DIY Medicine

It seems like ages since I last blogged but I've not really been up to much. I'm doing a 3 week SSC at the moment, and rather than do yet another clinically based one I decided to make my own, and so I'm spending 3 weeks looking at Medical Education, I subject which I'm for some reason almost ashamed to say, fascinates me. It a fairly simple project, or so I thought, mainly a library based literature review sort of thing. Also means I don't have to drive to hospital every day which is a good thing and I get the occasional long morning in bed (when missbliss doesn't poke me for a lift to school)

So, medical education, bit of an odd topic for an SSC I hear you cry, well maybe it is. To be honest, I was hoping for the chance to write 4000 words on the shortcomings of Problem Based Learning (PBL), that is probably what I'll end up doing but already I've found so much more than that. I've even dared to venture into the depths of learning itself, what is learning? What is knowledge? Two questions which lots of old dudes with long names seem to have take a lifetime to waffle about back in the days of temples and dragons. I find myself strangely curious about it all, if somewhat embarrassed that I'm this interested.

I still don't know how to feel about PBL and I've been doing it for 4 years! As a concept its probably quite good, and it has its advantages, but in practice it just doesn't work like it should, whatever the reasons (and there are plenty.) Although saying that, I think a lecture based course would have killed me. So, this SSC is going to be a bit of a voyage into the unknown, who knows where I'll come out on the other side, and what I'll think by then, perhaps I'll have solved a few of the worlds problems along the way, one thing is for sure, if you stay tuned, I'll let you know.

Hot for teacher...

As promised in reply to missbliss's advantages and disadvantages of going out with a medical student below are the advantages and disadvantages of going out with a teacher, in particular an English teacher. Personally I think teachers and doctors go quite well together, I think my gran would agree, she was a teacher and my grandad was a doctor.

Disadvantages:

• They always beat you at scrabble
• They have too many books
• They shout at you like you’re a child and are actually quite scary *cowers*
• They are always stressed with paperwork/marking/other school crap
• They use their ‘classroom tactics’ on you to make you do things that you don’t really want to (or is this just a thing that all girls do?)
• They get too many bloody holidays!
• You get an idea just how shit schools are, and what a state some of the children are.
• They have no patience left after a day at school so you always have to be on your best behaviour or face their wrath.
• They have good classroom hearing and always hear when you mutter under your breath
• They have the ability to phase out people talking to them, consequently you often get ignored.
• When you’re out, every child is a potential disaster area and if said child falls over or does something naughty they are first on the scene.
• You’re the teacher’s boyfriend so whenever you pick them up from school you get stared at.

Advantages:

• They are great at checking blog posts/projects/other writing for punctuation and grammar
• They are generally clever and can therefore just about keep-up with you when you babble about medical stuff
• They are CRB checked so are probably not psychotic murderers
• They can teach you really well about stuff you don’t know how to do. (Spelling in my case – no more spelling definitely with an a)
• They’ve always got interesting stories about school and children
• They can tell you about good books so you don’t have to go reading any old rubbish
• They have resources and can tell you all about special needs in education. (Very useful when you have to do a presentation on said topic aimed at teachers)
• You get to tag along with trips to the theatre (I wasn’t sure if this was an advantage or disadvantage but on the whole its been good so far)
• They are great potential parents and so are useful to hang on to for the future
• They get long holidays and so can look after you when you have long days.
• They are organised and can keep track of all your important documents when you just have them in a big pile

The Post-Exam Relaxation phase...

Everyone who has ever sat an exam will know the feeling you get as soon as you've finished them. Even if you've not done great, once it's over with if feels wonderful, you can stash into a folder/tear up/burn your revision notes and forget about them (at least till finals.)

