Hello!

This week we've been doing similar sorts of things to last week - taking histories, examining patients etc., and although it's still fairly unpredicatable what we'll be doing fom one day to the next, the general pattern of the sorts of things that go on is now more clear. On Monday we had manual handling training, which was unfortunately at the same time as the consultant ward round, where we usually get a bit of teaching. It was useful to be shown ways to lean immobile patients forward in bed of roll them to examine their backs, but a lot of the instruction we were given was fairly impractical because it invloved using sliding sheets which aren't normally available on the wards.

Yesterday we were on take again, receiving and clerking new admissions from GP referrals and A&E. This time it was much busier and I could actually be of use examining patients and reporting to the doctors for them to check out my findings. I also had another chance to take blood and another, unfortunately unsuccessful, attempt at cannulation. Reassuringly, the nurse who took over from my failed cannulation attempt also had trouble.

Today, after joining a ward round, I went with a patient who was admitted yesterday for a CT pulmonary ateriogram. This scan shows up blood clots on the lungs. I also watched a heart ultrasound today, on a patient with an abnormal heart valve. Apart form that, it was a fairly quiet day. I examined a couple of patients and was about to examine another but sadly she died just before I got there. By 3pm there was nothing going on so I came home and did some reading up on the conditions I'd seen.

Learning on the wards...

Hi,

We're now getting used to learning on the wards, although students attached to different firms seem to be having quite different experiences. Some people have been in surgery, helping with amputations and aortic aneurism repairs, and others have spent more time chatting with elderly patients with multiple medical problems. Some have had less pleasant experiences - one group watched one of their patients have a heart attack and die, despite the doctors and crash team trying to resusitate her, today.

The wards I've been in aren't too busy at the moment, and the latest I've stayed this week is 8.30, when we were on-take (our firm's turn to admit new patients). Most days I've finished before 5, although the unpredictable timing can make it difficult to make plans! At the moment, there are a limited number of patients who are suitable for me to practise examinations and history-taking on (i.e. conscious, reasonably cooperative patients who are well enough to talk or move a bit) but there is enough going on to keep me busy most of the time. I've been able to follow a patient from her admission to her discharge, clerking her myself and presenting her to the consultant on his ward round, and then taking her blood sample and sending it off for testing, and accompanying her to and exercise ECG test. There are some frustrations (for example, spending a lot of yesterday waiting for a patient to go for an ultrasound-guided pleural tap and another to go for a gastroscopy so I could watch, and then missing them while I was with another patient), but the experience is still really interesting and enjoyable. As well as watching how things are done and practising examinations, I've been able to be of some use - today there was no house officer on duty during the ward round so I could make the patients' notes. I've also got a nursing shift planned for next Friday (one of a few things that we have to complete in the 3 weeks we're with these firms), when I should be able to take some more bloods and maybe cannulate a patient or two.

Alongside the practical experience, we've had a bit of teaching - some from the doctors on our firm and some central teaching from the medical school. For example, we've had teaching on Basic Life Support and communication skills (with actors in place of patients), and some Clinical Problems teaching (today about an HIV positive patient with pneumonia). Although there's no-one checking up on how much work we do, it's useful to read up a bit in the evenings on the cases we see during the day, as it's much easier to remember facts about conditions that you've actually seen. Our consultant has also asked us to read up on a few things he's pointed out on ward rounds, and then asked questions on them aftewards, but the amount of work involved in that sort of thing is pretty insignificant compared to what we've been doing for the last 3 years. Plus, it's actually really interesting to read about the reasons that our patients are in hospital!

So I'm looking forward to getting back to the hospital after a bit of a rest over the weekend (there are A LOT of stairs between the Medical Assessment Unit on the 1st floor and General Medical wards on the 7th floor, where our patients are located!)

Bye!

Byebye MedEds!

Hi,

Our 6th year tutors (MedEds) have gone off to revise for their finals and left us now. They cooked us dinner on Wednesday night, introduced us to our House Officer on Thursday, and then yesterday we were all on our own! We now have 3 weeks to practise our examinations on patients and learn from the firm of doctors we've been assigned, before our GP placements and miniOSCEs (tests). Although I was initially part of a group of 6 students, the 'firm' we are atttached to, General Medical C1, actually consists of two separate firms of doctors, C1a and C1b. So we've split our group in half and I am with two other girls on C1a.

