tag:blogger.com,1999:blog-26466727818912652612024-03-20T20:29:56.742+00:00I'm a Medical Student, Get Me Out of HereThe Little Medichttp://www.blogger.com/profile/05743228690074334742noreply@blogger.comBlogger198125tag:blogger.com,1999:blog-2646672781891265261.post-84979184824787612402008-06-13T14:58:00.003+00:002008-06-13T15:59:53.106+00:00Results Are Out...So, results came out today.<br /><br /><br /><br /><br /><br /><br /><br /><br /><br /><br /><br /><br /><br /><br /><br /><br /><br /><br /><br /><br /><br /><br /><br />I guess you're going to want to know how I did right?<br /><br /><br /><br /><br /><br /><br /><br /><br /><br /><br /><br /><br /><br /><br /><br /><br /><br /><br /><br /><br /><br />You're going to have to keep scrolling.<br /><br /><br /><br /><br /><br /><br /><br /><br /><br /><br /><br /><br /><br /><br /><br /><br /><br /><br /><br /><br /><br /><br /><br /><br /><br />Click here to find out:<br /><a href="http://thelittlemedic.blogspot.com/">http://thelittlemedic.blogspot.com/</a>The Little Medichttp://www.blogger.com/profile/05743228690074334742noreply@blogger.comtag:blogger.com,1999:blog-2646672781891265261.post-49681961166795850912008-06-04T16:32:00.005+00:002008-06-04T17:26:21.229+00:00Training a Bunch of MonkeysBecause a) I've got nothing better to do, b) I quite enjoy it and c) the £40 will pay for a takeaway, today I volunteered yet again as a patient for the 3rd year <span class="blsp-spelling-error" id="SPELLING_ERROR_0">OSCE</span> exam. It is the 5<span class="blsp-spelling-error" id="SPELLING_ERROR_1">th</span> or sixth time I've done so but each time I learn something new about the whole process. Today I had aortic regurgitation and 39 candidates did their best to impress the examiner as I laid there watching the ducks out of the window.<br /><br />Now I should say that I think <span class="blsp-spelling-error" id="SPELLING_ERROR_2">OSCEs</span> are a very important assessment of a medical student's abilities. However, they aren't, certainly at my institution assessed effectively in my opinion. I recognise the difficulties in running a fair exam but when you're trying to do so simultaneously at 4 sites, with different equipment and different examiners in the morning and afternoon but supposedly the same stations it must be impossible! You might think that it all averages out in the end, and perhaps it does eventually but there are huge <span class="blsp-spelling-corrected" id="SPELLING_ERROR_3">inconsistencies</span>. I would have thought some methods are employed in an effort to standardise the marks but it would be almost impossible to do this for every conceivable variable. Blah, blah, blah, I could moan about this all day long.<br /><br />Lets take today for example, admittedly I only saw a snap-shot of what went on, just 1 out of 13 or 14 stations. We started in the morning with one examiner, who's marking was rather erratic. There was one student who was a country mile above the rest who scored average to below average whereas others who were average at best were scoring higher. It doesn't help that the mark scheme leaves things very open to interpretation by the examiner but what can you do? An open mark scheme is too open to subjectivity but a more rigid mark scheme makes it more difficult for students to score <span class="blsp-spelling-corrected" id="SPELLING_ERROR_4">consistently</span>. Overall that examiner was fairly generous. In the afternoon, same station, different examiner. This time, a much more <span class="blsp-spelling-corrected" id="SPELLING_ERROR_5">consistent</span> marker but at the same time, much harsher with the marks (perhaps rightly so). Next we should consider the students, frankly, overall they weren't that great but <span class="blsp-spelling-corrected" id="SPELLING_ERROR_6">I'll</span> get to that in a minute. For no particular reason that I could see there was a significant variation between the morning lot and afternoon lot. The morning lot were on the whole, <span class="blsp-spelling-error" id="SPELLING_ERROR_7">ok</span> (remember they also had a generous marker) whereas the afternoon lot were, apart from one, not as good (and also had a harsher marker). I might not have explained that too well but what I'm getting at is that there was more than one variable affecting each group skewing the distribution of marks further between morning and afternoon.<br /><br />As for the students themselves, let me explain what I thought was wrong. This might sound a little harsh and hypocritical (I was exactly the same when I was a 3rd year). Neither is it really the students fault. Every student was able to make a decent effort at completing a cardiovascular examination. But, you could teach a monkey to do a textbook <span class="blsp-spelling-corrected" id="SPELLING_ERROR_8">cardiovascular</span> examination. Very few students looked like they were actually looking to <span class="blsp-spelling-corrected" id="SPELLING_ERROR_9">elicit</span> signs. Perhaps the main issue here is that it is such a fake situation and the students are expecting a normal <span class="blsp-spelling-corrected" id="SPELLING_ERROR_10">volunteer</span> to examine therefore there won't be any signs so it doesn't matter. I spoke to the examiner about this and he agreed, he had previously examined a thyroid station where students had all done a textbook examination but 5cm above where the thyroid actually is. They are only 3rd years, perhaps it is unfair to expect them to <span class="blsp-spelling-corrected" id="SPELLING_ERROR_11">elicit</span> signs at such an early stage. You can clearly tell the students who've examined real patients and who are actually trying to <span class="blsp-spelling-corrected" id="SPELLING_ERROR_12">elicit</span> the signs from those who are just going through the motions, the former group generally score higher, I believe rightly so.<br /><br />During finals for instance we had 6 stations of real patients, these were not only the most difficult but were the most interesting and dare I say it, enjoyable stations from my point of view. Why not have a few real patients for earlier years? Yes, it would take more organisation but patients are usually quite willing to spend a morning being examined. We're not trying to train monkeys, we're trying to train competent, dynamic doctors who're able to think on their feet so why aren't we assessing this properly?<br /><br />My experience of <span class="blsp-spelling-error" id="SPELLING_ERROR_13">OSCEs</span> from both sides has led me to the following conclusion:<br />Performance = 30% luck in each and every station + 30% examiner subjectivity + 30% confidence (or false confidence) + 10% knowledge<br /><br />Clearly, luck makes up a rather large proportion and this is what needs to be <span class="blsp-spelling-corrected" id="SPELLING_ERROR_14">eradicated</span> if possible. How we do this <span class="blsp-spelling-corrected" id="SPELLING_ERROR_15">I'm</span> not quite sure. Perhaps having more stations 30, 40 (as some other medical schools do I believe) to average things out, or improving the <span class="blsp-spelling-corrected" id="SPELLING_ERROR_16">consistency</span> of marking by reducing the subjectivity.<br /><br />I love to get my hands on a chunk of results data to run some of my own statistical analysis on. Although the chances of that happening are about the same as winning the lottery.... 4 times. If I asked for it, I'd just be ignored.... again.<br /><br />One other thing from today; what is with all the all black stethoscopes? At least half the students had them and yes they might look quite cool but they sure as hell don't make you any better at using them!