0

Module 13 Placement: Anaesthetics & ICU (Weeks 2 and 3)

Lowest point of my week with the anaesthetic team was being on the verge of tears because of my cannulation fail in theatre. It’s kind of funny looking back on it now, because I eventually managed to successfully cannulate in ICU; why do I get so emotional over little things?? An age old mystery.

Anyway, the moral of this tale? Clinical skills are all about practise so don’t beat yourself up too much if you don’t get it right the first time… or twenty.

Apart from that though, anaesthetics was pretty fun! We had teaching sessions on the principles of general anaesthesia and drugs involved, and we also got to practise airway management on models, which was nothing compared to doing it for real in theatre – the anaesthetists let me put in laryngeal mask airways like this:

Laryngeal mask in use

The anaesthetists were really nice- I actually got offered a seat in theatre for the first time ever, and that made being in theatre so so much better. I assisted with drawing up drugs and sedating patients, and it made me realise that I prefer orthopaedic procedures because they’re way more straight forward. Maybe it’s because first year was the only year I really made an effort with understanding anatomy…

ICU was a bit less fast paced – with no more than 10 patients at a time, and at least one nurse per patient, so there wasn’t as much for me to do. I was mostly observing what they did, but I got the chance to put in a male catheter and help with central line insertions, so again that was pretty good. I kept getting asked if I was a college student on work experience though, so the baby face strikes again…

Advertisements
7

Module 7 Placement: Ophthalmology

A summary of ophthalmology in three words? Death by clinic.

So. Many. Clinics.

I had no idea that ophthalmology had so many sub-specialties within it, as a lot of our teaching sessions were in different clinics. From eyelid disorders, to corneal disease, to glaucoma and strabismus (squints), we saw a wide range of patients, so that was really good.

My favourite clinic was the paediatric one, where I was with a consultant that specialises in squints seen in children, and this is when the eyes point in different directions. The consultant really grilled me, but he wasn’t mean about it, so I learned quite a lot in his clinic. The best part was he asked me to help distract the children, so I had to keep them focused by playing games that ensured they were looking behind the consultant, in order for him to examine their eyes properly. Such fun! It made me even more determined to go into paeds when I qualify.

Anyway, you know how I said otoscopy was hard when I did ENT? Yeah, it’s a walk in the park compared to fundoscopy. FUNDOSCOPY IS SO HARD.

Related image

It involves the use of an ophthalmoscope to look into the back of eyes, and I really struggled with it. The hardest thing about it is that when you’re looking into someone’s left eye, you have to use your own left eye, and that’s difficult for me because I struggle with closing just my right eye. So I’ve been practising winking with that eye, and it’s helped, sort of? I guess this is another one of those things that will get better with time, I hope!

Examining the eyes is very #longforman in general to be honest; there are so many steps to remember! I was taught ‘AFRO’ as a good way to ensure you don’t miss things out, and it’s been really helpful:

A – acuity (Snellen chart, Ishihara plates)
F – fields (as well as inattention and blindspot)
R – reflexes (direct, consensual, RAPD, and accommodation)
O – ophthalmoscopy

So good! Again, practise practise PRACTISE.

Finally, the week in ophthalmology taught me that I’m really not my best when I haven’t had much sleep. As it was our final week at this hospital, we still had to get the 8am bus from campus, so it was early starts all week. The smart thing to do would have been to go to bed early to ensure proper rest, but I’m more productive at night, you see, and that’s why I end up going to bed late.

The lack of sleep definitely showed every day, because I was crankier, more impatient, and got irritated more easily. Apologies to anyone I was snappy with- it’s not you, it’s me. I really need to start sleeping earlier because the more sleep you get, the more energy you have for the next day. Who knew?

0

Module 7 Placement: ENT

For anyone who doesn’t know, ENT stands for ‘Ears, Nose and Throat,’ and my first week of secondary care was a very intense week spent trying to fit everything in. For module 7 I’m back in my favourite hospital, which has the best teaching in my opinion, but the down side to that is early starts in the morning, as our bus leaves at 8am from campus. I can’t really complain though, because as medical students, we get free transport to and from placement. This is something other healthcare students don’t get, so we’re quite spoilt to be honest.

As we only had one week in ENT, our timetables were very busy, meaning that apart from our hour lunch break, we had something on from half 9 till 5. I really enjoyed it though- the consultants and registrars were really nice, even though they were disappointed that none of us were interested in ENT…

My days consisted of teaching sessions, clinics, structured patient teaching (where patients with certain conditions are brought in for us to practise our history and examination skills), and theatre.

