Theads

Hello,

This week I've had teaching on all the bits and pieces that are bundles together under the title of "Threads". I've been role-playing in Communication Skills, analysing papers in Evidence-Based Surgery, studying chemotherapy regimes in Oncology and debating controversial issues in Ethics. Some of the sessions have been useful - we've had pracise at speaking through an interpreter and some good tips on breaking bad news in Communication Skills (despite a cringeworthy performance from the sobbing actress who was receiving the bad news). Ethics has also been interesting. We covered consent and end-of-life issues this week, which involved a lecture on the law and the ethical principles behind it, followed by discussions based around cases.

As part of our Ethics assessment, we have to write a short essay based on a patient we've seen and the ethical issues surrounding their care. I'm thinking of writing mine about a man with learning disabilities who I met on my special study module, who was living alone with some help from carers and was rapidly increasing in obesity and deteriorating in health. He had been assessed by a psychologist as competent to make his own decisions about where he lives, but questions were raised as to whether he would be better off living in a home where he could have more help to stay healthy, as he appeared to have little insight into the consequences of his lifestyle.

Other parts of Threads have not been so thought-provoking. One lecture on patient safety stood out as mindnumbingly boring, and Evidence Based Surgery was simply a repeat of previous teaching we've had on Evidence Based Medicine, with the medical papers replaced by surgical ones. However, the teaching sessions haven't been particularly strenuous and I've had plenty of spare time to write an essay for an essay competition on issues related to student health that has been advertised to medical students, and to fit in some college-based tutorials.

End of SSM - Start of "Threads"

Hi,

I had my Special Study Module Assessment on Thursday,which involved sticking a poster up and being asked a few questions about it, and doing a 2 minute presentation in the lecture theatre. I doubt it gave much indication of how much or little work I've done over the 4 weeks, but at least it wasn't too strenuous! Since it's impossible to present everything I've found out about learning disabilities on a 105 x 55cm poster, let alone in a 2 minute talk, I chose to concentrate on the possible reasons behind the increased prevalence of schizophenia in people with learning disabilities compared to the general population. I wrote an essay on schizophenia in learning disabilities first, including other aspects like the diagnosis and treatment, just to get a better understanding of the area. I also found a case study to make the poster and presentation a bit more interesting - a lady in a treatment unit that I visited had schizophenia as well as learning disabilities so I spoke to her and had a look at her notes.

Now that I've finished my 4 weeks with the learning disabilities team, I've got 2 weeks of "Threads" teaching, which includes all the odds and ends that don't fit in elsewhere, like communication skills, ethics, and evidence-based medicine. It's not likely to be very exciting, but it does have the advantage of having a predictable timetable so I'll know what time I'll finish in the evenings and can plan other things more easily than when I'm on the wards. After that I'm off to Reading for a District General Hospital attachment for six weeks to refresh my memory of general medicine and surgery before our end-of-year exams.

Special Study Module

Hello,

I'm now over half way through the module I've chosen to do in Learning Disabilities and I've had the chance to see what most of the members of the learning disabilities team do. I've followed psychiatists on home and school visits, and seen a psychologist assessing children with learning disabilities who are new to the team. I've also spent time with the community nurses and with an occupational therapist. I think I'm just about getting an idea of how they all fit together!

The Learning Disabilities Trust in Oxford is a combination of social and health services, and there is a separate children's team. Most people using the service live at home, either alone (often with support from carers or family) or in groups of 4 or 5 in staffed houses. There are three inpatient units on the site where I'm based, for people with mental health problems or challenging behaviour associated with their learning disabilities - one is a short term assessment and treatment centre (although "short term" can stretch to months or even years), one is a longer term unit, and the third is a "step-down" unit for people getting ready to go back into the community. There is also a medium-security forensic unit for people with learning disabilities who have been taken out of the criminal justice system because their offences were associated with their abnormal behaviour or mental disorders. I've been to visit these units, and I've also been out to the shops with one of the STATT residents and a member of the staff there.

Yesterday I watched the child psychiatrist assessing a 7-year old boy with learning disabilities, to see whether he fits the strict criteria required to receive services from the learning disabilities team. The psychiatrist discussed his abilities and behaviour with his mother whilst watching him create havoc in the interview room, chewing up crayons and tearing up cardboard toy boxes. She explained that formally assessing his IQ, for example by seeing whether he could draw smiley faces, would be less useful than just watching how hw plays and interacts with people and using her clinical judgement.

After that, I joined a children's community nurse on a home visit to a pair of autistic brothers. They displayed some classical autistic behaviour, humming whilst sorting balloons into piles by colour and refusing to wear clothes, which was great for me to see. Although their mother was clearly an expert on their behaviour already, the nurse could help her understand and manage some of the stranger things they do. For example, one boy was creating problems by continually turning the washing machine on, and the nurse explained that this was probably a result of his sensory overload and attempts to control background noise, and suggested ways of preventing this, such as by providing toys that make a similar noise.

Finally, I spent the remainder of the afternoon in a management meeting, which contrasted starkly with the clinical visits by being possibly the most boring two hours of my life. It contsisted almost entirely of jargon about "virtual models" with "accounatbility" and "panels". It seemed to me like a very ineffiient way of developing plans to enable more children with learning disabilities to be helped within the county, which was the aim of the meeting. It also seemed ridiculous that this meeting was entirely for the purpose of formulating a summary to present at another meeting, where someone else would then hear the ideas and present them at a third meeting, and no doubt there would be many more jargon-filled meetings before any action was actually taken. Still, it was interesting to get an idea of what goes on behind the scenes of the NHS!

I'll look forward to getting back to following the learing disabilities professionals on their daily business today though.

Bye.