Hello,
I'm a little bit sleepy after another night-take on Tuesday, although I did get to walk up to the hospital so early in the morning for the post-take ward round that I was one of the first people to trample all over the snow! The take was reasonably quiet but I managed to clerk two patients, and did an took blood from an artery for the first time. Getting blood for arterial blood gas testing isn't actually very difficult, and probably takes less skill (and maybe a bit more luck) than putting lines in peripheral veins, but it is a lot more painful for the patient, so not getting it right first time means they have to be put through an unpleasant procedure twice. While we were on-take, there was also a bit of excitement in the resuscitation room, when someone with a ruptured aortic aneurism came in and were quickly rushed off to surgery.

Yesterday, I clerked some the newly admitted patients who I didn't see on take, including a university dean who knew more about blood circulation than me and insisted on telling me about various experiments while I was examining his cardiovascular system. We also had some bedside teaching, where a doctor took us to listen to some interesting heart and lung sounds. We have a "cross-firm" assessment next week, when I'll be tested on taking a history, examining ,and presenting my findings on a patient to a doctor from another firm. So the teaching was very useful to help with identifying signs of disease, and hopefully I'll be able to practise clerking more patients this morning, and tomorrow when we're on-take again.

I'm planning on being a bit more wide-awake this afternoon, as I have my case presentation assessment on the girl with diabetic ketoacidosis, who has now gone home. I'll have 20 minutes to talk about her case and the evidence for her treatment, and then be asked some questions by my consultant and other students on my firm. But right now, Im off to the hospital for a multidisciplinary team meeting.

Bye!

Hi,

After hitting a low of two patients, when one of our remaining 3 died, we went on take on Wednesday night and refilled our list. Night take lasts from 4pm until 8am the next morning, and is followed by a post-take ward round that goes on until about lunchtime, before the usual activities continue the next afternoon. Fortunately, students don't have to completely miss out on a night's sleep - I left before midnight and was back in the hospital in time to check on the patients I'd clerked before presenting them on the post-take ward round. Living near the hospital was particularly advantageous, as it meant I could go home to my own bed instead of using an on-call room at the hospital.

So after the lull at the beginning of last week, I now have plenty of patients to talk to and examine, and we're on take again twice this week so there certainly won't be a shortage in the near future. As part of our assessment for the general medicine attachment, we have to present a case to a consultant and the other students, and discuss an aspect of their care with critical analysis of a research paper. It's my turn to do a presentation this Thursday, and I've chosen to talk about a patient who came in on our take with diabetic ketoacidosis last week. She stands out from the usual general medicine patients, amongst whom under 80s are labelled as "young", since she is only 17. Ideally, we should have clerked the patient ourselves when they came in, but this girl went straight to intensive care so that wasn't possible, but I've been able to catch up on her original condition by looking at her notes. I'm currently writing my powerpoint presentation and reading up on the role of bicarbonate in the treatment of DKA...

Down to 3 patients

Hello again,
A week after out last take, my firm is now down to 3 patients and we won't get any more until our next take on Wednesday night, so there's not a lot of clerking patients to be done. The lack of patients has meant that our house officer has had a bit of spare time to teach us, but she's taking Monday and Tuesday off while things are quiet because she's owed some holiday, so there might be even less to do at the beginning of this week. It might give us an opportunity to do some of the jobs she normally does though, and practise at things like taking blood is always useful. And when there's nothing else to do, there's always the library to read up on topics covered by our syllabus.
On Thursday we had the first set of case presentations by students on our firm - each student has to be assessed on one at some point during the attachement. The idea is that we learn from each other at the same time, and I did learn a few new things from the three presentations. We also have a few other timetabled bits and pieces, including some pharmacology teaching and lectures on Friday afternoons. Teaching arranged with doctors on our firms is more flexible and is sometimes bedside and sometimes in little tutorials going over a particular topic like what to do with a patients presenting with chest pain or shortness of breath. Some colleges also arrange teaching from college tutors, and we have one who we can contact if we want any teaching. In addition, the 6th years, who are about to sit their finals, have offered to give teach us when they have a bit more free time!
I'm also still doing a bit of work based on my 3rd year project on embryology, since my project supervisor and I are hoping to publish an article about heart development. The unpredictable finish times at the hospital make it a bit tricky to arrange other things in the evenings, but I managed to meet him on Friday to go over the article and to sort out what we need to do next. I'm currently drawing some diagrams for it while he tries to get permission to reproduce some relevent images from reference articles.
Weekends are refreshingly free - other than drawing embryology pictures and a bit of reading and note-making on conditions I've seen at the hospital or on the syllabus, I don't have to do anything work-wise at the moment. It makes a nice change from preclinical essays, although there are occassional things like case-presentations to write at various stages. Fortunately, I've ended up on a firm that happens to have no weekend takes while I'm on the general medicine attachment, while others have several. Takes at weekends inolve being at the hospital Saturday night and Sunday during the day, so they are pretty exhausting and don't give you much of a break between weeks. Although at least having a weekend take might give me more than the current 3 patients to talk to and examine - I think they're getting a bit bored of medical students now!

