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!