So this week, with no exams hanging over my head I've had a relaxing time, except well...I haven't really. I mean I've got now 'work' as such to do but I still find myself with a to-do list the length of my arm. Wednesday was taken up with such niceties as visiting the dentist. Thursday I spent the day hunting consultants in the hospital to organise what I'm doing for the 3 months. Unfortunately both of them remained elusive, much to my annoyance (mumbles to self: Consultants are busy people I must not moan when they aren't where they say they'll be...grrr) Seriously no wonder the waiting lists are as long as they are, its impossible to see a consultant that you're supposed to be under if your a medical student never mind a patient. Friday I spent the entire day doing a little job to earn some money to try and make the tiniest of dents in my very large overdraft. Although I must admit, I also spent the whole day paying Football Manager on the computer at the same time as working.

I've still got huge list of things to do which includes preparing my portfolio before I meet with the Dean next week to discuss my progress. This meeting usually descends into a list of moans and groans on my part, but I've got lots of reflection to do before then. I've also got to start researching medical education for a student selected component (SSC) which I'm doing for the next 3 weeks. I need to organise an MOT for my car and sort out the insurance (oh joy of joys). I also need to finalise plans for my elective by sorting out the flights. I foresee a very expensive few weeks ahead.

Coming soon: In response to missbliss's pros and cons of going out with a medical student, I'll be preparing a similar list about teachers.

I love vaginas!

Ok, well maybe not, but obs and gynae has come to my rescue! (I never thought I'd hear myself say that)

Today's obs and gynae OSCE went really well, much better than yesterday's disaster so I'm happier now and hopefully more confident. Again it was a very fair exam but this time I feel I just about did myself justice.

OBS AND GYNAE (again, excuse the dodgy numbering, I did them in the following order)

Station 3 - Scenario: You have been asked to take a swab for chlamydia and perform a bimanual examination, please do so on on this model and talk to it as though it is a patient.

I walked in and I thought shit, there is no way I'm going to be able to do this in 5 minutes but I launched in and before I knew it I was finished. I'd done everything that was expected of me, even my communication skills were almost perfect (although its bloody strange talking to a plastic pelvis.) I had a spare minute at the end. Maybe I forgot something major, it seemed too easy...

Rest Station - This time I was able to reflect on my good start, and I got an orange slice and a drink to refresh me

Station 4 - Scenario: This lady has an embarrassing gynaecological problem, take a history from her.

Hmm, another full history in 5 minutes... it's ridiculous to expect us to do that really. But I did my best. I made sure my communication skills were up to scratch and I was fairly pleased but I didn't have time to discuss the potential treatments and or tell the examiner that I thought she had stress incontinence. That was more of a time problem than a problem with me though.

Station 5 - Scenario: GUM viva - Given results of various tests and had to give a diagnosis and treatment and talk about other aspects of the case.

It was a strange one but I kind of stumbled to the conclusion that the diagnosis was bacterial vaginosis and mumbled something about metronidazole as a treatment because I think that's what I read. But from then on I was back to waffling like I did yesterday. Hopefully I said some good stuff and got some good marks but I was a little unsure about this station.

Station 6 - Scenario: Counsel this simulated patient re. male sterilisation as a contraceptive technique.

I wasn't really prepared for this station but I think I came out of it pretty well, I don't think I emphasised the permanence of the procedure but I addressed his concerns and allayed some fears. It was all about communication really (at least I hope it was because I didn't know a great deal about the procedure itself)

Station 7 - Scenario: Comment on and discuss this partagram.

The only station that went badly. I've never really looked closely at a partagram before, yes I've seen them in books and on the ward but I've never studied one or seen exactly what is on one and why. I managed to bluff my way through explaining most of it although the examiner obviously knew I'd not really seen one before (thankfully other people said the same afterwards) I kind of messed this station up but the examiner was nice and hopefully I bluffed some marks somewhere along the lines. If only it had been a CTG.

Station 1 - Scenario: Examine this pregnant lady as you would during a routine ante-natal appointment.

Another success, again I'd learnt and practiced the procedure well. I knew what I was doing and what I was talking about. My communication skills where up to scratch and I'm fairly sure I didn't miss anything dramatic.

Station 2 - Scenario: Examine this plastic model of a breast, as you would a patient. Answer questions on your findings.