<br /><br />If you've not already done so check out my latest, and probably final post here: <a href="http://thereallm.blogspot.com/">http://thereallm.blogspot.com/</a>The Little Medichttp://www.blogger.com/profile/05743228690074334742noreply@blogger.com18tag:blogger.com,1999:blog-2646672781891265261.post-54537921148663196142008-06-01T15:50:00.005+00:002008-06-01T16:10:28.507+00:00Everyone Wants My MoneyAfter 5 years at university accruing several tens of thousand pounds of debt I suppose it should come as no surprise that the final few weeks are full of costly expenses. I suppose I should get used to it, things are only going to get worse, I should really count my lucky stars that I didn't have to pay to sit my final exams.<br /><br />Among the expenses, GMC provisional registration (£135), MDU (£20 approx), graduation robes (£37) was a colourful leaflet from the BMA listing all the potential benefits of being a BMA member as an F1. I am a student BMA member and enjoy my regular sBMJ so I figured I'd probably keep my membership up as an F1. I looked all the way through this colourful leaflet and couldn't find anywhere how much its going to cost me, something tells me it won't be cheap.<br /><br />Becoming a doctor has always been an expensive process but it really doesn't come at the best of times towards the end of student life.<br /><br />Perhaps, rather than medical school I should taken up a life renting graduation robes. Lets do some maths. So my graduation robes are going to cost me (well, hopefully my parents) £37 to rent for a couple of hours. There will be over 400 people graduating from the medical school alone, that is the best part of £15,000. Multiply that up for all the students graduating throughout the country and I'm fairly sure it will come to a very substantial amount.<br /><br />Whilst I've got my chequebook out, who's next?The Little Medichttp://www.blogger.com/profile/05743228690074334742noreply@blogger.com10tag:blogger.com,1999:blog-2646672781891265261.post-49519325070782880132008-05-23T10:28:00.003+00:002008-05-23T10:50:37.268+00:00The Week After The Week BeforeWow, its now a week after my last exam. Doesn't time fly when you're having fun or, in my case doing bugger all.<br /><br />What exactly have I done in the last week? Well, not a great deal really. My post-exam to-do list which was already as long as my left arm hasn't been reduced and now in fact stretches around my back and down my right arm too. Saying that I have been 'busy', after all I must have been too busy to blog right? Well, yeah, but then again, I've not had a great deal to blog about. There is only so much material one can get out of waking up, playing computer games, eating and sleeping.<br /><br />My main objective for the week involved a great deal of football manager, for those of you who know, I need say nothing more. For the rest of you, it's a totally addictive, virtual football manager PC game, like a boy's version of sims according to missbliss. I also got a new gadget on Tuesday and have spent many an hour playing with it, and i've not even read the mahousive instruction manual yet (by far the most exciting part) and yes, every single page is in English - no being disappointed when 5/6ths of the book is in Japanese/German/etc etc.<br /><br />Yesterday, an excursion took us to the hospital I'll hopefully be working at come August. It was the first time I'd been there, and the first time I'd even been to the city in question. The city is lovely, if slightly quieter and more serene than what I'm used to. The hospital reminds me of a hospital some of my clinical placements were at. It is relatively small, seems mainly modern, and has a few odd, but rather cool quirks. We went for a wander round, obviously to scope out the important places, those being a) the shop, b) the cafes and c) the chocolate machines, all of which, I'm pleased to say, were up to standard.<br /><br />This week has gone ridiculously quickly, perhaps I should be grateful after all that we have to wait a month for results! Hopefully next week, I'll be able to tick a few things off my to-do list.The Little Medichttp://www.blogger.com/profile/05743228690074334742noreply@blogger.com10tag:blogger.com,1999:blog-2646672781891265261.post-44285273790299938172008-05-17T10:51:00.003+00:002008-05-17T10:59:55.557+00:00The End ........ (hopefully)Yes ladies and gentlemen, it is over. My last exam on Friday went <span class="blsp-spelling-error" id="SPELLING_ERROR_0">ok</span>, it was certainly better than Monday's. I broke my rule of "never change your first answer" and that cost me a couple of marks I think but on the whole it was OK.<br /><br />As <span class="blsp-spelling-corrected" id="SPELLING_ERROR_1">I'm</span> moving out of deanery I don't have to do my shadowing period now, in fact, I don't have to do it until the week before I start my job. This means that I'm now free, free to do whatever I want until the end of July!<br /><br />I am now in a strange sense of limbo, I don't know what I am. I have a whole month to wait until results. Don't even get me started on that... honestly, how long does it take to put all the multiple choice papers in a scanner?<br /><br />Hopefully I'll be able put results out of my mind and just enjoy my free time, sadly, I don't think it'll be that easy for some.<br /><br /><span class="blsp-spelling-error" id="SPELLING_ERROR_2">Wheeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeee</span>!The Little Medichttp://www.blogger.com/profile/05743228690074334742noreply@blogger.com14tag:blogger.com,1999:blog-2646672781891265261.post-8196953700804882532008-05-15T20:02:00.003+00:002008-05-15T20:09:16.784+00:00The OSCESo now everyone has done their <span class="blsp-spelling-error" id="SPELLING_ERROR_0">OSCE</span>, I think I’m <span class="blsp-spelling-error" id="SPELLING_ERROR_1">ok</span> to talk about what came up. Especially as the information will be freely available <a href="http://www.askdoctorclarke.com/">here </a>in a couple of weeks time. I’d advise anyone sitting finals to register and take a look at the section where feedback has been collected from students who’<span class="blsp-spelling-error" id="SPELLING_ERROR_2">ve</span> sat finals in the past few years at most of the medical schools in the country.<br /><br /><strong><u><em><span class="blsp-spelling-error" id="SPELLING_ERROR_3">OSLERS</span> – 15 minutes history/5 minutes discussion</em></u></strong><br /><br /><strong>Asthma<br /></strong>This <span class="blsp-spelling-error" id="SPELLING_ERROR_4">wasn</span>’t too bad; I’m not entirely sure what type of history you’re supposed to take from someone who has had their diagnosis for 30 years. It’s more of a chat about their condition than anything I hope. You’re supposed to consult with them for 15 minutes and then tell the examiner what you think their diagnosis is. Now for some things this is easier than others. It sort of gives it away when the patient tells you their diagnosis (I don’t think they’re supposed to do that). When you’<span class="blsp-spelling-error" id="SPELLING_ERROR_5">ve</span> finished the history, there is a 5 minute period for questions. The examiner was a little mean and impatient but I think I did <span class="blsp-spelling-error" id="SPELLING_ERROR_6">ok</span>.<br /><br /><strong>MS</strong><br />This was harder than the other <span class="blsp-spelling-error" id="SPELLING_ERROR_7">OSLER</span>, mainly because it <span class="blsp-spelling-error" id="SPELLING_ERROR_8">wasn</span>’t barn door MS. At first I thought it could be <span class="blsp-spelling-error" id="SPELLING_ERROR_9">MND</span>, then I thought it was some weird <span class="blsp-spelling-error" id="SPELLING_ERROR_10">myasthenia</span> problem but I eventually did decide it was MS (mainly because when I asked if he saw any specialist nurses – he told me he’d seen the MS nurse before). Again I think I did <span class="blsp-spelling-error" id="SPELLING_ERROR_11">ok</span> with the history part and managed to waffle my way through most of the questions.