Enthusiastic obstetricians

Hello,

After a week of obs and gynae lectures, I think obstetricians and gynaecologists are the most enthusiastic doctors I've come across. Either that, or they're desperate to recruit more of us to an area that is short-staffed at the moment. Most of our lectures seem to start with a talk about how amazing it is to be an obstetrician/gynaecologist, and some lectures are almost entirely taken over by raving about the speciality. The enthusiasm has been accompanied by some great teaching, though, and the lectures on everything from scanning babies to prolapse and incontinence have been interesting.

I sat in on a family planning clinic yesterday morning, which operates on a drop-in basis and was unfortunately rather quiet. I only saw two patients, one of which left with an appointment for a termination. However, the nurse and doctor who I was with were very helpful and talked to me about relevent things while we waited for patients.

I've got several lectures on complications of labour and pregnancy coming up next, so I'm off to read up on those now!

Obs and gynae begins

Hello again!

I'm back after a three week holiday, to stary year 5. Interestingly, this "term" is longer than a whole year's worth of undergraduate terms at Oxford!

We're now in firms of about 27 students, which we chose ourselves by a ballot system. Each firm rotates round a series of 8-week attachments, and my firm is starting with obstetrics and gynaecology. We've got two weeks of teaching (mostly lectures) to start with, followed by clinical experience of delivering babies etc, for which I'm off to Stoke Mandeville hospital in Ayelsbury.

The teaching so far has been great - we had an introductory day (with quite a lot of waffle, but the impression that the attachment is well-organised by thise in charge), and we've had lecture on normal labour, menstrual disorders and menopause & HRT today. This afternoon we had an ethics session on termination, discussing our views and the law around a few case studies.

We also have a bit of hands-on experience during the lecture course, with a clinic or two, some laparoscopy training, and practise at vaginal examinations on "clinical teaching associates" (normal, healthy women who are paid to teach us how to examine their own gynaecology). But more about that when I get to it!

Post-OSCE

Hi,

I had my end-of-year OSCE (Objective Structured Clinical Examination) on Wednesday, and found out today that I passed it. There were 11 stations, which we rotate around every 5 minutes (or 10 for the communication skills station) when a bell sounds.

I started off with breast examination, where a model was tucked up in bed and in the 5 minutes I had to examine its breasts and lymph nodes and present my findings. Next, I was given a post-op fluid balance chart to interpret and answer questions on. Following that, I moved on to a practical skills station, where I was asked to insert a nasogastric tube into a model, and then to another data interpretation station with a chest X-ray to discuss. Then there was 10 minutes of explaining catheterisation to a patient (well, an actor pretending to be a ridiculously over-concerned patient) to assess my communication skills, followed by 5 minutes to take a history from another actor complaining of leg pain on exertion and answer questions about his symptoms. Although most of the examiners were very friendly and encouraging, the surgeon in charge of this station seemed to have got out of bed on the wrong side. Fortunately, discussing the OSCE with other students afterwards revealed that he was equally unpleasant with everyone. ECG interpretation came next, where I had to identify signs of a heart attack affecting the inferior part of the heart and discuss management of the condition, and then interpretation of a set of blood results showing chronic renal failure. Then came a cranial nerve examination and ophthalmoscopy, basic life support skills on a dummy, and finally an abdominal examination of an actress with the most over-the-top abdominal pain I've ever seen!

The OSCE wasn't quite at the end of the year, as we still have another week left, allowing those who have failed to resit. Next Friday we've got a written exam, but this one is formative (meaning that it is designed to help us see how we're doing rather than to test us, so our marks don't actually count for anything) unlike the OSCE which was summative (has to be passed and marks are recorded). There wasn't a lot of point in going back to Reading for one day so I'm just taking the opportunity to read up on some rheumatology ready for going back next week. Hopefully the complicated fiddling about with various drug regimes in rheumatology clinics will make a bit more sense next week than it did last week when I was more concerned about preparing for the OSCE than mastering rheumatology.