A nice easy one to finish off, I knew exactly what I was doing, I'd practiced well and I was slick at the examination. I found the two lumps in the fake breast and was able to give a diagnosis, how I came to that diagnosis and how I would confirm the diagnosis.



So, all in all, not a bad exam today, most of it I could have predicted and I'd revised most of it quite well. My examinations were good as were my communication skills, there were a couple of dodgy moments but aren't there always? Hopefully I've picked up a few more marks today to drag my mark up a little. The best thing about today was that post-exam relaxation feeling, although being in quarantine for a couple of hours soon saw me wanting to maim some of my colleagues. So...WOOO! Potentially no more OSCEs till finals *touch wood*

Children Down, Vaginas To Go.

I didn't think 'one down, one to go' was quite right for this post.

My paediatrics OSCE is done, to be honest I'm disappointed in myself, I know I should have done better, it was a relatively fair exam, I just didn't fulfil my true potential. Its worse when that happens. I could just about cope if it was a horrible exam or if I didn't know anything but when you know the stuff but it all just goes a bit tits up, its fucking annoying.

I hope the uni won't get mad at me for explaining the stations (they shouldn't because everyone has done the exam by now)

PAEDIATRICS: (excuse the dodgy numbering, its the order I did them in)

Station 3 - Scenario: Young boy admitted previous night with exacerbation of asthma, comment on his vitals and examine him.

So, I looked at his vitals, but I wasn't exactly sure what comment on them meant so I just remarked that they had improved and took a few guesses at normal ranges of peak flow for children. Then disaster struck, I flunked the respiratory exam, Fuck knows why, I've done it a million tomes, maybe it was nerves, maybe I'm just stupid but I completely fucked it up, I did stuff in completely the wrong order, I forgot to even bother to do most of the stuff and the stuff I did do was rushed and messed up. What a waste, a fair and easy station but I flunked it.

Rest Station - Great, 5 minutes to reflect on my disastrous first station, just what I needed, I took a drink and a jammy dodger before carrying on.

Station 4 - Scenario: Mother attends GP because she is worried about her 7year old daughter who is putting on weight. Take a history.

Probably my best station, my history was good, I almost froze at a couple of points but I bought myself some time with open questions and managed to cover as much as I possibly could in 5 minutes, which again is ridiculously little time to take a decent history. (even GPs have longer than that) I addressed the mothers concern, I even summarised, and started to make a plan before the buzzer went.

Station 5 - Scenario: Mother has just a baby which has been diagnosed with Downs syndrome. She would like some more information on the condition. Discuss it with her.

A strange and somewhat unexpected station although it was fair I suppose. I could have talked about the signs and symptoms of Downs, even discussed the genetics in depth but I was much less sure of this station. I managed to waffle a lot and managed to elicit and address most of the mother's concerns but I'm not sure I did what was expected of me. Goodness knows how I did in this station, hopefully my blagging was enough.

Station 6 - Scenario: 2 brothers have impetigo, calculate their doses of antibiotics using BNF

Another fair, if rather unexpected station, I don't think I did too badly here either but I couldn't for the life of me think of some contra-indications for penicillin, obviously I got allergy but apparently they were after renal impairment. I got half way there by waffling about metabolism. I also tried to give one of the children, a baby the wrong dose until I used my eyes to bother to actually read the BNF.

Station 7 -Scenario: 14yr old boy in a+e after mother became increasingly worried about symptoms of paranoia. Viva station.

Ah yes, the obligatory child psych station, I don't if I shafted this station big time or if I just misread the examiner. I mean, its a waffle-y topic at the best of times and I answered her questions but I was ridiculously vague and waffled like never before. I still don't know what I was actually supposed to say but hopefully I did ok, psych isn't my strong point but I had a vague idea about schizophrenia and I tried to satisfy the examiner.

Station 1 - Scenario: Young girl in clinic complaining of facial weakness, examine her cranial nerves.

