Wednesday, 16 August 2017

Start of Final Year!

“Hi, my name is….., I’m a final year medical student”

I haven’t achieved this by passing any exams, but since coming back to university from our summer break I am now technically a final year! This feels weird to say and I haven’t quite got used to it yet. What feels even weirder to say though is my new surname, because just over 2 weeks ago I got married! It was a crazy and wonderful day and it all still feels a bit surreal.

I timed getting married with the first weekend of our summer “break” so that I could go away on honeymoon straight away afterwards. I say summer “break” in inverted commas, because having been on clinical placement everyday (and yes, most days that is 9-5pm (or longer if doing an on call). Long gone are the frequent early finishes and “study days” of second year) since January, only 2 weeks off doesn’t feel much of a break! We got the bank holiday days off, but we didn’t even get given an Easter break *tear*. My partner husband and I went away to Italy for my 2 weeks off after the wedding. We had an amazing time, but the time just flew and now I’m back to clinical placement, and it still feel as though I’m in need of another few weeks off! The most upsetting thing is that we don’t get another holiday until Christmas, but given that our first finals exam is on January 8th I don’t think I’ll be having much time off over Christmas!

Last time I updated I’d just finished my paediatrics block. Since then I’ve done 3 more blocks in O&G, Medicine and Surgery. They all went well, and overall I mainly enjoyed them. During the surgery block I was assigned to 2 awesome female consultant surgeons who were really nice and got me involved as much as possible. A lot of my previous surgical experience has just been stood in the corner of theatres, being ignored and standing on my toes to try and see anything at all. In this block the surgeons all made an effort to involve us, meaning that I got to scrub up and assist in a lot of the surgeries so that I could actually see what was happening! I still don’t want to do surgery, but I did really enjoy my time in surgery.

Now that I'm starting my final year of medical school, I feel as though I'm slightly more useful/less of an inconvenience than previously, where we just trailed around after the doctors and got in the way. The most useful thing I used to be able to do was pull the curtains round the cubicle during ward round, but now I'm able to do things which actually feel slightly doctor-y and useful. For example; clerking in new patients for the doctor when on-call, seeing patients by myself during clinic so that the consultant only has to review my history/examination quickly before determining a management plan and assisting in surgeries as the 2nd surgeon when no juniors are available to assist the consultant. This is slightly stressful at times but definitely more interesting, and I feel that I'm learning more by actually being involved.

I’ve just started my Acute Medicine block. I’m looking forwards to it but it looks pretty intense. We’ve been assigned shifts to do and already I’ve done a 12.5 hour ITU shift yesterday and today I’ve got a 12 hour night shift in A&E.

During my ITU shift yesterday there was a patient who needed RSI (rapid sequence induction to put the patient to sleep quickly) and intubation. They also needed an arterial line fitting and a central line. The intubation and ventilation was fine initially but then the patient had several episodes where they just suddenly started desaturating fairly quickly and quite badly, until the anaesthetist bagged them and readjusted the tube. This happened quite a few times. During one of these incidents I noticed that the patient’s chest expansion looked really unequal. I pointed this out to the junior doctor, who mentioned it to the anaesthetist, but they were struggling to get in the arterial line and the nurses were all around doing things and no-one really paid attention to this. Later on the patient’s saturations had dropped to 50% and the consultant anaesthetist came in and took over. He realised that the patient had no air entry over one lung on auscultation and a deviated trachea (hallmark signs of a pneumothorax) and immediately performed a needle compression to release the air. The patient had a chest drain placed and was fine, but it made me think that maybe I should have spoken up more about the unequal chest expansion (another sign of a possible pneuothorax)? The weird thing was though that in-between these episodes of desaturations, the patient was fine and the anaesthetist said that they could hear air entry on auscultation so it was a bit strange. It made me realise though that I should have more confidence in my abilities in detecting clinical signs. Whenever I’m doing a clinical examination, for example for my end of block test or during bedside teaching, I often think that I detect something but I’m never 100% confident and say it in terms of “I think that there’s this” in a timid voice. Recently though, most of what I’ve been saying the doctor has agreed with, so maybe I need to try and be more confident in my abilities. I think a lot of doing well in OSCE exams is appearing confident in what you’re doing so I’m going to try and work on this!

