Sunday, 11 December 2016

but what are we meant to be doing?!

I haven't updated in a while and the reason is a simple one; I completely forgot that I even had a blog. I forgot how to do life for a bit when I was thrown into my clinical years. After a shakey few weeks, things began to settle and the rough and tumble of a busy medical students life began. If I felt time pressure before, deadlines and commitments, I was being stretched to the maximum now.

My biggest confusion about this year was what an earth would we be doing this year. Hilariously, my friends and I joked about whether or not we would be on the wards at 6am. Before beginning we had the usual talk about what was expected of us: yes, turn up on time, do your portfolio, take every learning opportunity etc etc. But seriously; what was a third years timetable like and what are we meant to be doing?

A couple of weeks before my first placement began, my timetable showed

  • "Firm Teaching" 2-3 times a week for about an hour each time. [What is a firm? Where does it take place? Who is it with?!] 
  • I had "Patient-centred consulting" and "Themed-case Discussion" on a Friday morning. 
  • I had a singular "Ward round" for the whole block, 
  • but an "Outpatients clinic" every week. In short; my timetable looked incredibly empty. 
In short - the timetable looked incredibly empty.This was incredibly confusing when everything I had read before I started medical school described just how "packed" the clinical years were. It turns out - and what I wish had been explained to me before I started was that the remaining time you had it was expected you would be on the ward, possibly attached to a doctor, possibly not, to learn, observe and fill this new "quota" - something newly implemented this year.


This quota was

  • taking down 3 medical histories / week, 
  • performing an observed examination / week, 
  • taking a history + examination + presentation to a doctor / week, 
  • an on-call / block, 
  • an outpatients clinic / week, 
  • and a ward round / week.

This was monitored by filling out an e-form on our shiny new iPads. And for those that required observation / attendance (so everything excluding history taking) would be "signed off" by taking a time-stamped photograph of the doctors I.D. badge. And the doctor? Must be an ST1 or above. This meant no fresh-out-of-medical-school-and-most-willing-to-help-foundation-year-doctors were going to be signing us off.

The first few weeks was pure chaos. We learnt quickly, that due to the changes the medical school had implemented, some wards were now completely empty of students and other wards were completely rammed. There were 16 students on my particular ward. Do you know how difficult this makes it, tiring out patients with good clinical signs, badgering doctors for their time and I.D. badges, seeking out learning opportunities never mind actually managing to fill these quotas? I was timetabled to attend one ward round for the whole block, never mind one / week. I spoke to a tutor quite early on about these quotas none of us were meeting. She expressed shock and surprise that we had one ward round a week. "But you should be on a ward round every day! You should be seeing the changes in patients over a period! 1 ward round / week is ridiculous never mind only having 1 / block!" Yes, I know.

And so began the onslaught of a very tiring few weeks where the medical school scrambled to revisit, change and better the absolute administrative nightmare of our course. Things did get better though.

A few weeks in, the medical school changed the rules so that we could be signed off by junior doctors. After some badgering, they timetabled in ward rounds on other wards so that we could meet our quota. We soon got the hang of how to fill our quota's and I learnt a lot, fast. It was mainly all self-taught. I had so briefly been taught how to take a history in my pre-clinical years that taking so many histories a week, being observed and presenting them, made my learning curve incredibly steep. By the end of that first block, I could perform a full respiratory examination with my eyes closed. I could take a detailed and focused history on anything respiratory related. I knew the right questions to ask, and while I still didn't have a clue how to form a differential or which tests would be useful when; I had a solid foundation to start with. I was beginning to really enjoy being a medical student.


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