My heart sank at this station, for 2 reasons, a) I hadn't really expected this to come up as it came up in neuro last term, I hadn't revised it but I had vague idea., and b) All 12 cranial nerves in 5 minutes? In fact, more like 4 minutes with traveling between stations and a bit of admin work. Are they having a fucking laugh? Oh well, I launched in saying "I'd also do this, and that and t'other" Whilst trying to be quick but rushing made me forget things, I got into a muddle and ended up having no idea what nerve I was up to. 5 Minutes is just too short, if it had been a 10 minute station I could have gone thorough it all slowly, systematically and properly. I was also bamboozled at the presence of orange quarters on this station, I didn't know whether to eat them or to use them to test taste and smell. In the end I chose the latter, although I could have done with refreshments at that time. I fucked up my diagnosis at the end too but he said I did ok so we'll see.

Station 2 - Scenario: mother accompanies child to a+e, child has a mark/rash on his bottom. Take a history

Now I thought this was a bit of a silly station, I mean it would have been ok as a viva or discussion but as a history it didn't make much sense. It was ok, I managed to deal with the mothers worry about the possibility of meningitis and asked her about the possibility of non-accidental injury (NAI) It turned out that the child had recently stayed with its father who had a new girlfriend. But just as I was discussing the NAI aspect of the case the buzzer went and that station ended. 5 minutes just isn't enough.


And that was the end of that, time flies when you're having......fun? (hmmm, not too sure about that). In summary, my histories were good but 5 minutes is way too short to get anywhere, my examinations were crap and overall I should have done a lot better. Bring on obs and gynae tomorrow, hopefully I'll make up for today's semi-disaster.

The day before...

I've been moaning about OSCEs and my lack of revision for weeks now but they're finally here. Tomorrow is paeds and Tuesday obs and gynae (at least it fucking better be because that's what we've been told, if its not then I'll be buggered and someone will get some abuse), 7 or 8, 5 minute stations per day. I'm not prepared, nowhere near in fact but I never usually am until right before we enter through the doors into the fiery hell that is the skills lab during OSCE time. I've not been as enthusiastic about revising for these exams than I have previously, maybe I'm complacent, maybe because I hate obs and gynae perhaps I'm just exhausted but anyway its too late to moan about that now.

I know my examinations, I can wash my hands, introduce myself and obtain consent, I can take a history, I can even counsel patients and parents. Ok so my subject knowledge is patchy but hopefully I'll be ok. *crosses fingers (and toes..and legs..and arms)*

OSCE day always makes me chuckle, it must be quite the logistical nightmare for the staff. But its also quite a ridiculous experience. The 'same' exam is run over 5 sites, how they can ensure this is standardised is beyond me. It can be interesting when you recognise the examiner at a particular station, perhaps its a consultant with whom you got on with well, or perhaps one who you didn't get on so well with either way, the fairness of using 'familiar' examiners is debatable, indeed the GMC didn't really approve. We get quarantined after the exam until everyone has started at all sites, oh yes, that lovely time when everyone dissects each station...point...by...point, over and over again. Just get the fuck over it, there is nothing you can do about it now! I don't want to know exactly what I've missed.

Roll on Tuesday afternoon and that lovely feeling of freedom.

P.S - Thanks to all who wished me luck in previous posts, I might just need it this time. By Tuesday evening all my OSCE moaning will be done and dusted and normal blogging will return.

North and South

I have returned alive from the South. Devon was lovely, the weather was beautiful and a good time was had by all. I even made friends with missbliss's cat which usually runs at first sight of me. I've actually had a very full and enjoyable Easter holiday I'm sad to say its coming to an end. I could have done with another week but c'est la vie.

If you give the South a chance its actually quite nice, although I'm thoroughly fed up of walking up hills. Exciting southern pictures can be seen below. We saw dolphins in the sea, (albeit from the top of a very high cliff.) Even the journey wasn't bad, a 4 hr drive each way with very little traffic. What more could I ask for?

Sounds almost too good to be true...Oh shit...I seem to have forgotten about the 2 OSCE exams I've got in a couple of days time... It's going to be an interesting weekend... watch this space.

