Thursday, 30 April 2015

Elective or: how I learned to stop worrying and regain my perspective

Block: Colorectal surgery, week 1

Okay so I've been back at med school for a week now, currently on an eight week surgical attachment which will see me rotate through colorectal, breast, and ear, nose and throat surgery. I don't mind surgical blocks - the clinics are normally good, but standing at the back of theatre for hours staring at the backs of the consultant and registrar is not that educational. If only there was more opportunity to be scrubbed in, even being the retractor monkey is more fun than simply standing around!

Also, surgeons are infamous for being massive grillers - they will ask you awkward questions, stare at you impassively whilst you try and piece together a coherent answer, then play all sorts of mind games with you once you actually come up with an answer. For example, they may ask - with a smirk or quizzically raised eyebrow - "is that really what you meant? Are you sure about that?" or worse, they sometimes ask another student "so, do you think he's right?"...and in the midst of such incredulity, I am often tempted to change my reply...only to be informed that I was right the first time all along. Words cannot describe how frustrating it is to get a question wrong because of self-doubt rather than lack of knowledge!

The medical side

My elective was a decent experience. I stayed in the UK, so if you're looking for stories about margaritas and Caribbean beaches or leprosariums (see "Extras") I'm afraid I have none to offer. I stayed in the UK mostly for financial reasons and because I thought I might have more learning opportunities. Yep, I'm a nerd. Since starting medical school, I have wanted to do pretty much every specialty there is, but for about a year now I've been quite attracted to emergency medicine. So I decided to do an elective in EM at a large UK trauma centre.

For the most part, what I did was quite similar to what I normally do on placement. I clerked in lots of patients, especially children in the paediatric emergency unit. I have yet to do my paediatrics block, so this was the first time (outside of GP block) where I've had the chance to clerk in children. It was a fun experience and one that I enjoyed. I realised that if I did want to do emergency medicine as a career, I'd probably want to subspecialise in paediatric emergency medicine. I also got the chance to brush up on the clinical skills I hadn't had a chance to practice in GP block e.g. taking blood and placing cannulas. I also got to do my first urinary catheter - not glamarous, but something I'll no doubt be doing as a foundation doctor, so a useful skill to get to grips with on a real person as opposed to a plastic model (it went in with no problems thankfully!).

I did a night shift and found it surprisingly un-crazy, though quite tiring too - by 5 AM I was really struggling to keep focused. I liked the team atmosphere in the emergency department, but I did feel quite nervous about simply slotting myself into a brand new department where no one knows me. I can't have been that awkward though since my supervising consultant gave me an "excellent" on my evaluation sheet for "integration into work environment", which was nice!

I observed the trauma cases and cardiac codes in resus and even got to have a go at chest compressions when a patient went into cardiac arrest in the cath lab following a heart attack. I  marveled at the brutal efficacy of the Lucas2 machines - there's no denying it, emergency medicine is exciting! You just don't see traumas or cool equipment like this on a normal ward. These aspects of emergency medicine were certainly interesting, but not a regular occurrence, contrary to what TV wants us to believe.

However, I found the lack of continuity a bit frustrating - whenever a patient was sent home to see their GP for further investigation or admitted to a ward, I kept wondering what happened to them! This was actually a big sticking point for me and made me think that emergency medicine perhaps isn't for me...I want a specialty where I get the feeling I've completed the job, as it were. I'll write more about this at a later date as it deserves its own post. I did follow up the patients who were admitted to the ward though, and it was gratifying to see that many times when I had clerked them in, the medical or surgical team who received them also had the same differentials in mind as I had.

The non-medical side

I think the most important thing I learnt wasn't actually related to medical science at all though. This was the first time I've ever worked with medical students from another university in a hospital environment. It made me realise something - medical students are all largely the same wherever we are in the country. We do the same tasks, get frustrated by the same things, have to complete the same sort of logbooks, sign off sheets and other bureaucractic things. We all feel overwhelmed, unconfident and can flounder under pressure whilst being grilled.