We had a clinic with my favourite ENT lecturer, the one who broke his nose and is a P&P fan too. He really grilled us, so when he said one of my patient presentations was perfect, it was such a proud moment for me. YAY.

I’m slowly getting there with otoscopy, which is the use of an otoscope to examine the ears.

Image result for otoscopy
The correct way is to hold it like a pen, but for some reason I keep overthinking it, so when I hold an otoscope, I sometimes forget how to hold a pen? It’s so frustrating, but I guess all I can do is keep practising.

I really enjoyed my time in theatre too- I got to watch the insertion of grommets, as well as a few tonsillectomies. The anaesthetic team were so brill with the younger patients- they told them stories as they were put to sleep for surgery, and it was all very cute.  I think some of the parents were more nervous than their children; one mother was literally sobbing, even though her son’s procedure (a nose fracture reduction) took less than five minutes!

Another great moment during my week in ENT was when I jokingly suggested for music to be played in theatre, to lighten the mood during a tonsillectomy, and they listened to me! So we had a little singalong to bangers like All I Want for Christmas and Wham’s Last Christmas. So much fun!

Anyways, what are my take home lessons from ENT?

1) Surgery isn’t as bad as I thought it’d be, 2) I’m considering taking a year out after F2 to do a Masters, 3) You can be a registrar and still nice to students- shout out to Mr A for his advice on intercalating and how to get involved with research.

And finally, NEVER clean your ears with cotton buds!

1

Module 3 Placement: Haematology 

I am now officially a vampire. And by vampire, I mean that I can now take blood from patients, of course. Here’s proof:

Venepuncture

(Don’t worry that’s a fake arm, so no patient confidentiality was broken for the purpose of the photo above 😉 ) I did get to take blood from four patients during my time in the Phlebotomy clinic though, and that was a lot of fun.

So yeah, haematology was great! MUCH better than dermatology in my opinion, and I was actually a bit sad to leave, because everything was very well organised. The teaching was excellent; after getting told off for not using enough medical terms when describing blood results (whoops), I now feel more confident with interpreting them. The registrar we had for the majority of our sessions grilled us so much! The session we had on blood films was one of the most challenging- nearly two hours of going through pictures, naming the cells and then coming up with a diagnosis. So. Many. Blood. Films.

He really was a great teacher though, and I feel that in the future, when I’m (by God’s grace!) a doctor, he will be one of the people that I will tell anecdotes about, when I’m reminiscing about my time in medical school. Like, “When I was in my second year ,there was this registrar…” Good times.

Another highlight of my time in haem was the ward rounds, where the junior doctors let us write in the patient notes with them dictating. I’ve always been quite critical of illegible handwriting when reading patient notes, but now that I’ve experienced how fast paced ward rounds are, I can understand how difficult it is to keep your handwriting neat.

In other news, splenomegaly. I felt big spleens and they were so weird! But weird in a, “Oh my gosh that’s cool” way. Venesections, which are pretty much a modern version of blood-letting, are pretty cool too. I also got to watch a bone marrow biopsy, which looked painful even with local anaesthesia, and the patient did so well! I could not have handled it like she did…

I’d go as far to say that haematology has been one of my favourite modules so far. Second only to orthopaedics, I reckon. The only thing putting me off it as a specialty is the fact that haematological malignancies are quite a huge part of it. The majority of secondary care is the management of blood cancers like the Leukaemias, as well as Hodgkin’s and Non-Hodgkin’s Lymphoma subtypes, so that might be a lot of cancer to have to deal with.

It’s not all doom and gloom though- I got to see a patient get the all clear for Hodgkin’s after chemotherapy. The joy and relief from him made me realise that for moments like that, haematology is worth it.

0

Module 3 Placement: Dermatology

I’ve been putting off this post because I found dermatology really slow, so writing this post brings back the tedium I felt during my time in derm. One thing I know for sure is that I am not going to be a dermatologist.

Don’t get me wrong, the consultants we shadowed were really great, so lovely, and the teaching was much better than what I had during my respiratory placement, but it just doesn’t interest me. People have said this might be because I’m too “squeamish” when it comes to skin conditions, but I’ve become quite used to them now and still find it slow, so it mustn’t be just that.

Dermatology involves a lot of pattern recognition in rashes and various skin lesions, as well as new descriptive words like, “papules and macules,” excoriations and fissures,” “vesicules and bullae,” and so much more. It took me a while to wrap my head around it all, but it’s slowly starting to make more sense. Blisters in dermatology are not blisters as we know them… mind = blown. (Well not really blown because derm is still pretty dead tbh, but that little tidbit was something I found interesting).