After a couple of lectures about learning on the wards, the three of us decided to bleep our House Officer and ask if we could have a look at some patients. He suggested three patients who were non-demented and well enough for us to examine, of which one was alseep and one had a visitor, so we were only able to see one. Our history-taking was a bit tricky because she was profoundly deaf but, when looking in her notes after examining her, we were pleased to find that we had correctly identified her heart murmur, enlarged heart and lung crackles. By then the House Officer was busy and couldn't think of anything else for us to do so we had a break and wrote up the case, just for practise. The morning was a good taster of the sort of thing we'll be doing for the next few weeks, as well as following ward rounds, and helping with any jobs like blood-taking and cannulation that we are allowed to.

Yesterday we had our first sponsored lunch, where companies such as the Medical Protection Society and Medical Defence Union feed us and give us free pens, tourniquets etc., and discounted books, in the hope that we will join them later on. There were also stalls where we could sign up to the various clinical medics' societies. I signed up to get more information about a few societies, for example Restart, which goes into local schools to teach children basic life support, and the Christain Medical Fellowship, which I've not really had time to get involved with before now.

And now I'm home for the weekend, so I'll let you know how MedEd-free clinical school continues next week!

Bye!

Work and relaxation

Hello,
We've continued to speed through more examinations and practise them on patients, usually people who don't actually have anything wrong with the system we're looking at. At the moment we've just got to get the hang of all the different examination routines, rather than worry about what we find. Friday was neuro day - we went to the soon-to-close Radcliffe Infirmary for some lectures and bedside teaching on examination of the nervous system. We also had a lecture on ophthalmoscopy and were sold ophthalmoscopes, and hopefully tomorrow we're going to be taught a bit more about their use (rather than just shining bright lights in friends eyes and having a look!). We're also going to the skills lab again tomorrow, where we'll be able to practise our blood-taking, and also learn some new skills like cannulation.
So far, although it's a bit tiring being in a new environment and doing new things as well as having Fresher's Fortnight stuff organised for the evenings, the pace of work is much easier than preclinical. The longer terms seem to be alleviated by fairly free evenings and weekends. At the weekend I went to Stratford-upon-Avon for a day and then had a friend to stay, which would have been impossible in much of our first and second years. It was reassuring to chat with our medic "parents" on Friday night, as well as other 5th years, and hear that apart from around exam times, we will continue to be able to get all our work done during the week.
At the moment, however, armed with our new tendon hammers etc., enthusiastically practising techniques in the evenings is something we want to do whether it's neccessary or not! In fact, I might go and examine another housemate now!
Bye bye!

Getting stuck in...

Hi again,
It might only be 24 hours since I lasted posted anything here, but we're speeding through the basics of clinical medicine and have now covered abdominal examinations and practised a couple on patients on the wards. Living in a house of 4 medics, we've also been practising poking and prodding each other. We're all in different groups and so have done things in a slightly different order but it's useful to have an advance preview of how to do a cardiovascular examination at home before we do it with our MedEd tutors. A poor visitor who popped in to say hello last night heard nothing but our overexcitement about things we'd seen on the wards and comparisons of what we'd learned.
Since it is our Fresher's Fortnight at clinical school, there are also activities arranged for the evenings. So far we've had a BBQ, a trip to St Giles Fair, and last night a pub quiz at Osler house, which is the equivalent of a student union for clinical medics. As well as being a bit of fun and helping us to get to know the medics we've spent the last 3 years with better, this encourages us to intergrate with the 15 newcomers who have transferred from Cambridge and the 3 from London. Within our MedEd groups we are also getting to know each other better (including our organ systems!), and we have been allocated 5th year parents and 4th year brothers and sisters who we will meet for a meal tomorrow.
Now I'm going off to the hospital to learn and try out some more examinations.
Bye!

Clinical School

Hello,
The finals results were a bit delayed so I was off on holiday before they came out, which seems like a long time ago now. I passed clinical anatomy, got a 2i in my finals, had a good break over the summer and am now back in Oxford for clinical school. I came back a couple of weeks ago actually, to help with a children's holiday club and settle into my new house, but term only started this week. On Monday, we had a series of introductory lectures, and sorted out administrative things like security badges, as well as buying stethoscopes, tendon hammerds and pen torches, and collecting white coats. Yesterday we got stuck in with a morning in the clinical skills lab, where I learned to take blood, first on a model (just like at medsim!) and then on my MedEd tutor. MedEd tutors are 6th years who have chosen to so a special study module in teaching, and they're looking after us in small groups, attached to a medical firm, for the next couple of weeks. Taking blood was actually much easier on a real person, and I was qiote happy to let another student have a go on me. In the skills lab we also tested some urine and did a blood glucose test. Then in the afternoon we learned to take a medical history from a patient and then went onto the wards to practise our new history taking skills.
Today we're off to do some abdominal examinations!