<br /><br /><strong><u><em>5 Minute ‘Spotter’ Stations</em></u></strong><br /><br /><span class="blsp-spelling-error" id="SPELLING_ERROR_12">Charcot</span>’s joint<br />A strange station really, I was told to purely inspect a patient’s leg and not to examine it. There was an obvious amputation and slightly deformed ankle, I <span class="blsp-spelling-error" id="SPELLING_ERROR_13">wasn</span>’t entirely sure what else I was supposed to see/say. I guessed it was <span class="blsp-spelling-error" id="SPELLING_ERROR_14">charcot</span>’s joint and the examiner seemed quite pleased. I was able to answer most of the questions quite well too.<br /><br /><strong>Parkinson’s</strong><br />Not the most of obvious of Parkinson’s, must have been pretty well controlled on medication. I found that the patient had increased tone but I thought it was <span class="blsp-spelling-error" id="SPELLING_ERROR_15">spasticity</span> rather than the typical rigidity of Parkinson’s. I did spot the shuffling gait and managed to reel off and demonstrate a number of other tests for Parkinson’s.<br /><br /><strong>Stoma</strong><br />Probably my best station. I was asked to inspect a patient’s abdomen, he had an obvious stoma. The rest of the station was questions. I managed to answer them all confidently and completely. We finished in about 3 minutes and spent 3 minutes talking about politics. <br /><br /><strong><span class="blsp-spelling-error" id="SPELLING_ERROR_16">Dupryten's</span></strong> <strong><span class="blsp-spelling-error" id="SPELLING_ERROR_17">cotracture</span></strong><br />Another barn door diagnosis, I was slightly unsure what to examine in terms of the patient’s hand, but the station was mostly question based and I think I coped with them pretty well.<br /><br /><strong>Psoriasis</strong><br />What annoyed me most about this station was the examiner; I felt she was rather mean. I managed to spot the diagnosis of psoriasis and answer the questions well, if not perfectly but the examiner still <span class="blsp-spelling-error" id="SPELLING_ERROR_18">didn</span>’t seem particularly happy for some reason. Maybe she was bored as it was my last station and she’d been there all day long<br /><br /><strong>Heart Murmur</strong><br />The only 5 minute station I really <span class="blsp-spelling-error" id="SPELLING_ERROR_19">didn</span>’t like. I was asked to examine a patient’s heart. I was told to go straight to auscultation and at first <span class="blsp-spelling-error" id="SPELLING_ERROR_20">couldn</span>’t even tell whether or not the patient even had a heart. When I finally found it, I could hear an obvious murmur and I tried to time it with the pulse and decided it was a diastolic murmur. I then decided that it was loudest in the <span class="blsp-spelling-error" id="SPELLING_ERROR_21">tricuspid</span> area and so decided on a diagnosis of <span class="blsp-spelling-error" id="SPELLING_ERROR_22">tricuspid</span> <span class="blsp-spelling-error" id="SPELLING_ERROR_23">stenosis</span>. God knows why, patients with that must be as rare as hen’s teeth. Anyway, the examiner told me that it was in-fact systolic and atrial <span class="blsp-spelling-error" id="SPELLING_ERROR_24">stenoisis</span>. Oops! I managed to answer the questions though so I’m hoping that brought my mark up for that station.<br /><br /><strong><em><u>10 minute stations</u></em></strong><br /><br /><strong>Abdominal examination</strong><br />I made such a hash of this potentially easy station. It is because I was told to go straight to the abdomen. If I’d had to examine the whole system it would have been the easiest station of the lot. Anyway, the ‘patient’ was simulating that she was in a lot of pain which put me off completely. I <span class="blsp-spelling-error" id="SPELLING_ERROR_25">didn</span>’t want to cause her any more pain by examining her. I royally fucked up the order of my examination but did eventually mention most things in a haphazard manner. I gave a decent differential diagnosis and mentioned just about every possible test under the sun.<br /><br /><strong>Testicular examination</strong><br />This was my first station, and I was well chuffed. It was a nice easy start. I’m pretty sure I had my testicle examination down to a fine art. And apart from a question on the cause of painless <span class="blsp-spelling-error" id="SPELLING_ERROR_26">epididymitis</span>, I also did quite well with the questions.<br /><br /><strong>Hearing tests and hearing aid viva</strong><br />I <span class="blsp-spelling-error" id="SPELLING_ERROR_27">wasn</span>’t impressed with the examiner in this station. I knew exactly what I had to do and I had it perfectly clear in my head about R<span class="blsp-spelling-error" id="SPELLING_ERROR_28">inne's</span> and <span class="blsp-spelling-corrected" id="SPELLING_ERROR_29">Weber's</span> tests. Unfortunately the examiner decided to take me round in circles and completely confused me by twisting what I’d said. Anyway, I managed to get the other questions right so I’m hoping to have only dropped a mark for getting slightly confused.<br /><br /><strong>Diabetes – Driving <span class="blsp-spelling-error" id="SPELLING_ERROR_30">DVLA</span></strong><br />My worst station, I <span class="blsp-spelling-error" id="SPELLING_ERROR_31">didn</span>’t have the faintest idea about diabetes and driving. The scenario was; “a patient has come for his routine diabetes check-up”, here was me expecting to have to examine him but no. He had actually come to ask about driving as he’d just got a new job. Would he have to tell work and the <span class="blsp-spelling-error" id="SPELLING_ERROR_32">DVLA</span> about his diabetes? I <span class="blsp-spelling-error" id="SPELLING_ERROR_33">didn</span>’t know, I said I’d have to look up the details but I told him to notify the <span class="blsp-spelling-error" id="SPELLING_ERROR_34">DVLA</span> and encouraged him to tell work. I don’t think he as the patient was particularly pleased with the outcome of our discussion so god knows what the examiner thought. Here’s hoping I got a mark for washing my hands.<br /><br /><strong>Child psych – mother concerned about daughter losing weight<br /></strong>I haven’t a clue how I did in this station because I’<span class="blsp-spelling-error" id="SPELLING_ERROR_35">ve</span> no idea what it required us to do. It was difficult to take a history from the mother as third person but I got in most of the important questions. I presented a decent differential diagnosis and made a vague effort to explain to the mum about the possibility of anorexia.<br /><br /><strong>Explaining bad news and consenting a schizophrenic with cancer</strong><br />This station had come up before, just as the other scenarios I asked about had. Again I’<span class="blsp-spelling-error" id="SPELLING_ERROR_36">ve</span> no idea what was expect of us and how I did depends entirely on what the mark scheme asked for. The simulated patient who kept hearing voices during my consultation first of all declined surgery but was happy to consider it by discussing with his parents by the time we’d finished so that has to be a good thing. I think he had capacity but I found it difficult to get this point across to the examiner who <span class="blsp-spelling-error" id="SPELLING_ERROR_37">didn</span>’t say a word to me throughout the whole station apart from “you have 10 minutes to use as you please” as I asked her a question.<br /><br /><strong>Pill counseling<br /></strong>Hope I did <span class="blsp-spelling-corrected" id="SPELLING_ERROR_38">OK</span> in this station, in hindsight (AKA talking to <span class="blsp-spelling-error" id="SPELLING_ERROR_39">missbliss</span>) I could have done better but at the time I think I mentioned most things that I needed to. My mind went blank with regards to the side effects but I remembered the other things. The simulated patient was annoying in that she kept asking me questions about things I’d already told her about, but I suppose that made her an accurate patient!