A highlight of the two weeks was our emollient session, where we rated different creams on smell, texture and taste. Yes, taste. The reason for this was apparently patients come in complaining that their partners don’t like the taste of their creams… yeah. So the nurse leading our session thought it might be good for us to understand issues patients have, by tasting them ourselves. How did it go? Well it took me a while to get rid of the taste of urea in my mouth, so I can confidently say it’s something I won’t be trying again.

On the up side we got free samples, so it was well worth it:

Emollients

Our time in derm involved clinics, watching minor operations (So. Many. Biopsies), and phototherapy, which was pretty cool. Another highlight was an introduction to suturing, where we practised the basics on a fake arm and some chicken. I wasn’t much of a natural, so surgery might not be for me either…

Suturing Chicken

The best thing to come out of my time in dermatology was learning that GPs with ‘special interest’ come in once or twice or week to run clinics or do surgery. You see, I’ve always been under the impression that GPs don’t leave their surgeries at all, so this has completely changed the game for me; I could be a GP with special interest in something else! This is now something I’m considering as well as Paeds; the possibilities are endless…

0

Module 2 Placement: Weeks 3 & 4

So we’ve come to the end of our secondary care placement, and I’m actually a bit sad. Today was our last day together as a PBL group, as we change groups next year, so goodbye, group M! I’ve been really blessed to be in such a chilled group, with people who didn’t take things too seriously, but still produced great work. Not going to lie, it’s not all been smooth sailing sometimes, but overall it’s been great.

The last two weeks have involved a lot of teaching sessions, which have all been quite good, but draining. A highlight was being drilled in a rheumatology clinic by the consultant, whose disappointed face when I got questions wrong will always remain with me. Seriously if I need motivation to revise, that’s what I will picture in my head…

I really enjoyed visiting the Children’s Physiotherapy Clinic, which only fuelled my wish to specialise in Paediatrics in the future. The kids were so cute! Taking histories from children is more challenging, especially when their parents get involved, so that was good for revision.

Another highlight was getting to clerk patients before they saw the consultants in fracture and pain clinics. I felt like a “proper” doctor, as we then had to examine the patients, present our findings to the consultant, and then come up with a diagnosis and management plan. So much fun!

In other news, our end of module OSCE in 2 days, ahhhhhhh, time has really flown by! At the moment I’m calm and doing my best not to panic, so that’s a good thing. The OSCE will consist of 6 stations, and we’re not told what they are beforehand, so it could range from joint examinations, to prescribing and giving injections, as well as consultation skills and data interpretation. Exciting times!

So I guess I should probably get back to revision then…

1

Module 2 Placement: Week 1

From people being left behind by the coach and having to get £40-£75 taxis instead, to inappropriate touching by consultants, as well as PBL group tension, our first week of secondary care placement was definitely not drama free! But I managed to get through it, so I thank God for that.

As we have now finished our lectures for Year 1, we have four weeks of hospital placement before our OSCEs and written exams, and the first week really flew by! The hospital I’m at is about an hour’s drive away, and we start at 9am, so I’ve been getting up around half 6 everyday. Not going to lie, the first day was really tough (probably had something to do with me only getting 6 hours of sleep…), but when you sleep earlier, you have more energy for the day, who knew?

I guess I shouldn’t really be complaining about early starts- medical students at my university have transportation provided for free, so we’re quite lucky in comparison to other healthcare students, who have to make their own way to placement. And during the drive to and from placement, I’ve been managing to get some revision done, so it’s not been too bad.

A highlight of the week was orthopaedic surgery, where I got to watch some hallux valgus corrections and bunion removals, which was quite cool. The surgeon I was with really grilled me on anatomy and carpal tunnel presentation and treatment; he put me on the spot and asked me to draw the brachial plexus! Fortunately, I was able to do it as that was the only upper limb anatomy I really went over during the Easter holidays, phew! Brachial Plexus 0-1 Tai.

Other highlights included going over examinations of the shoulder, hip, knee, cervical and lumbar spine. The consultant who went through that with us was our PBL tutor, so it was a pretty chilled, and very useful session. I’m feeling more confident with the examinations now, so I just need to practise, practise, PRACTISE. Our first aid session was also fun- I now (kind of) know how to do the Heimlich Manoeuvre, so yay for that! Here’s hoping I never have to actually use it in real life…