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!

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.

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 1^st one to concentrate on history and examination, the 2^nd to focus on diagnosis/investigations and the 3^rd 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!