<br /><br /><strong>Death certificate<br /></strong>One of my better stations, don’t think this was too challenging though I think I spelt pneumonia wrong. They were sneaky in trying to catch us out with a particular detail which I <span class="blsp-spelling-error" id="SPELLING_ERROR_40">wasn</span>’t sure about but said I could check. I was able to answer most of the examiner’s questions. There was a fair amount of spare time in this station during which I sat there like a <span class="blsp-spelling-error" id="SPELLING_ERROR_41">numpty</span> trying desperately to think of more answers to the questions.<br /><br />So there you have it, 5 years of medical school condensed into 2 hours 40 minutes.<br /><br />4 weeks to wait to find out whether or not I passed.The Little Medichttp://www.blogger.com/profile/05743228690074334742noreply@blogger.com10tag:blogger.com,1999:blog-2646672781891265261.post-3079375958883073982008-05-14T09:25:00.003+00:002008-05-14T09:47:20.000+00:00Finals UpdateFollowing a rather <span class="blsp-spelling-corrected" id="SPELLING_ERROR_0">disastrous</span> start to my finals on Monday(although it seems most people feel the same), yesterday was the <span class="blsp-spelling-error" id="SPELLING_ERROR_1">OSCE</span>. This is the big one, the most important one, the one everyone is most worried about. I'm usually quite calm around exam time but <span class="blsp-spelling-error" id="SPELLING_ERROR_2">OSCEs</span> bring out the nerves in even the calmest of us.<br /><br />It is the waiting that annoys me most, we reported to the hospital about 12, only to be forced to sit and wait for an unknown period of time, a period where minutes feel like hours. I imagine it is like waiting for an execution, only at least with that you know what is going to happen, with an <span class="blsp-spelling-error" id="SPELLING_ERROR_3">OSCE</span>, you never know if you'll come out dead or alive! In that final hour, some nervously flick through their notes aiming to cram those final few facts, others sit calmly contemplating what is to come. Only when we had to put all our belongings in <span class="blsp-spelling-corrected" id="SPELLING_ERROR_4">quarantine</span> did the reality of the situation hit me, I don't often get butterflies in my tummy but at that point yesterday a swarm of them descended upon me. I defy anyone to sit an <span class="blsp-spelling-error" id="SPELLING_ERROR_5">OSCE</span> without feeling those nerves. When we were finally marched upstairs and given a short briefing I knew this was it, 3 hours that could make or break my future.<br /><br />Placed outside the first station by an unfamiliar but friendly face, I could feel my heart beating, in fact, it felt like it was about to explode. The time had come, my body responding with its fight or flight mechanism. As tempting as it was to run out of the door and never look back, my thoughts were interrupted by the first buzzer and the fight began.....<br /><br />That <span class="blsp-spelling-corrected" id="SPELLING_ERROR_6">I'm</span> afraid is where the story must end for today. I will write about each station but as other students still have to sit the <span class="blsp-spelling-error" id="SPELLING_ERROR_7">OSCE</span> I don't think it would be a good idea to talk about it till Thursday.<br /><br />All I will say is that it could have been much worse...<br /><br />Just Friday to go.The Little Medichttp://www.blogger.com/profile/05743228690074334742noreply@blogger.com5tag:blogger.com,1999:blog-2646672781891265261.post-74804670427013771432008-05-12T17:09:00.003+00:002008-05-12T17:21:03.592+00:00What a Ridiculous Exam- If you're going to insist on asking us a load of microbiology questions, please tell us in advance so we can learn it. Alternatively, you could, you know, actually teach us something rather than making us do it all ourselves in <span class="blsp-spelling-error" id="SPELLING_ERROR_0">PBHell</span>.<br /><br />- If pt x has so and so wrong with them, my 'initial management' would probably include the answers a, b and e. Please don't make me guess what Dr Jones wanted as the correct answer, based on how he was feeling when he wrote the question, when all 3 are potentially correct.<br /><br />- To all of those studying a <span class="blsp-spelling-error" id="SPELLING_ERROR_1">PBL</span> course, unsure what exactly you need to know, the answer is everything. Yes, absolutely every last possible detail of every conceivable thing. You must know every textbook inside out and be prepared to answer questions on everything.<br /><br />- I've done this exam 5 times now, and this time was by far the hardest in my opinion. At least most people seem to have found it rather difficult.<br /><br />- I pity the poor 1st years who did the same exam, they must have literally had to guess all but a couple of questions.<br /><br />- I've got a headache.<br /><br />- <span class="blsp-spelling-error" id="SPELLING_ERROR_2">OSCE</span> tomorrow.<br /><br />- Onwards and upwardsThe Little Medichttp://www.blogger.com/profile/05743228690074334742noreply@blogger.com7tag:blogger.com,1999:blog-2646672781891265261.post-85211339155043593192008-05-09T16:19:00.002+00:002008-05-09T16:23:47.903+00:00Close To The End3 years of life in hospital as a medical student hopefully came to an end today. Shitters<br /><br />Exams Monday, Tuesday, Friday next week. Shitters<br /><br />Then its all over. Shitters.<br /><br />Results 1 month later (don't even get me started on that). Shitters<br /><br />Argh shitters!<br /><br /><span style="font-size:78%;">The next update will probably be Tuesday after my OSCE. See you then</span>The Little Medichttp://www.blogger.com/profile/05743228690074334742noreply@blogger.com11tag:blogger.com,1999:blog-2646672781891265261.post-39435128901075128282008-05-04T08:54:00.003+00:002008-05-04T09:09:14.504+00:00Blogging Revision<span class="blsp-spelling-error" id="SPELLING_ERROR_0">Ok</span>, so <span class="blsp-spelling-corrected" id="SPELLING_ERROR_1">I'm</span> not supposed to be blogging because I'm supposed to be revising but I had a wonderful thought - what if I combined the two?<br /><br />What better way to revise ethics and consent than to discuss it. It's a grey area without a yes or no answer. It is more a matter of common sense and opinion so I'm asking for your opinions on the following scenarios:<br /><br />1) You are the <span class="blsp-spelling-error" id="SPELLING_ERROR_2">SHO</span> on an upper GI surgery firm, you are told to explain a diagnosis of gastric cancer and start to consent a schizophrenic patient for surgery.<br /><br />2) You are a new GP partner in a GP surgery seeing a woman who is going in for a elective operation, and she doesn't want the people in the hospital to know about her Hep C status... it turns out that she thinks if the hospital knows about her Hep C status, her social worker would find out and not let her to see her daughter.<br /><br />3) A husband slept with prostitute in Thailand on business trip. Wife is unaware but attends GP with sore throat & demands to know what’s wrong with husband & wants same treatment.<br /><br />So, how might you approach the above situations, go on, leave a comment and help with my revision.The Little Medichttp://www.blogger.com/profile/05743228690074334742noreply@blogger.com10tag:blogger.com,1999:blog-2646672781891265261.post-12773737817428294772008-04-29T20:49:00.003+00:002008-04-29T20:55:48.573+00:00Shingles MinglesSo <a href="http://frolickingthroughlife.blogspot.com/2008/04/oh-bobbins.html"><span class="blsp-spelling-error" id="SPELLING_ERROR_0">missbliss</span> has shingles</a>, poor her, everyone who has had it seems to have oodles of sympathy. Unfortunately, nobody seems to be quite sure whether or not <span class="blsp-spelling-corrected" id="SPELLING_ERROR_1">I've</span> had chicken pox. I thought I had and was merrily poking her rash before she went to the doctors, but it seems that I might have just made up me having chicken pox as a child. I guess we'll find out in about 14 days or so (the incubation period) right before my finals start. <span class="blsp-spelling-error" id="SPELLING_ERROR_2">Wahey</span>.