elbow is constantly resting on the hard surface and sometimes I can feel my hand go tingly and numb. Also my elbow is sore from resting on the hard surface. The things you sacrifice for exams. Sacrifice sleep, good food (yay for quick microwave food), social life, going out, sanity, blah blah blah, and now sacrificing joints! Prospective future for my body. YES!

I hate revision. I miss lounging around and being lazy.

SSC and Random Thoughts.

I just finished my SSC project (Student Selected Component) and sparked me to write a little entry about it as it is a requirement for all medical schools to do them. At my school, we have three of these per year. For first year we have:

1) History of Medicine
2) Critical Analysis
3) Communicating Health Information

The first one is a 2500 word essay and you would choose an essay topic from something ridiculous like 260 topics? I found this to be the hardest of the three assignments. If I remember correctly, they expect you to have about 12-20 references for this essay and it really kicked me in the ass. I cannot recall borrowing so many books from the library before! But other than collecting the info, writing the essay was pretty straightforward and easy. It was practically just summarizing your findings.

The second one is where we chose a drug from a list of topics and we would have to analyze it and present it to a small group. I found it pretty easy and actually did it up only a few days before deadline (shhhh). Really straightforward...and requires hardly any energy.

Third one is what I just finished. It is a public health assignment. We can pick our own topic just as long as it is a public health problem and do up an information poster about it. Again...really straightforward (zzzZzzzZZ). Finally pulled my brain together and managed to finish the entire thing in five hours.

I don't know what the other medical schools do for their SSC topics but personally I think the ones that we have are pretty bland and straightforward. Most of my friends truly believe that they give us these SSCs just to keep us busy. Personally I don't find that I learn a whole lot from doing the SSC unless I pick a topic that pertains to what I want to do in the future and what I am interested in. For example: the critical analysis SSC to me was pretty pointless. I found out a lot from ONE drug...and a bit about others but the stuff we present aren't that informative for the future. It was pretty much just a brief outlook on the drug. On the other hand the History of Medicine and Communicating SSC are the complete opposite. The two topics I chose are something I am interested in and I am considering to possibly specialize in either one of them - so I find these projects more informative. I guess it really depends from person to person.

Also forgot to mention that these are marked on a 1-5 scale.
1 = Outright Fail
2 = Borderline (kind of failed - require meeting)
3 = Satisfactory
4 = Good
5 = Excellent

It is pretty hard to fail...the only way to fail is to not hand it in or do absolutely nothing. OR the scariest part is plagiarism. I still remember the first lecture we had on plagiarism and the university takes it really seriously. I get really nervous every time I hand in my work and I always make sure I did all my citations correctly and stuff.

Random thought: I was thinking the other day if I should register for a volunteering job at a hospital back home when I go back for summer. The problem is that most hospitals are not keen to accept people for short term volunteering and I think I will only be home for 1.5 months, which ain't a long time. Hmmm. Thoughts? Opinions?

Newborn Medical Student - 7 months old to be exact!

According to the consultant paediatric surgeon who I shadowed for a week: I am just a newborn medical student....7 months to be exact. And what have I learned so far? A crap load of stuff.

Highlight so far has been the two week placement at the hospital. I got the opportunity to shadow two consultants (well technically three) which I found a lot of fun. Don't know if the consultants enjoyed being stalked but they seemed pretty helpful and ok that there is a first year medical student following closely behind. First week I was at the HPB Surgery ward and I saw mainly elderly patients. Also got the opportunity to scrub in and watch a few surgeries. Highlight surgery I saw was a gastrectomy. Made me realize how complex and how intricate surgery is. I thoroughly enjoyed watching the 3.5 hour surgery. On the other hand, I don't think my back enjoyed it...nor my feet. But I was genuinely fascinated. However, my partner somehow was bored to death and non-stop bugged me to go back to the ward with her to watch ward-rounds. Second week of placement was probably the best week. I was placed in Paediatric Surgery and shadowed a consultant who was quite busy so another consultant took me under his wing. His team of doctors were really knowledgeable and taught quite a bit. Learned about various illness that affect children. Saw patients with appendicitis, Hirschsprung's disease, Barrett's syndrome, Meckles, and many more. Again, I had the opportunity to go to theatre and this time my partner was ill so it was just me and the consultant. I learned so much more and I felt more ready to ask questions and be more relaxed. The consultant did remark that he quite enjoyed my company as some of the students that has shadowed him have been very quiet and boring...and not keen/interested at all. It was neat hearing that from a consultant - I didn't think I was overly keen but I guess I was just enjoying my time on my placement. I did have a lot of fun. I have to admit, prior to this paediatrics placement I was pretty sure I would not specialize in paediatrics but to be honest, after one week of shadowing and finding out so much about it, I just might reconsider paediatrics. It is amazing seeing such small babies who are critically ill, and with medical technology, their disorders can be corrected and these babies can live a full life. Truly fascinating. One thing that hangs on my mind about going into paediatrics is the stress of doing surgery on such small bodies. One wrong move can send everything into a nosedive. Surgery on children is so delicate and some of these kids probably have only lived for a few weeks! But again, I found paediatrics fascinating and I think I might apply for another placement in paediatrics in third year. Just maybe.