Friday, 24 March 2017

End of Paediatrics Block

This block seems to have gone so fast! The above year have had their finals exams and have just had their results back. In less than a year that will be me, a scary thought! A year feels like a long time but I know it will go quickly, and there’s so much to learn in that time.

I was pretty apprehensive of paeds at the beginning of the block as we haven’t done that much previously and ill kids are scary. I feel more confident with it now, but I still think ill kids are scary. They can be seemingly ok and then get really ill, really quickly.

I’ve learnt a lot and seen a lot of different presentations. The block was organised so that we spent time on the paediatric ward, SCBU (special care baby unit) and in a variety of clinics. We also had several evening on call shifts timetabled. These were actually really good as we got to go see patients in A&E and also be the first person to clerk in patients on the ward. I’m glad that I had this block now. Being winter the wards were fairly full most of the time with a lot of new admissions and referrals every day. I’ve heard that during the summer the ward can be pretty empty some days, so I’m glad I did get to have exposure to many different conditions.

Before the start of my clinical blocks I vowed to have all my notes for each speciality completed by the end of the block. GP was difficult as there were no pure GP learning objectives, and all of the objectives were covered in other specialities (eg. angina in cardio, fever in a child in paeds) so I just did as many as possible. This block however had a big list of paeds specific learning objectives and I’m really pleased that I’ve actually done work throughout the block and have my notes up to date. This will make revising closer to finals a lot easier, and doing the notes now makes more sense as it’s currently fresh in my head. I just need to actually print my notes now. I was holding out on this as the hospital I was based at for paeds gives us free printing in the student computer room, but annoyingly the printer has been broken for the whole block. I was hoping it would be fixed before I left the hospital but it wasn’t. This means that I’ll have to pay to print my notes in uni tomorrow as I currently don’t have any ink in my printer at home.


I’m going to a student GP conference tomorrow (Saturday). I kind of regret signing up to go now as I would really like that day off to relax/read up on O&G before starting my O&G block next week. But my friend is organising the conference so I said I’d go to increase the numbers, and there’s a free lunch which is one plus. O&G at the hospital I’m based at next is notoriously difficult and full on with a few mean consultants so I’m a bit nervous. I need to brush up on my O&G knowledge, especially anatomy so I don’t seem like an idiot and get off to a bad start with the consultants I’m assigned to.

Saturday, 11 February 2017

End of GP Block

Sorry I haven’t updated in a while. When I last posted I was doing my research project. I’m glad to say that I’ve since finished it and passed it with good marks!

At the beginning of January we started our first specialist clinical placements. My first block was in GP. Last year on clinical placements we weren’t placed on any particular speciality, but instead rotated around lots of different random areas (geriatrics, ortho, paeds, O&G, derm, ophthalmology etc…) and basically had to learn a bit about everything. We did 3 of these 10 week blocks from January until August – the 1st one to concentrate on history and examination, the 2nd to focus on diagnosis/investigations and the 3rd to look at basic management. We also did 1 day a week in a GP surgery. At the time these blocks felt quite unstructured, but I appreciate that they’ve given us a good grounding in basic clinical knowledge. This year however we have 8 speciality rotations, a revision block and then final exams (which take place this time next year – a scary thought!). The order of rotations I have is:
  • GP
  • Paediatrics
  • O&G
  • Medical
  • Surgical
  • Acute
  • Psychiatry
  • MSK