<br /><br />On the plus side, the football rocked my socks. And so <span class="blsp-spelling-corrected" id="SPELLING_ERROR_3">I've</span> got the champions league final (no legs involved <span class="blsp-spelling-error" id="SPELLING_ERROR_4">missbliss</span>) after exams.The Little Medichttp://www.blogger.com/profile/05743228690074334742noreply@blogger.com6tag:blogger.com,1999:blog-2646672781891265261.post-7732251528604916242008-04-27T13:33:00.002+00:002008-04-27T13:37:28.404+00:00piss off!I don't seek out the most remote and quietest place in the library for you to come and sit on the table next to me and spend 10 minutes talking to your 'bro' on your mobile. Prick. Kindly piss the hell off!The Little Medichttp://www.blogger.com/profile/05743228690074334742noreply@blogger.com8tag:blogger.com,1999:blog-2646672781891265261.post-90534601214339066622008-04-26T18:22:00.004+00:002008-04-27T08:38:33.064+00:00They Think Its All Over....Well it very nearly almost is. I finished my last clinical placement on Friday. This signifies a couple of things, firstly that I'm supposed to know everything that I could possibly need to function as a doctor and secondly that finals are in 2 weeks.<br /><br />2 weeks tomorrow, my first exam, then 2 more, spread out over the rest of the week and that is it. I'm free...at least for a month until results.<br /><br />As a result of this, <span class="blsp-spelling-corrected" id="SPELLING_ERROR_0">I'm</span> not going to be writing, or reading blogs much over the next 3 weeks. Well that is the plan anyway. I know <span class="blsp-spelling-corrected" id="SPELLING_ERROR_1">I've</span> already <span class="blsp-spelling-corrected" id="SPELLING_ERROR_2">mentioned</span> my upcoming exams plenty of times and thanks to all those of you who've wished me luck.<br /><br />Best of luck to all those readers who are also sitting exams as we come towards the end of another year.The Little Medichttp://www.blogger.com/profile/05743228690074334742noreply@blogger.com6tag:blogger.com,1999:blog-2646672781891265261.post-72388990003168754502008-04-23T15:19:00.007+00:002008-04-23T19:25:20.695+00:00A Dream Becomes Reality - But Not In A Good WayHow many people have dreamt about being a hero at the scene of an accident? For the majority it will remain just a dream, one in which they are cool, calm, confident and heroic. For others, this dream becomes real, but the reality of the situation is somewhat different to the heroic dream.<br /><br />This afternoon we went for a drive in the countryside, the sun was shining and we were merrily winding our way around the country roads. Up ahead, over the brow of a hill I noticed an accident, it soon became clear that it was quite serious. There was a distinct lack of emergency services, I was faced with a decision, should I stop or carry on? Despite having little to offer I decided to stop, I pulled over, just beyond the accident. My heart began to race, I hadn't paid much attention to the scene as I was pulling over so I didn't really know how serious things were. The accident had obviously happened barely a minute before we passed and a couple of other people were already on the phone to the emergency services.<br /><br />As I approached, I realised this wasn't just a shunt, it was a high speed, head-on collision involving two cars (car 1 with one man in, car 2 with two women). Metalwork was strewn across the carriageway and the cars were in quite a state. I approached what I initially thought was a police woman talking to an obviously distraught and injured passenger. I introduced myself as a final year medical student and asked if there was anything I could do. It wasn't until afterwards that I realised that she was just a smartly dressed passer-by.<br /><br />As a final year medical student I've not exactly got a wealth of experience of medicine, let alone in pre-hospital care. I'm not afraid to admit that I was terrified, realistically, what could I do? No experience, no equipment, no nice doctor telling me exactly what to do, absolutely no idea what I was doing. Not only that, all my brain could think was "Oh SHIT!" So not exactly the cool, calm, confident hero?! I went to the driver's window of car 2, the driver was slumped, she was barely breathing. I tried to introduce myself but she was barely, if at all conscious. The only thing I could think of was ABC (Airway + c-spine, Breathing, Circulation), she was obviously trapped and severely injured, I tried to assess her pulse, I couldn't convince myself that she even had one. I tried the back door so I could get in to stabilise her head and neck but it was stuck. I was focused on trying to assess ABC it wasn't till later that I noticed (actually missbliss pointed it out) her other arm was broken so badly it was bent in 3 places. Eventually a policeman who'd arrived managed to get into the back and to stabilise her head, but by this point she looked terribly grey. I'm no expert, I'm not even a novice, but something inside me thought she was probably exsanguinating internally.<br /><br />By this point the only emergency services on scene were the police, I moved on to the driver of car 1, he was the better of the 3 casualties, although he was still trapped inside his vehicle. Again I introduced myself and briefly assessed him, he was alert, although completely disorientated. I tried to reassure him as much as I could, his neck was painful, so I was doing my best to make sure he kept his head still. By now the scene had become littered with firemen, although they were concentrating on the other car so I stayed with the man in car 1 talking to him, although he couldn't remember anything at all.<br /><br />Eventually the ambulance arrived, I explained who I was and one of the paramedics asked me to stay with the man I'd been talking to until the other ambulance arrived. I could hear the emergency service working frantically behind me to free the women in the other car. I kept being as reassuring as I could and after what seemed like days the other ambulance arrived, I briefly explained what I knew and what the man in car 1 had told me about his condition. Finally I took a step back to look at the carnage.<br /><br />Despite the carnage, the whole scene was rather calm and quiet. It is impossible to describe but certainly the reality is completely different to anything you could ever dream or see on TV. As I stood there talking to one of the witnesses, he asked who I was and I explained. "Coming towards your exams eh? You'll soon have a different title then won't ya?" he said. The reality is that if I pass these exams he's right, I won't be a final year medical student, I'll be a doctor. My worry then is that people will expect things of me in such a scenario. It was clear to me that there are no heroes in a situation like that, it takes a real team effort by everyone involved. Without that, things wouldn't get done, and people would die. I don't know what happened to the casualties today, indeed I may never know but I really hope that everyone involved is ok, and my thoughts are with them and their families.<br /><br />Finally, and not that I've ever had anything but respect for paramedics and the emergency services but after today, I've got a whole new admiration for the work they do. It is one thing being the doctor in A+E surrounded by all their equipment and a team of nurses on the receiving end of an ill patient, but a paramedic, first on the scene to something like this. They really do deserve a great deal of respect!