To be honest, this two week placement was mainly for us to learn how to take patient histories and to just see how a hospital works. Some of my friends hated it and thought it was a waste of their two weeks. Some people did not mind it. And some were like me: thoroughly enjoyed it. I personally think that I took away quite a bit from this experience and it will be an experience that will stick with me for the rest of my career. I never had the opportunity to visit hospitals or watch a surgery. It was my first time and it really gave me a kick up the rear end and certainly turned my motivation level up a notch to do medicine. For others, I have heard it actually shot down their motivation to become a doctor and some people are now reconsidering whether or not medicine is right for them. Scary how it can easily go either way from one two week experience. I experienced quite a bit: ward rounds, clinics, paperwork, surgeries, etc...pretty much the life of a doctor. I found all parts of it interesting. Yes there were some boring parts but that comes with every job and every career. It is not fun and games 24/7. There will be parts that is boring and repetitive. But I really don't mind. I also got to say that after placements I really am starting to think what I want to go into for specialties. I know it is a bit early to start thinking about it, but it does not hurt to do some planning/thinking. I feel like I am strongly leaning towards specializing in surgery. I feel that I really want to be in the operating theatre and I like being on my feet. I have this fascination to be able to diagnose and fix things. Makes me feel more complete. Definitely this will be something I will be thinking about for the next four years and definitely will seriously thinking about specialties once I go into hardcore placements starting in third year.

Currently I'm on my final unit of the year. We have gone through cardiovascular and respiratory. Now we're covering GI and Liver. Scary to know that exams are just around the corner though. After sorting out my notes the other day, I was a bit shocked at how much I have learned in the last 7 months. I have two 2.5" binders stuffed full of notes from lectures. Slightly worried about the amount of stuff I have to study. But I think it'll come quite easy as I am interested about these things and I'll feel a bit more motivated to study. Some of these topics have been quite interesting. So far, I have enjoyed the cardiovascular unit the most. I really felt like I understood most of the stuff and have a strong interest for it. I found myself wanting to know more and more motivated to read up on it. Hmmm.

What has been annoying me lately has been histology. I am a bit worried as it is hard and you look at microscopic samples stained with H&E. Our lecturer says that we should be past the "pink and blue blobs" stage and should start recognizing things, but I still see pink and blue blobs. Yeah some stuff I recognize but I'm scared that everyone else is seeing stuff clearly while I'm still going like "yeah...blue blob...oook...". A bit worried about this for exams so I know this Easter break I'm going to work on my histology so I can at least pass the exam.

In general university life is still great. Getting a bit busier now. Had like 3 essays/assignments due within like two weeks. Lots of reflection from our placements. My friends think that they have done so much reflecting, all they can do now when they sit around is reflect. But I guess it is something you need in order to learn. I'm sure they teach/drill us to reflect for a good reason. I don't mind reflecting...actually if I hated reflecting I wouldn't even be typing up in this blog. It is nice to look back on what you have done and what you have learned from it. Initially you don't see it, but once you take some time and think about it - yeah some of the stuff that you experience is quite handy. I know once placements were over I thought I didn't learn anything and it was just shadowing (stalking) doctors around. After doing my reflection I really appreciate the placement and it definitely gave me a lot of motivation to work hard.

However, lately I feel like there is a chip on my shoulder. All my friends have not been acting like normal especially after placements. My friends claim that I'm not acting normal after placements too. I think it is the thing in the back of our head going like: "Eeeek exams in 9 weeks!". Scary close. I think we're all a bit stressed and working a hell lot harder than usual. We are all medics and we got in for a reason. They don't accept a bunch of lazy people. When we need to we can work like horses and get a lot done. Starting to see this now and I feel like I definitely turned it up a gear in terms or working. Finding myself more tired than usual, but I have been getting a lot of work done. Give and take. Sometimes you got to make sacrifices such as less time hanging with friends, or having less night outs. Speaking of night outs...I haven't been out since the CNY party in February. Jeebus. I don't think I'll be going out anytime soon either. There is a light at the end of the tunnel...after exams will be summer! And that means I can go out as much as I want?

Work hard. Play harder.