So basically, by the end of each rotation we need to have enough knowledge in that area required to pass finals. So even though finals are a whole year away, we have to start preparing for them now. We got given a massive list of learning objectives we need to know for finals and it’s pretty scary! Thankfully though, as GP is so broad and covers a bit of most specialities, all of the GP learning objectives are covered again in other blocks, which took the pressure off a bit for this first block. This turned out to be a good thing as GP block had a load of extra pieces of work and sign offs which most blocks didn’t require. Over the 6 week block we had to do a minimum of 18 consultations, 3 OSLERS, 1 assessed case discussion, 1 mini-CEX, a therapeutics presentation, an end of life presentation, film and get feedback (from our tutor and student group) on 2 consultations, multiple SIM sessions with actors pretending to be patients (including breaking bad news where I had to tell a lady she had incurable cancer), 1 piece of written reflection, 1 end of block OSLER in exam conditions and an end of block written exam. Add onto that the fact that the GP surgery I was placed at was a 56 mile round trip, meaning that I had to leave the house at 7:20am and didn’t get home until 6:30pm, and I’m pretty tired by the end of this block!

I have enjoyed the block though. My GP surgery was really well run and everyone was lovely. I feel that I’ve learnt a lot and that I’ve massively improved my consultation skills. For some of our consultations the GP allowed us (myself and my clinical partner – one person doing the consultation, the other observing) to do the consultation independently, and the GP just came in at the end to hear what we’d found and to make sure that they were happy with our diagnosis and treatment. This was rather scary, but also exciting as it meant we were doing actual doctor stuff by ourselves rather than just observing!

This week was our last week of the block. I’m pleased to say that I’ve had everything signed off for the block, and so next week I’ll be starting my paediatrics block. I’m slightly apprehensive as I haven’t done a lot of paeds so far and I’ll have a lot to learn. I’m also getting married this year, so on top of all of my uni work I’m also trying to organise everything for the wedding and our honeymoon!


Saturday, 19 November 2016

Report Writing

I'm currently finishing off writing the report for my research project which we had to undertake as part of our SSC2 block. I'm finding it really hard to motivate myself to do it though. I was quite lucky with my project in that it is a pretty straightforward project, my supervisor is really supportive and helpful, and I'm nearly certainly going to get published from it (which is good as it means an extra point for my F1 application). I could also do it from home (some projects required people to go into the hospital or labs), which has meant I've been able to plan my own time, sit in my office with the cat, and drink tea whenever I want to. So in the majority of ways I've been pretty lucky, but the one downside is that my project is really boring. Like I tell people about it and their response is "oh, that doesn't sound very interesting", and it's not. I'm finding myself longing for the time of learning clinical medicine, and yesterday I even revised knee anatomy as a way of procrastination. This project wasn't my first choice (we had to rank about 30 projects and then we got assigned to one of them), and I'm looking forwards to getting it finished and out of the way. The deadline for handing it in isn't until 5th December, but our allocated time for the project is ending and we're back in lectures/hospital next week (something I'm actually excited about!). I'm aiming to finish my first draft to send to my supervisor for Monday which will then give me time to make changes and submit it in plenty of time. So I really need to get on and finish it!

It's really cold today and there's still frost on the roofs. I've got the heating on and the cat's currently asleep in my office with me, pressed up against the wall below the radiator. She's so so fluffy, so if even she's cold it must be cold! It's not helping with my motivation, instead of sitting in my office I'd much rather be curled up on the sofa with a blanket and a cup of tea, watching TV or reading a book!

Monday, 14 November 2016

A long overdue update

Sorry I haven't posted on here for so long, I didn't feel much like blogging for a while. I didn’t pass the 2nd year resit exam, which was really shitty. And it was made worse by the fact that I only just didn’t have the marks to pass.