<br /><br />As for exams, they're a walk in the park compared to this. Reality is so much more terrifying.<br /><br />It was so difficult to even begin to write about today's events, I'm not even sure I should have. I know I had little to offer and I don't think anything would have been different if I hadn't stopped, but I'm glad I did, and if I'm ever in that situation again, I hope I'll be a little more confident that I can do something, even if it amounts to little more than nothing.The Little Medichttp://www.blogger.com/profile/05743228690074334742noreply@blogger.com14tag:blogger.com,1999:blog-2646672781891265261.post-21238791317644236192008-04-22T17:41:00.004+00:002008-04-22T18:02:57.424+00:00A Momentous OccasionToday was a momentous occasion in terms of my career as a medical student. I have been counting down to today for the past 8 weeks at least! In fact, it was a cause for celebration for at least 8 of us, although only 4 bothered to turn up. Have you guessed yet? Today was my last ever PBL session, the last 2 hours of problem based learning I'll hopefully ever have to endure (at least as a student).<br /><br />I was going to bring cake, and even champagne to celebrate the occasion but I'm not sure hospital is the best place for alcohol and I couldn't find any suitable cakes. As it turned out, only 4 of us turned up anyway, quite sad really that final session was more of a damp squib than anything else, not that PBL is much more than that in the first place.<br /><br />The session itself was more a small tutorial than a classical PBL, saying that, we've not done 'textbook' PBL for years. I'm just happy I never have to waste 2 more hours of my life sat in a room trying to teach each other medicine from the titbits of knowledge we've all cobbled together from various sources. It is quite ironic that such emphasis is placed on group learning and PBL, where we're encouraged to help each other to learn, only to be examined and assessed against each other when it comes to exams and ultimately ranked against each other when it comes to job applications. I can't quite understand that logic.<br /><br />I must have done a couple of hundred hours of PBL in the last 5 years and I can probably count on one hand the number of useful sessions. I can't even remember how PBL is supposed to be done, it is that long since we followed the proper steps. I'm still very much of the opinion that PBL doesn't work as an exclusive method of teaching medical students. I think there are huge gaps in some of our knowledge, some of us more than others of course. Sadly too much time, effort and money has been put into developing such a course that even if those that be wanted to revert to a more traditional style, it would be far from easy.<br /><br />Who knows, perhaps in a few years I'll be proved wrong and it'll be the PBL trained doctors leading the way, unfortunately I just can't see it happening that way. I expect that once more evidence becomes available, PBL will be shown to be the pointless, farcical waste of money that it is.<br /><br />In the mean time, I'll rest safe in the knowledge that the words "time for PBHell" will never again cross my lips!<br /><br />HELL YEAH!!!!!!!!!!!!!!!!!The Little Medichttp://www.blogger.com/profile/05743228690074334742noreply@blogger.com12tag:blogger.com,1999:blog-2646672781891265261.post-62893546061507216722008-04-19T12:16:00.003+00:002008-04-19T19:00:43.456+00:00The Final PushA month from now it'll all be over one way or another. 3 more weeks until exams, <span class="blsp-spelling-corrected" id="SPELLING_ERROR_0">I'm</span> ridiculously fed up with waiting for them. I can't wait till they're over and I can spend my time doing bugger all/playing computer games/sleeping or a <span class="blsp-spelling-corrected" id="SPELLING_ERROR_1">combination</span> of the three.<br /><br />4 more weeks and medical school is over. <span class="blsp-spelling-error" id="SPELLING_ERROR_2">Shitters</span><br /><br /><br />Also want to take this opportunity to say hi to the people who've been reading through most of my archive. Some of you seem to have spent hours reading, considering exam time is approaching, <span class="blsp-spelling-corrected" id="SPELLING_ERROR_3">I'm</span> guessing you're all procrastinating!<br /><br />Finally is anyone else having problems with blogger emails? I'm not getting messages about comments and other various emails.The Little Medichttp://www.blogger.com/profile/05743228690074334742noreply@blogger.com8tag:blogger.com,1999:blog-2646672781891265261.post-40072733871131248842008-04-16T07:26:00.002+00:002008-04-16T07:47:46.408+00:00Univeristy Says NoYesterday we began a series of 'safe prescribing' lectures, there is the potential for a station in our <span class="blsp-spelling-error" id="SPELLING_ERROR_0">OSCE</span> on prescribing but I think these lectures are more aimed towards making us safer doctors. It is a shame that these lectures are starting 3 weeks before finals, it would have been much more useful to have them regularly throughout the year or even the whole 5 years. It was fairly basic stuff and it would have been better had there been slightly more pharmacology <span class="blsp-spelling-corrected" id="SPELLING_ERROR_1">involved</span>.<br /><br />That said, the lectures were quite useful but it was the other things I learnt which I found most interesting. We asked why these sessions had been left so late, after all we've better things to be concentrating on at the moment. The answer was most enlightening.<br /><br />It seems that they have had some trouble putting on these sessions, and others like them. In fact, we learnt that in previous years, one of the surgeons had offered teaching sessions throughout the year on things he thought were lacking in our course, suturing for example. Unfortunately for the students, the university had contacted the surgeon in question and ordered him to stop giving the sessions as it would be unfair on students at other hospitals. (For those of you who don't know, the 3 clinical years of our course are spent at 1 of 4 teaching hospitals in the region). Let me get this straight, the university had told staff at this hospital, not to teach us topics where there might be gaps in our knowledge? I was flabbergast, I really hope <span class="blsp-spelling-corrected" id="SPELLING_ERROR_2">I've</span> misunderstood something here because as far as I can see the university are actively withdrawing learning opportunities! Perhaps they're right, maybe it isn't fair on students at other hospitals, but that is the university's problem, it shouldn't prevent people from offering to teach! The university should be doing everything it can to ensure everybody gets these opportunities, not preventing them! It must be virtually impossible to prevent this kind of teaching at all 4 hospitals, so <span class="blsp-spelling-corrected" id="SPELLING_ERROR_3">I'm</span> sure somewhere some students are going to be getting something that other students are missing out on.<br /><br />Why don't they just lock us all in a room for 5 years with some textbooks? God forbid we might actually be taught something!<br /><br />What sort of institution is this and what sort of doctors is it trying to produce?The Little Medichttp://www.blogger.com/profile/05743228690074334742noreply@blogger.com8tag:blogger.com,1999:blog-2646672781891265261.post-66755419185664835642008-04-13T09:54:00.003+00:002008-04-13T10:02:16.593+00:00If you knew then what you know now...A topic came up over lunch the other day which I think sums up quite well just how low morale is among medical students and junior doctors at the moment.