This sounds really obvious, but I think I'd sort of lost sight of it and for a long while I suppose I'd been erroneously assigning many of my frustrations to MY medical school, rather than the medical school process on general. I assumed everyone else was having a great time and I was the only one feeling cross about this and that.And that's meant that I've had a bit of a rubbish time as of late - every little thing that's gone wrong or been annoying has been due to MY medical school being a pain. But when I met and worked with other students from a totally different medical school, I saw that actually, they have the same grievances and worries as me. And that their med school makes them jump through the same hoops too, for better or worse.

By the end of the six week elective, I realised I actually really missed my medical school, the  teaching hospitals, and even the region I work in. I came back to my university town and my flat, and I actually felt quite happy and content, something which I've not felt in a while. This newfound perspective was worth much more than any number of patient clerkings or trauma calls, as it means now I can focus on my remaining placements safe in the knowledge that whatever I'm frustrated by, it seems to be the same everywhere. So hopefully that's another of my New Year's Eve worries alleviated.

Next time

I'll talk a bit about specialties - I wanted to do EM for a long time, but I'll go into the reasons as to why I no longer think it's for me and why being a gasman might be.

Extras

For an account of a less typical medical elective, I would really recommend The Motorcycle Diaries. A great film and well worth a watch.


Saturday, 11 April 2015

GPland, exams and elective

Block: Elective, week 4

I really need to update this thing more regularly - it's supposed to be for my own therapy so I have somewhere to discuss my feelings etc, but I neglect it shamelessly. Aside from anything else, it gives off the impression that I only come here to make negative posts. Talk about publication bias!

General Practice

GP was in January and February. From my last post I think it's quite apparent that I was in a very low period...2014 had been a very tough year and it hadn't ended amazingly well. A trip to GPland was just what I needed (though I didn't realise it at the time). So often as a student on hospital placements it's easy to feel totally disconnected as you try to slot yourself into a busy ward on a temporary basis. It's very easy to feel "in the way" and especially if you end up attached to a team where the consultant doesn't really take an interest in teaching you, it's very easy to feel lost, which raises stress levels, which doesn't help learning or mood.

Thankfully with GP it was different. My GP consultant was very friendly (as were the nurses, receptionists, patients and the caretaker!) and very keen to get me involved in seeing and managing the patients. The block was extremely well organised with regular teaching and clinical skills sessions, and all the tutors were really helpful and keen. It's the first block I've had since starting clinical medicine where I've felt I've really been able to enjoy myself with minimal stress.

It's also the first block where I've felt there's been enough time to actually talk to the patients. On a busy ward it's so easy to feel like a spare part, even if you take the time to take a history from a patient and present it back to a junior doctor it often feels like you're not really making a difference. But in the GP practice there was enough time to see the patient (who's often coming in with a brand new problem), come up with a diagnosis and a plan, present it back to the GP, then have it acted on. It felt like I was actually doing something. Me, the student!

I think the best way of alienating a medical practitioner (even one as formative and junior as I) from their job is to make them feel ineffective and as if their work boils down to box ticking and meeting targets. Targets can come in all different kinds of sizes and shapes, from government ones to med school demands on the number of reports you need to hand in per block. GP block does not have any reports which need to be submitted, just a logbook, so I was able to spend this eight weeks solely immersed in the medicine as opposed to running around trying to get signed off for this and that. Getting reacquainted with just how fun and amazing talking to patients can be is exactly what I needed to regain my motivation - something I was quite concerned about on New Year's Eve!

Exams

In mid-March I passed my first summative exams since starting the clinical phase of my course - very pleased with that! It had been a stressful few weeks leading up to the exams (as usual) and there had been no time set aside for study leave. I finished GP block on a Friday and the exams began on the Monday - but thankfully I managed to pass both written and practical parts which means...

...I roll onto the final year of medical school in September! It's nearly all over! Finals to go this time next year, then god help us all, I might actually be a doctor!

And I have more confidence in myself now since the fact that I've passed means that I must have been learning in an effective way since I started clinical medicine 14 months ago. Again, this was something I was worried about on New Year's Eve, so it's good to have some confirmation that things are going to plan!

Elective

Educational and illuminating - I'll do a proper post on this in a couple of weeks when I've finished.

If anyone is still reading this blog, I hope you're doing well.

Grumpy