After the results day I was in a unique situation due to fairly big changes to the structure of the course, which had been made for the year below me. Normally it would have been a simple case of repeating the year. The exam board clearly stated that they thought I was capable and should be allowed to resit the year due to my mitigating circumstances. One other person wasn’t so lucky and after failing the exam she had no option but to leave the course. However, the changes to the course meant that there were no Christmas exams in 2nd year any more, just big exams at the end of first year (which mostly include everything that was previously examined in first year and the 2nd year Christmas exams on the old course), and then the next set of exams aren’t until the beginning of third year. I had several meetings with the head of the medical school and they kept me waiting for almost a month whilst they decided what to do with me. In the end the medical school decided that it would be unfair of them to put me back in with the year below as that would mean I would have to sit their end of 1st year exam. By this point it was February and the exams were in May, and the medical school thought that that wasn’t enough time for me to be prepared for the exams and that it would just be “setting me up to fail”. This meant that my only option was to restart first year in September, effectively dropping me back 2 whole years, which was pretty rubbish to say the least. The only comfort was that by way of recognition of it being so shit making me restart the course from the beginning, the uni waived my fees for my repeat first year so I didn’t have to pay anything/no tuition loan for that year.

I had about 8 months out away from uni before starting the course again in September 2014. It was quite nice to have a break from Medicine and the intense studying for a while. I worked a lot of locum pharmacist shifts and managed to save quite a bit of money.

So I started the course again in September with the first years. It wasn’t much fun. I felt like a bit of a fraud being with all the new students when I’d already completed first year previously. At first I was fairly open with people and told them about my situation, but after a couple of unpleasant responses from people (including one girl who immediately turned round and told everyone else around her “Did you hear that, this girl failed and has to start again haha”) I now only tell people if it comes up or if they ask. I got through first year though, made new friends and passed the exams pretty well.

I worked a lot during the summer holiday between first and second year, and combined with the money I’d earned on my time out from the course my partner and I were able to buy our first house last year! My boyfriend also asked me to marry him that summer (I said yes!), and during first year we also got a cat J. I feel in a much better position now than I did previously, and a lot of that is due to the time out from the course when I was able to work. We’re in a much better position financially, which makes things a lot easier as I’m not constantly stressing about money and working all the time like I did previously. This house (which we now own) is also much nicer and warmer, and the mortgage is actually cheaper than what we were paying in rent for a much worse house! So that’s one good thing that’s come from repeating the year.

Second year was fairly enjoyable. In the first term we mostly had lectures that built on year 1 work with more of a clinical emphasis. After Christmas we were then based in the hospital for the majority of the time. We weren’t on specific specialist placements, but instead we went around different areas of the hospital, and one day a week at GP, building up our clinical knowledge and skills and getting used to learning in a clinical environment. It’s difficult at times, especially when you have a disinterested consultant and just feel in the way a lot of the time, but I still really enjoy being in the hospital, opposed to sat in lectures, and feel that I’ve learnt a lot this year.

I worked really hard for the exams we just had in September. We had a few weeks “summer holiday” off before the exams but I just used it as revision time. I was really happy with my exam results. I got 79% on the SAQ (short answer questions) exam (pass mark 67%(which was really high, normally it’s around 60%!)) and 72% on the MCQ (multiple choice questions) exam (pass mark 62%). I also passed 15/15 OSCE stations (pass mark 11/15 stations). I don’t know what decile I am as they haven’t released the decile information yet as the resit exam results are only being released today.

I feel in a much better place now than if I had scraped through the exams back in 2014. I feel like I know a lot more, I’m passing everything comfortably and I can hold my own when being quizzed by consultants on the ward. So although it was rubbish having to start again at the time, now I think that it was probably for the best.

I was a bit sad seeing my original year graduating earlier this year and all the “I’m a Dr” posts on facebook. But then I found out that a high amount of people didn’t pass the exams. 14 people are needing to retake the year and 5 people aren’t even being allowed to re-take the year and they’re just out, after 4 years work with nothing to show for it. I’m pretty certain that had I just scraped through the exam I failed, that could have easily been me, so I’m very glad that I got the fresh start and feel like I’m doing pretty well currently, not just scraping by.