<br /><br />The question was: knowing what you know now, would you apply to medical school again? The answer from 3 out of 4 of us was a fairly firm no, surprisingly I was the only one who probably would apply again albeit to completely different medical schools.<br /><br />I opened this topic up to a wider audience and was pleased to see that not everyone had lost faith in medicine. It was also interesting to note that among those who would apply again, many would have applied to different places for a variety of reasons.<br /><br />So...<br /><br /><strong>Whatever stage you're at, be it 1st year student or consultant (not that any consultants are likely to be reading this), if you were applying to university today, knowing what you know now, would you choose medicine again?</strong>The Little Medichttp://www.blogger.com/profile/05743228690074334742noreply@blogger.com34tag:blogger.com,1999:blog-2646672781891265261.post-5253297288746689392008-04-10T07:40:00.003+00:002008-04-10T08:04:32.477+00:00A RevelationTwo Things<br /><br />a) <a href="http://news.bbc.co.uk/1/hi/education/7338431.stm">This article</a> doesn't surprise me, especially the bit at the bottom: "Medical students formed the largest group of complainants "<br /><br />More importantly<br />b) How, after almost 5 years did I not know about The Office of the Independent Adjudicator for Higher Education ("OIA")? An independent complaints board. Something else to add to the list of things to do after finals!The Little Medichttp://www.blogger.com/profile/05743228690074334742noreply@blogger.com7tag:blogger.com,1999:blog-2646672781891265261.post-42774673117611762862008-04-08T07:22:00.007+00:002008-04-08T16:47:14.522+00:00Have the BBC Missed The Point?This <a href="http://news.bbc.co.uk/1/hi/health/7328448.stm">story</a> appeared quietly and with little fuss over the weekend. Afterall, unless its about £100,000 salaries or patients dying, nobody seems to care what happens to doctors.<br /><br /><br />The BBC story highlights an important point, although I can't credit the BBC as the remark originally came from a professor at the Royal College of Physicians. With the complete introduction of the European Working Time Directive (EWTD) from 2009, all professions, including doctors will be limited to working 48hours a week down from the current 56 hour limit. Now I don't know about other professions but this has some pretty serious consequences for doctors and perhaps more so for patients.<br /><br /><br />The BBC article states that patient care will suffer because there will be less staff available, this clearly makes sense as if all doctors are working 48 hours rather than 56 each doctor is working 8 hours less. Who is going to cover those lost hours? Patients are still going to get ill 24 hours a day, 7 days a week. Who is going to be there when Mr Jones arrests but Drs Smith, Brown and Wood have all worked their 48 hours this week? Of course, everyone knows that the vast majority of doctors are still going to work more than 48 hours a week, they just won't get paid for it as it is effectively 'illegal'. When it comes to auditing hours, these doctors will be 'encouraged' to lie about their hours to make the trust EWTD compliant. So patient care probably will suffer in the short term, but Dr Smith and his colleagues won't leave Mr Jones to die, they will ignore the EWTD, safe in the knowledge that what they are doing is illegal and they're not getting paid for it. Another solution to this problem is the use of night nurse practitioners and such like. I'm sure <a href="http://nhsblogdoc.blogspot.com/">Dr Crippen</a> wouldn't approve and to be honest, I know who I'd rather be looked after in the middle of the night during an emergency.<br /><br /><br />Anyway, I think the BBC have missed the point, it isn't the short term, immediate care of patients which is at risk. I'm far more worried about the implications for the future in terms of training. Talk to a doctor who qualified 5, 10, 20, 30 years ago and they'll tell you about the 'good times', the 100-120 hour weeks, the 48 hour shifts without sleep. Strangely, most of them will tell you they enjoyed it in a sadistic kind of way. Not because they get a kick out of working more hours than there are in a week, but because of the experience they gained. Most doctors will tell you that on call, during the night is where they learnt the most.<br /><br /><br />Lets consider for a second Mr Bone, a consultant orthopaedic surgeon. He became a consultant within about 11 years of graduating from medical school. When he qualified, he worked 100 hour weeks as a house officer and similarly throughout his training. That is about 50,000 hours or so of training.<br /><br />Next, lets consider me (or equally one of my colleagues) who, having studied a PBL course doesn't know all that much to start with. If I were to become an orthopaedic surgeon about 11 years after qualifying having worked no more than 48 hours a week. I would have received about 25,000 hours of training. About half that of today's consultants. It certainly won't be considered acceptable to double the length of time it takes to become a consultant and so we're left with one scenario.<br /><br />In 10, 15, 20 years time, the 'consultant led' NHS is going to be staffed by doctors with roughly half the amount of training their predecessors had.<br /><br />Who would you want to replace your hip?The Little Medichttp://www.blogger.com/profile/05743228690074334742noreply@blogger.com8tag:blogger.com,1999:blog-2646672781891265261.post-45737468475964019902008-04-06T07:18:00.003+00:002008-04-06T08:23:14.626+00:00Random Musings For a Sunday Morning- This year it was my turn to pick the winner of the Grand National. (About bloody time too I've not won owt for years). As comply or die romped home I was cheering at the TV, as I tend to do when I get a little overexcited. I was very pleased indeed to collect the best part of £100 of winnings.<br /><br />- Bring back winter! At least on those dark, cold, dreary mornings, you can lie in quite happily and sleep until your heart is content. I was really looking forward to a lie in this weekend but on both days we've been awake well before 8. Its ridiculous, I've not had a lie in for weeks! It doesn't help when you have curtains that may as well not even be there they lot so much light through. It feels like daytime but its so early and I just want a lie in now and again! Is it really too much to ask?<br /><br />-<span style="font-size:180%;"> <strong>We're going to Glastonbury!!</strong> </span>Just got tickets! It'll be the last time we get such an open opportunity to go so we thought we'd better make the most of it.<br /><br />- Pancakes for breakfast. Yum Yum Yum. Now if only I had someone to deliver my Sunday Times...The Little Medichttp://www.blogger.com/profile/05743228690074334742noreply@blogger.com3tag:blogger.com,1999:blog-2646672781891265261.post-39003822185931243712008-04-04T16:25:00.005+00:002008-04-04T17:32:50.158+00:00The Student Becomes the Master(I wish)<br /><br />This week a friend and I took it upon ourselves to teach the 4th years. It is approaching the end of the year and therefore exam time for everyone. Thursday afternoon a group of about 15 or so 4th years assembled themselves in the skills lab to be taught obs and gynae for OSCEs. I was taken a little by surprise and consequently hadn't prepared. I ended up going over breast exam, pelvic exam and pregnant abdo exam all from memory. I think it turned out quite well, although who knows what the students thought, it was also very useful revision for me as I learnt things from them too. As you'd expect, they were more interested in what stations had come up previously and any hints and tips for the exam. I tried to emphasise the important things and even collected a list of email addresses to send round some resources.