Bye.

OSCE preparation with added interest from the cardiology ward

Hi,

Yesterday, whilst looking for patients to practise my examinations on, in preparation for my end of year OSCE (objective structured clinical exam), I came across the first person to ever have a permanent artificial heart, or ventricular assist device. He had the pump implanted 7 years ago in Oxford and it's still going, although he did once have the camera bag in which he carries the power supply stolen - fortunately an alarm that went off when the batteries disconnected frightened the thief and made him drop the bag, and the temporarily heart-free man was able to quickly plug his pump back in. A house officer suggested I examined his cardiovascular system without telling me why, but when I saw the power lead coming out his head, felt his lack of any pulses, and heard the continuous whir in his chest instead of heart sounds it soon became clear what was going on. Unfortunately, not all patients are that obvious - the next one I examined had three different heart murmurs all on top of each other and was a retired chest physician who added to my difficulties by quizzing me on the physiology of haemoglobin while I tried to decipher the plethora of sounds coming from his heart (needless to say, I didn't get them all!).

As well as examining various body bits (abdominal, cardiovascular, vascular, respiratory, neck, breast, lumps, cranial nerves, peripheral nervous system and general examination) in the OSCE, we'll be asked to take a history from a patient, demonstrate our basic life support skills, and other practical skills (like nasogastric tube or IV line insertion), and interpret results (from ECGs, chest X-rays, blood tests, etc). We rotate round the stations, each of which is only 5 minutes long apart from one ten-minute communication skills station. All the "patients" are actually just actors so there shouldn't be much to find on examination - it's just to show we're confident with all the routines really. It's a good practise for 6th year when we have real patients in the finals OSCEs.

As well as finding any willing patients, housemates, etc, to practise clinical examinations on, and looking at as many ECGs and chest X-rays as possible, I'm still doing the usual ward rounds and clinics with the rheumatology firm I'm on at the moment in Reading. Most of the patients on the ward are general medicine rather than specifically rheumatology patients, but there have been some interesting cases to see in clinics - rheumatology encompasses a lot of autoimmune and other conditions that affect many body parts as well as the joints. Because they can affect so many systems, these conditions (things like lupus and vasculitides) pop up on lists of differential diagnoses all over the textbooks and it's interesting to see them in real life. A few have added interest because of their very descriptive names, like the "stiff man syndrome" affecting one of the rheumatology patients!

So it's a busy week ahead spread between rheumatology in Reading and OSCEs in Oxford. With tendon hammers, pentorches and stethoscopes at the ready to practise on any volunteers!

Finishing surgery in Reading

Hi,



I've come to the end of my 3 weeks of surgery in Reading, and I'm about to move onto medicine there, with the rheumatology firm. I've enjoyed the surgery attachment, especially having the freedom to go to clinics, operating lists and wards outside of my upper gastrointestinal firm to see a broader range of conditions. As well as seeing lots and lots and lots of gall bladders being removed and hernias being repaired, I've also seen a leg being amputated, an abdominal aortic aneurism being repaired, an oesophagus being removed, an unexpected tumour being found (during one of the many gall bladder operations) and a stomach being tied around the oesophagus to prevent reflux. In addition to being free to roam around the wards seeing and examining patients, I have been able to visit departments to see investigations (like barium radiology and angiography) and procedures (such as putting central venous lines in) that I haven't watched before. In terms of practise for the practical exam that I have coming up, the most useful time spent has probably been in the Surgical Emergency Unit where new patients come in and we can take histories and examine patients before anyone else gets to them (when it's actually part of their care as well as our learning and before they get bored of telling their stories). After seeing a patient in SEU, we present our findings to a doctor with our impression of the problem before the doctor goes to see the patient for themselves and checks out our diagnosis. It's also a great place, along with the anaesthetics room before surgery, to get practise taking blood and putting venous lines in, as pretty much every patient in SEU requires this.