So now I’m officially a third year medical student. I’m over half way through the course. I’m currently finishing off my research project, and then we’re going back into the clinical environment, which I’m looking forwards to. We have 3 week’s worth of consolidation lectures and some time in the hospital, and then after Christmas we start our proper specialist clinical placements. I’m getting there, slowly!


Saturday, 18 January 2014

A bit more optimism

Apologies for the outpouring of self pity the other day. I've perked myself up and accepted that whatever will happen, will happen and there's no point moping about it. I've pretty much come to terms with the fact that I could be resetting the year, so if I do pass it'll be a pleasant surprise, but if I don't hopefully I won't be too disappointed, although it would suck a lot.

I'm currently working another 15 hour locum shift today. It's been pretty busy up until now so it's nice to have a bit of quiet time. If I do pass the exams, then I've found out that my first proper clinical rotation will be in Orthopaedics and Anaesthetics. We have a 3 week community learning placement and then we go straight into proper rotations. Orthopaedics is probably my most dreaded speciality, probably because I don't have a massive interest in it, and MSK is my worst topic. If I knew that I'd passed exams I could be revising in preparation for it now, but I can't help but think that I'll be jinxing myself if I did now, so I'm refraining. I really wish that I have passed the exam as I'm so looking forwards to the time where I can go into the hospitals instead of lectures. Going back to lectures and group work full time again will be so hard.

As an aside, why do people leave it until 10pm on a Saturday to take action after running out of their prescription? Last Saturday at 10.30pm we had a flurry of people coming from the GP on call centre awaiting faxes of their regular prescription to be sent over. Except that the fax machine was broken, but as the patients all kicked up a fuss about needing their medication tonight, I had to try to contact all the different on call GP's to organise emergency supplies. If their medication is so important, why didn't they order it a week ago when they saw they were nearing the end of their supply, or even ask the Pharmacy to sort it for them on the Friday, or even come in on Saturday day time. Most of the medications were things that the patients took in the morning, so why didn't they take action on the Saturday morning, when we may have been able to get a script from their GP? Why Saturday night at 10.30pm????? It reminds me of when my sister (who's a nurse in A&E) had a patient call up an ambulance on a Friday evening and came into A&E by said ambulance because they'd run out of their regular medication..... Patients drive me crazy sometimes.

Monday, 13 January 2014

Giving up

I feel like a bit of a train wreck at the moment. As you might of guessed from my recent silence, I didn’t pass the exam. I did well in the OSCE, but failed the written, not by much but still a fail. Despite spending my whole Christmas holiday revising (new low – revision on Christmas day), I’m not confident that I’ve passed the re-sit exam either.

Today was our first day back at uni. We had an induction day in preparation for the clinical phase we’re about to enter. Except, I might not be allowed to enter the clinical phase but as we don’t get results until next week, I still have to attend the induction. The day also involved everyone asking how the exams went and our group supervisor greeting us with “congratulations everyone on passing the exams, except for anyone who didn’t’”. Pretty much just constant reminders of my failure, so today was pretty rubbish.

If I have to re-sit the year, I really don’t know if I’ve got it in me to do so. I really just feel like quitting everything right now, not just medicine but the world, and refusing to leave my bed and self-destructing. I would resit the year obviously as Medicine is the only thing I want to do but the thought of going back a year is completely soul destroying. I genuinely worked so hard last term, and yet other people passed no problem, so what’s wrong with me? Why are my brains so shit?

I’m also exhausted from a hard 15 hour locum shift I did at the weekend, and idiotically I’ve agreed to do a 15 hour shift every weekend bar two until the end of March. But, I’m poor so I don’t really have much choice.

Sorry for this torrent of self-pity. I’m just really tired and demoralised and needed to have a rant. I'll get over it, but I just need to mope for a while.