<br /><br />Today I was slightly more prepared in that I'd read what I was supposed to be doing and prepared handouts. At half 12 there was hardly anyone there but 5 minutes later a group of 20 or so had appeared expecting to learn about orthopaedics and neurology. We split them into two and I took half to 'teach' them cranial nerve examination and neurological examination of limbs. My cranial nerve exam was a bit rusty but again I hope they found it useful, certainly they seemed quite pleased with the handouts which out to make up for any gaps in what we'd taught. In the end we ran out of time so I didn't get chance to go through everything with the second group and by now I'd run out of handouts but lovely person that I am, I took all their email addresses and promptly sent a copy to those who'd missed out.<br /><br />And so, the students had become the masters. Albeit masters in the very loosest sense of the word. It was more going through the examinations together and pointing out where each other had gone wrong. Nevertheless, teaching this was and a sparkly certificate I shall get. Not only was it good revision for me, I enjoyed the experience. It was refreshing, if rather more difficult than I thought it'd be, to teach other people. The students were quite willing to learn and I wasn't short of volunteers which made things easier. I've never really been a position where people are expecting me to teach them and I did quite enjoy the whole thing, I just hope it was useful for them. I can certainly see why people are obsessed with feedback forms, having done these sessions I can see how difficult it is to assess how useful a session is.<br /><br />Oh well, I'm sure they at least found the handouts useful.<br /><br />I look forward to being able to do some more teaching in the future. Apart from surgery, medical education is another interest and I hope to be able to pursue that further.The Little Medichttp://www.blogger.com/profile/05743228690074334742noreply@blogger.com1tag:blogger.com,1999:blog-2646672781891265261.post-48515994569943882002008-04-02T18:01:00.005+00:002008-04-02T18:49:31.042+00:00Surgical Consult<p align="center"><object height="355" width="425"><param name="movie" value="http://www.youtube.com/v/AAxq_OdAbl4&hl=en"><param name="wmode" value="transparent"><embed src="http://www.youtube.com/v/AAxq_OdAbl4&hl=en" type="application/x-shockwave-flash" wmode="transparent" width="425" height="355"></embed></object></p><p>Without a doubt I want to be a surgeon. There is nothing else in medicine that inspires me like surgery. I realise that medicine and surgery might be considered separate entities but you get the idea. Medical specialties just don't press my buttons, I much prefer the blood and guts (<span class="blsp-spelling-corrected" id="SPELLING_ERROR_0">particularly</span> <span class="blsp-spelling-corrected" id="SPELLING_ERROR_1">relevant</span> to lower GI which <span class="blsp-spelling-corrected" id="SPELLING_ERROR_2">I'm</span> doing at the moment) world of surgery. Surgery has the tools and gadgets which I enjoy playing with so much, it requires <span class="blsp-spelling-corrected" id="SPELLING_ERROR_3">focused</span> attention to detail with which <span class="blsp-spelling-corrected" id="SPELLING_ERROR_4">I'm</span> slightly obsessed.<br /><br />I spent the morning (and most of the afternoon) elbow deep in bowels, I realise this might not be <span class="blsp-spelling-corrected" id="SPELLING_ERROR_5">everybody's</span> cup of tea but I was fascinated. Even when not scrubbed up I can quite happily just sit (standing and watching gets ever so slightly tedious) and watch. I learnt today that my back muscles are going to need some work if <span class="blsp-spelling-corrected" id="SPELLING_ERROR_6">I'm</span> to fulfil my ambition. The other thing that <span class="blsp-spelling-corrected" id="SPELLING_ERROR_7">I'll</span> have to work on is my anatomy, <span class="blsp-spelling-corrected" id="SPELLING_ERROR_8">I've</span> said this before and I really resent not being taught any useful anatomy. I suppose I shouldn't be surprised, we've not really been taught anything, I had to go elsewhere (and pay) to learn how to suture, God knows what else we've missed out on. If I go on and pass finals, I'm determined not to waste my last ever summer and in between much computer game <span class="blsp-spelling-error" id="SPELLING_ERROR_9">playage</span>, I will learn some anatomy. </p><p>I don't know which surgical specialty appeals most at this stage, although I've always had a soft spot for orthopaedics. To be honest, I'm not really bothered, as long as I get to cut people up (when they're still alive I should add) <span class="blsp-spelling-corrected" id="SPELLING_ERROR_10">I'd</span> be happy.<br /><br />Who knows whether <span class="blsp-spelling-corrected" id="SPELLING_ERROR_11">I've</span> got what it takes but with little else that inspires me <span class="blsp-spelling-corrected" id="SPELLING_ERROR_12">I'm</span> determined to try my <span class="blsp-spelling-error" id="SPELLING_ERROR_13">bestest</span>. </p>The Little Medichttp://www.blogger.com/profile/05743228690074334742noreply@blogger.com9tag:blogger.com,1999:blog-2646672781891265261.post-46177470316145783932008-04-01T17:00:00.003+00:002008-04-01T17:12:48.520+00:00Interesting ResearchI missed <a href="http://education.guardian.co.uk/higher/specialreport/table/0,,2256178,00.html">this</a> in the news a few weeks ago but was reminded about it over the weekend. Slightly worrying.<br /><br />Liverpool and Manchester - pioneers of PBL in the UK.The Little Medichttp://www.blogger.com/profile/05743228690074334742noreply@blogger.com6tag:blogger.com,1999:blog-2646672781891265261.post-26901075910531806592008-03-30T17:23:00.003+00:002008-03-30T17:48:28.912+00:00A Fitting EndContrary to the title of this post, it isn't a story about rectal <span class="blsp-spelling-error" id="SPELLING_ERROR_0">diazepam</span>.<br /><br />Tomorrow heralds the start of my final 4 week hospital placement: lower GI surgery. Rather fittingly, this is the same as my first ever clinical placement at the start of 3rd year (I wonder if the consultant will recognise me?). I wonder how much <span class="blsp-spelling-corrected" id="SPELLING_ERROR_1">I've</span> learnt and how far I've progressed in that time? Hopefully quite significantly! How much time <span class="blsp-spelling-corrected" id="SPELLING_ERROR_2">I'm</span> actually going to be able to devote to this placement <span class="blsp-spelling-corrected" id="SPELLING_ERROR_3">I'm</span> not entirely sure as I have an ever-growing list of other things to attend. I hope to spent most of the time with the F1 (fingers crossed that they'll be friendly and helpful, although its all change next week anyway as the F1s rotate).<br /><br />The fact that this is my final placement means a couple of things: the first and most important thing is that finals are just 6 weeks away, secondly, in seven weeks it'll all be over one way or another, <span class="blsp-spelling-corrected" id="SPELLING_ERROR_4">thirdly</span>, that I have 4 <span class="blsp-spelling-error" id="SPELLING_ERROR_5">PBL</span> sessions left EVER and finally, that in 6 weeks I will hopefully never have to set foot in a certain city ever again!<br /><br />To be perfectly honest, I wish finals were tomorrow. I just want to do them and get them out of the way. Sure 6 weeks is a long time and <span class="blsp-spelling-corrected" id="SPELLING_ERROR_6">I've</span> still got lots to learn, never mind revise but I'm awfully fed up of just waiting for these exams to come.<br /><br />This weekend I attended the medicine version of the revision course I wrote about 2 weeks ago. It was a completely different style to the surgical one in that it concentrated on exam technique more than knowledge but it was useful nevertheless.The Little Medichttp://www.blogger.com/profile/05743228690074334742noreply@blogger.com2