Posts

Showing posts from 2017

Feeling tired, broke and fat

It's two weeks to go till my OSCE, I feel very stressed, I am broke as hell and I just want to wake up on christmas day when it's all over and I can relax.
I'm trying to do relaxing things, i'm trying to do lots of things to take my mind elsewhere and be distracted. Yesterday I went to see a film (The Florida Project) with my friend Katie (non-medic). It was an awesome film, we had dinner out - and hence I consumed about 3000 calories more than I should have - and then she popped in for a brew. 
Yesterday morning I had a 'Breaking Bad News' practice and it went horrifically. "What went well?" the tutor asked and I just broke down, in tears, in front of my whole group. Nothing. This was an instinctively negative and immediate reaction I was having and I know it wasn't all bad but at that point, I just wanted the ground to swallow me up. I can't be fucking it up this badly with just two weeks to go. 
I don't want to do any revision any more.…

Reframing my negative thoughts

"I won't pass my OSCE in December"
Why do I think this?
"Because it's a tough examination under huge time pressure and I don't do well under 6 minute pressure"
Reframe the thought
"There is a possibility I won't pass my OSCE, but my current track record with any OSCE is 100%, formative or not. I have done lots of practice under time pressure. I have done lots of revision and I have dedicated more time and effort to this OSCE throughout this half of the year than I ever have,"
"The OSCE is not a true representation of anyone's clinical ability,"
Its a pressure cooker for 6 minutes, it's about as close a thing as we have to assessing someone's clinical skill.
"It recreates some of the pressure and anxiety we might feel as a practicing doctor in a busy a+e where we are short staffed and short of time. It would therefore be most important to be able to highlight and rule out red flags, so you don't kill someone&q…

All aboard my fucking speed train

I'm getting really really frustrated with myself. I feel like i'm either going at 300mph or i'm not going at all. For example today, even after having a lovely Friday wind down with friends, i've been eating shit, had a lie in, ate more shit and spent loads of money and ignored all the work I have to do. I know I have always struggled with getting the 'balance' and it takes me a long time to get it right during term time but it's doubly as hard during exam time.

I can't seem to maintain a sort of steady speed, i'm either giving everything my all, or i'm like fuck - no, good bye. It's so exhausting getting on and off this train, I just want to stay put. I probably keep jumping off because the 300mph is so unsustainable but gah, I have so much to be getting done and doing!!!!

This weekend, if nothing else - i'm going to be setting myself up for the week. I want meals prepped, clothes washed and ironed, I want it to be stress free in that  …

Geriatrics

So this next four weeks i'm on old age and complex health. I actually think i'm going to really enjoy this module, there's so many elements to it and I feel like Geriatricians have to juggle so many aspects of people care that I will learn a great deal.

It's mainly ward rounds and clinics for the 'elderly care' fortnight and my timetable is quite free-ing in order to really knuckle down for those all important OSCE's.

I'm getting lots of practice in at the moment which is good. I'm not quite at the stage where i'm running through everything every day which is concerning me, I want to be able to go through everything and if I think about all the elements to the OSCE I get stressed af. This week my priority is going to be to get histories down.

Also unbeknown to me, this is the first year that Opthomology and ENT will be assessed. I didn't know this before, so now i'm worried about all the new things they might try to assess which haven…

26 Days to go Till OSCE

Stress 6/10 Last nights sleep 3/10 Average step count: 13.5k

I'm back on a tight schedule this week. The closer it gets to crunch time, the more meticulous I feel I have to be with my time, scheduling and priorities. Last weekend, I boarded the emotional rollercoaster for 48 extremely hormonal hours. I cried when a supermarket assistant was slightly rude to me. I bought a lot of chocolate and ate it all. Fuck it, I'm going out out.

