Blogging Revision

Ok, so I'm not supposed to be blogging because I'm supposed to be revising but I had a wonderful thought - what if I combined the two?

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:

1) You are the SHO 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.

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.

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.

So, how might you approach the above situations, go on, leave a comment and help with my revision.

The Final Push

A month from now it'll all be over one way or another. 3 more weeks until exams, I'm 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 combination of the three.

4 more weeks and medical school is over. Shitters


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, I'm guessing you're all procrastinating!

Finally is anyone else having problems with blogger emails? I'm not getting messages about comments and other various emails.

The Student Becomes the Master

(I wish)

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.

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.

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.

Oh well, I'm sure they at least found the handouts useful.

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.

A Fitting End

Contrary to the title of this post, it isn't a story about rectal diazepam.

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 I've learnt and how far I've progressed in that time? Hopefully quite significantly! How much time I'm actually going to be able to devote to this placement I'm 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).

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, thirdly, that I have 4 PBL sessions left EVER and finally, that in 6 weeks I will hopefully never have to set foot in a certain city ever again!

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 I've still got lots to learn, never mind revise but I'm awfully fed up of just waiting for these exams to come.

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.

A Vision of Revision

I've spent this weekend camped in a lecture theatre at a finals lecture course, not only that, I paid for the privilege. At £95 a weekend, its not cheap, especially when there is one for surgery and one for medicine. I guess whether or not they're worth it is a personal opinion, perhaps sitting at home reading a book would be just as effective and £95 cheaper for some people. A few thousand students each year attend one of the finals revision courses run by companies like the MDU so there must be something about them that makes them popular, perhaps its the misguided vision that attending such a course is a one-way ticket to finals success. I'm not as naive to think that and if anything this weekend has made me more scared than I was before.

You do get comprehensive notes but its a bloody expensive text-book! The lecturer, who was a most charismatic surgeon from Imperial, must do rather well financially out of the weekends although he does have to give up 5 or 6 weekends each year in order to lecture around the country. He didn't strike me as someone who was doing it for the money, he seemed passionate about teaching which is perhaps what made it so good, he also seemed like quiet the high flyer and had accomplished rather a lot for his modest age. He was adamant that it shouldn't be just a session about finals and paid more attention to things which will be useful if we actually get through finals to our foundation years. His lecturing style was very clear and concise with the occasional humorous anecdote to keep us all awake. He did well, lecturing by himself, to keep my attention for 2 whole days. It was odd being back in a lecture theatre having not had a proper lecture for almost 3 years (not that we had many lectures before that). There were a number of comments from the audience, made up of students from various Northern medical schools, about a percieved lack of knowledge. Without saying it explicitly, the lecturer was rather critical of some of the modern medical education methods, there was no shortage of students who agreed with him either. Many students, and not just from my medical school, are worried about serious deficiencies in their knowledge. I imagine medical students have always been worried about how much they know as they approach the end of the course and I suppose you might say its as much the students fault as the universities - but is it though? Not in my opinion, I recognise the importance of self-motivated learning, but there is a different between being self-motivated and having to teach yourself EVERYTHING! I could sit here and rant about things as I've done so in the past, but I won't, I'll leave it there but I really wished I'd been lectured to a little more in the last 5 years!

It is no wonder such intensive revision courses are so popular with a promise to prepare you for finals and personally I think it was worth every penny. I've learnt a lot and revised a lot over the last couple of days. Admittedly I missed my lie-in and doing physiology on a Sunday morning is not something that I particularly enjoy. One of the things I've realised is that there are more important things than finals, what about when we actually become doctors? It isn't going to matter who knows about Landau Kleffner syndrome, its going to matter who can actually deal with patients and who is competent.

Kidneys - What Do They Do?

As finals are approaching fast, we're having a series of revision sessions from consultants. Yesterday's we had 2 hours on kidneys. This seems to be a notriously neglected topic by medical students, at least at my medical school. I remember back in 1st year we had a PBL case on the kidney and we were supposed to learn EVERYTHING about the kidney in a week or so with no support lectures whatsoever. I gave up before i'd even began and along with many of my collegues ended up neglecting the kidneys entirely. Fast forward 4 years to last night and this revision session was more like a first-vision.

The session itself was very useful and I feel that I learnt quite a lot. If only we'd had lectures on the kidney 4 years ago... perhaps PBL wasn't the best choice for me. I have an amazing ability to remember stupid facts that i'll probably never need to know, this is at the expense of remembering useful concepts. I haven't got the foggiest idea about renal physiology, I just about know my proximal from my distal tubule but other than that its just a load of wee.

I can tell you how many people are waiting for a kidney transplant and how long transplants last
(god knows why I remember that!) - but I can't tell you anything about ADH.

I've decided to pretend that kidneys don't exist - its much easier that way. I guess a career in renal is out then.

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.

OSCEs

Its that time of year again, as we approach the end of the module, examinations loom. Yes ladies and gentlemen its OSCE time (well it will be in a few weeks.)

I made my revision timetable at the weekend and I'm already a couple of days behind. Oops, I could do with some motivation. As it happens I don't mind OSCEs too much, in fact, in a sadistic kind of way I enjoy them although this time round it includes obs and gynae which automatically makes me want to shoot myself.

So 15, 5 minute stations, over 2 days, on paediatrics and obs and gynae. Simply by looking at previous years its easy to predict that there will likely be a few recurrent examiners favourites; breast exam, vaginal exam, family planning and various paediatric histories to name a few. At the top of all my revision notes is the phrase "WASH HANDS, INTRODUCE SELF AND OBTAIN CONSENT" I work on the proviso that if I do that in every station everything else will just kind of follow.

Maybe I should be more scared than I am about this OSCE, especially as I havn't exactly been enthused by obs and gynae and as a result have spent most of my time avoiding work. I can't wait till its out of the way and that post-exam feeling of having fuck all to do for a few days. The best thing about an upcoming OSCE is the fact that I can avoid the last 2 weeks of obs and gynae by attending as many revision sessions as possible. WOOOOOOO!!

Just for the record psych is still marginally ahead of obs and gyane in the 'firms that suck' league table.