My final 3 weeks in Reading are broken up by an exam in the middle of the second week, which I'll need to go back to Oxford for. Until then I'll be taking every opportunity to practise things that I'll be tested on, particularly examining patients. Hopefully, however, I'll also learn a bit about rheumatology - we're all spread around different general medicine firms so most people won't have the chance to do a specifically rheumatological attachment at any stage.

Bye for now.

Friendly surgeons!!!

Hello!

I've been back in Oxford for the weekend but I'm just about to go back to Reading for my second week of District General Hospital attachment. Despit being a lot smaller than the John Radcliffe, where I've been so far, the Royal Berkshire Hospital, where I'm working now, is very big for a DGH and since it only has 12 medical students in it, we have a lot of freedom to go and see what we want to without stepping on other students toes. I was originally meant to be attached to the lower gastrointestinal surgery firm but I'd already been on that firm in Oxford so the consultants were happy to let me swap to upper gastrointestinal surgery, but also for me to go and see what other surgical firms get up to as well. I was a bit concerned when I went to the lower GI consultants and asked to move off their firm and one said, "do you think you know everything about lower GI already?", but in fact he wasn't about to bite my head off but was just offering to let me come to his clinics if I wanted to see any more of lower GI after moving to upper GI! All the doctors are considerably less fed up with having medical students around than in the John Radcliffe Hospital, and even consultant surgeons seem to be friendly!

As well as being less fierce, the DGH surgeons have been making a more visible effort to teach us on ward rounds, in theatre, and in clinics. Whereas the doctors on some firms I've been with previously have never acknowledged my presence despite seeing me every day for several weeks, the ones I'm with now discuss patients with me on ward rounds and point out interesting patients for me to go back and talk to or examine. In theatre, I've been asked to scrub in and assist, rather than having to ask myself, and surgeons have gone over the anatomy with me in laparoscopic surgery where it's all very clear to see.

I'm living in hospital accomodation during the week. The other students are together in one housing block, and I'm just a few blocks down with some staff nurses. The rooms are very much like college rooms, with shared bathrooms and kitchens. It's not quite as nice as being at home in Oxford but it does have the advantage of only having to walk for a few minutes to get to early morning ward rounds (although at the moment it's taking me just as long to find where I'm meant to be going, as I don't know my way around the hospital yet!). It's also only about 45 minutes drive from Oxford, and I have a very kind fellow student coming to give me a lift back there now, so I'd better go!

Bye!

Off to Reading...

Hello,
I haven't got much to report, as I've just had another week of Threads teaching, which has been similar to the week before, but I thought I'd write something before I go off to Reading for my attachment at the Royal Berkshire Hospital. The second week of Threads included some more ethics, this time about genetics (for example, should you break confidentiality if information about the genetic condition of one member of a family could affect the reproductive choices of another member?) and human experimentation (e.g. is it ok to conduct research into markers for Alzheimers Disiease in the cerebrospinal fluid by doing lumbar punctures on people with too advanced dementia to give valid consent?). We also had some more communication skills sessions, including how to deal with an angry patient (there were even fewer volunteers than normal to be the first to face the actors!), and some more oncology teaching. In addition, we had some time to practise clinical skills in the skills lab - catheterising models, cannulating each other, etc.
For the first time, we've been given the Bank Holiday off today. Which means I have a nice short week to settle into living at the Royal Berkshire Hospital before I come back to Oxford for the weekend. I'm just packing to leave now, and I'm hoping to get back in time for Friday afternoon lectures, although that might not be possible. I haven't been told a lot about what I'm doing there yet - apart from that it will involve some surgery and some medicine. I suppose I'll find out soon though! I've heard good reports from other students about the hospital and all District General Hospitals have the advantage of more patients and doctors per student to keep us busy.
I'll let you know how it goes soon!