Hello,
A week into my general medicine attachment, I've trailed round after a fair number of ward rounds and yesterday we had our first "take" of the year. All the general medicine firms of doctors take turns admitting new patients on-take in the Medical Addmissions Unit. Take is a great opportunity for us to clerk patients (take their history and examine them) because, provided a doctor has confirmed that they're well enough, we can be the first to see them and come to our own conclusions about what's wrong and what can be done. We're supposed to clerk 30 patients in the 6 week attachement, some on-take and some of which can be re-clerking patients already seen on the wards. It's suprisingly difficult to find patients on the wards to clerk, in a hospital full if them, because they have to be being looked after by our firm, be awake, not have visitors/nurses/occupational therapists/physios with them, not be so ill or demented that it's impossible to talk to them, and agree to being seen by a medical student. Take is therefore a great opportunity to top up the number of patients we've clerked.
We were on Day Take yesterday, seeing all the patients referred by GPs of coming through A&E between 8.30am and 4.30pm. Unfortunately they all came in a rush in the afternoon, which meant that I only got to clerk one (although I also got to watch a doctor clerking a man with catatonic depression, which was interesting). After clerking a patient, you have to present them to the consultant on a post-take ward round - telling him all the important points you've found and your analysis of the situation. Since consultants are supposed to be scary and critical (although all the ones I've come across have been perfectly civil and generally fairly indifferent to students) and so that the ward round goes quickly and smoothly, we can practise presenting our patients first to a senior house officer or registrar, during the take.
After we saw all our newly-admitted patients and looked at their X-ray and other investigations with the consultant, we went to the doctors mess to discuss their management, and then were finished by 8. This morning we have another consultant ward round, where we'll see the same patients plus those who were already under our firm.
A little added excitement yesterday was a cardiac arrest call, which it was my firms responsibility to respond to because they had the arrest bleep. It was actually a false alarm, with a patient collapsing after a gastrointestinal bleed but not actually arresting, so he was just topped up with blood and clotting factors. Running up from the medical admissions unit to general medicine on level 7 made a refreshing change from standing around waiting for patients to clerk though!

Back on level 7...

Hi,

Having passed the pathology course (I got a merit) and had a 10 day break for Christmas (I had no work, other than writing a voluntary essay for a pathology essay competition, so even though the holiday was shorter than previously, it was more of a holiday), I'm now back on the general medicine wards. We had a day of learning some more new clinical skills yesterday, before we were let near any more patients. They included setting up drips and infusion pumps, giving oxygen and various inhalers and nebulisers, giving injections, and testing lung function. We also got to practise our cannulation technique on models and do ECGs on each other.

Today we had an introductory lecture and overvview of interpreting ECGs and chest X-rays, and then we met the doctors we'll be with for the next 6 weeks. I'm in a group of four students, two of which are fast-trakers (people who've done other degrees and are now doing a 4-year medicine course, and who tend to be scarily intelligent). Our pre-registration house officer and senior house officer gave us a quick tour of the wards, which are the same ones I was on before the pathology course, and a reminder of how to spot rapidly deteriorating patients and what to do about them, before we got started. We then followed them as they checked a couple of patients and took blood from a couple more.

Tomorrow we have a communication skills session first thing and then we'll be back to meet more of our patients. We have some timetabled lectures on Friday afternoons, but other than that we'll mostly be seeing patients and following doctors, and arranging a bit more teaching with our doctors, for the next few weeks. There are also various assessments, including a case presentation, and we have to fill in a log book about the patients we examine and take histories from, and when nothing else is going on we'll be free to read up on the conditions we see, aiming to cover the important presentations on our syllabus. That seems to be the general plan, anyway, but we'll see how it works out over the coming days...