Holidays

Happy Easter!

Since I get a whole week's 'study period' I'm heading down to Devon for a few days to stay with missbliss's parents. Hopefully it'll be as sunny down there as it is up here in the North! Yes, shock horror, its actually nice weather in the North.

I'm still in an exceptionally happy mood with the sunshine and springness. Long may it continue. I'm not letting revision get in the way of my happiness. This might come back to haunt me, we'll see, but a few days cramming before the exam should suffice.

Anyway, this might be the last you hear of me for a week or so...

Spring and its lovely wonderfulness!

Forgive me for going a bit crazy but for once I've got very little to moan about. I love Spring, it is by far the best season, and it makes me so happy. On top of that, today is officially my last day of obs and gynae. Fingers crossed I won't have to go near it again in the future.

I want to spend my time dancing in fields of sunshine and happiness. Unfortunately the burden of revision still hangs over me. It isn't going brilliantly but I'm too happy to be worrying about that. The weather this week has been superlicious! Yesterday me and missbliss went to a farm to see the baby animals. (I realise I'm not doing much for my masculinity by admitting such activities but I don't care.) They are SO cute, I love lambs and chicks, even little piglets make me chuckle. (Aren't they just the cutest things you've ever seen:)

Unfortunately my videos of the lambs jumping around being oh so cute didn't work :( Oh well, perhaps we'll have to pay another visit before the season is over.

Spring also makes me happy because it reminds me of when I met missbliss 2 years ago, another reason that spring is beautiful. Even though there are always exams in springtime it is still the best time of year. I wish it could be spring all year round. If only we could spend all day sitting around on the grass, having a picnic by a stream with lambs jumping around us, life would be perfect.

Spring is like a drug, if you could bottle it up and sell it, I'd by it by the truckload!

Nothing is going to upset me this week as long as the weather stays nice.

May I wish everyone a happy Easter, make sure you all take time out just to rejoice in the loveliness!
* goes off to daydream about springtime.............*

Lifestyle Managers

There was a programme on TV the other day about lifestyle managers, these not-so personal assistants are provided for a fee by a growing company. Their aim? To make life easier by taking menial tasks away from busy people such as organising meals out, holidays or a plumber to fix your boiler, this gives busy people more time to be... well...busy.

It's a bloody great idea. I always find myself with a list of necessary and boring tasks but I'm too busy (aka - can't be bothered) to sort them all out. Missbliss offered to be my lifestyle manager but she is busy too (busy baking me cakes that is). If I won the lottery, the first thing I'd invest in (after a trip to a Ferrari garage) would be my own personal lifestyle manager. Until those numbers come up I'll have to make do with my PDA.

Yes, maybe it makes me look like a geek, maybe it is a bit lame, maybe I could make do with a normal diary but I don't care. It's a godsend, I've recently been wondering what I did without it. One of the female SHOs summed it up quite well the other day simply by saying "Boys and their toys"

Isn't it just an extravagant diary I hear you ask? Well no, not at all. Although that is probably the most useful feature. As a medical student it can become almost impossible to keep track of where you're supposed to be and when. I don't have that problem anymore, I know exactly where I'm going, when I've got to be there and what I'm going to do when I've got there. No more missed birthdays or anniversaries either which is a bonus and list of tasks makes sure I don't forget those everyday things. On top of keeping me organised, I've sold my ipod on eBay as I can now have all my music and videos on a memory card, I can keep myself amused on the move by playing games on it (that comes in very useful as a medical student because I seem to spend most of my time waiting around for things.) I even have anatomy videos on there, I know that's lame but I've got to do something to teach myself anatomy because the medical school aren't too bothered that I don't know my pisiform from my xiphisternum. I can access the Internet on the go with a built in wifi connection which makes checking my emails and reading blogs easier than ever.

Obviously the most important thing is the poser factor, a sense of organisation and professionalism which even some of the consultants are impressed with. Except when they're having a look at it, only to find my diary has been vandalised by missbliss who scheduled a session of cuddles.

If only it was a phone as well...