This week, I've been ready to reset, recharge and go again. Last weekend was perhaps exactly what I needed, the stress I felt was just getting worse and worse probably due to a combination of things. On the back of that, i'm trying to keep more of an eye on my mental health and the things that are integral to it. 
For me, it is absolutely inevitable that my mental health deteriorates when I don't exercise, stay active throughout the day, eat well and sleep well. That's my absolute bare minimum. I can't even think about getting i…

Panic! No don't panic. Panic! No, stay calm...

It's about a month to go till OSCE's, I've just finished my ENT week (as part of Neurology and Special Senses block) and I keep dipping in and out of pure panic and then calming down.

I don't know what i'm more stressed about: the examinations, the explanations the history taking. I used to feel so comfortable with the explanations and history taking but i've seen myself properly fuck that shit up. I'm still trying to get used to the idea that those latter two are far far more about communication and structure of your consultation more than anything else. I think I've been more preoccupied with getting a diagnosis and saying the right information before but that's not what bothers me now. I either will or won't nail the diagnosis but who cares as long as I have some suitable differentials and the worst case scenerio is I don't actually know anything about the thing i'm explaining - reassure the patient as best as you can, refer to senior…

OSCE practice

I've practiced OSCE's before in a range ways - and mainly examinations, I've always tended to have down.
I would rehearse them in my room every morning - every single examination, and then every evening, practice on my flat mate - spin the wheel, go.
This time, I've got a month to go - and i'm not sure what stage I was a month before my OSCE's last time, but all I know is, I don't have a revision period and I am very scared. 
I've had a good go at 90% of the examinations and I think the rest will just be practice, practice and more practice. 
Yesterday, I got a group of 6 of us together and ran a little min-real-osce with my tutor playing the official timed buzzer and everything. I bought snacks, I bought mark schemes and I bought feedback sheets. It was really nice and I think I forgot the value of practicing with a range of different people who will call you out on different things. I think me and my flat mate by the end, were so confident and happy w…

I am going down

I don't know why this is happening to me (I do, I get up at 4am and don't stop till 6pm), why is my body betraying me (because you've been in a calorie deficit for 7 months) why is this happening to me now (because you've not had a day of relaxation for 9 weeks)...

I'm going down. I feel ill. I felt ill last week and then on Sunday, I felt momentarily better - Hoorah, I thought. Thank god, I have so much to do, practically sprinting out of bed at the faintest whiff of recovery. I was immediately knocked back down again, like a smug punch in the face for even thinking I could just get up and go at the same speed I was at before. I am finding it very frustrating.

OSCE's are a month away. I really, really, don't have time to be lying on the sofa for a week. I started Ophthalmology yesterday. I went to my induction, which was actually really well done (note to any speciality welcoming medical students - breakfast donuts go a hella of a long way, +10 if you have…

Could I be a neurologist?

For some really, really daft reason, we only spend 2 weeks doing Neurology in our fourth year. Despite the fact that there are very very few neurologists in the country per head meaning that most other doctors spend a significant amount of time doing lots of (less complicated) neuro stuff too, we get a grand total of a fortnight.

It was the best organised placement I think I've ever had. We had the best of the best teaching us. It was fun, I learnt a huge amount and now seriously consider doing it as a career. It's competitive, can be incredibly tricky and complex and there is still so far to go in this area of medicine, but it is fun. I said to one of the consultants I was clinic with this week, "I'd love to do it...but it's too competitive...I don't know whether I would be able to make enough sacrifices to do it. Did you have to sacrifice a lot?" I asked, wondering about how things were different when this middle-aged irish consultant trained in Neurolo…

Psychiatry

A very different specialty to anything i've ever known and yes, I mean different, not, a crock of shit. I was actually very prepared to hate it, the "wishy-washy" (cue every psych consultant rolling their eyes) parts of it but actually for the most part it's an area of medicine that is unfairly ignored for the "sexier" specialties. 
It is hard work too. Gone, are the images of sitting in a 3 grand arm chair listening to a patient talk about how being an only child ruined him. Instead, think of a cramped board room filled with more MDT members i've ever seen in general medicine, pacing patients, talking fast and loud,  illogical delusions, not stopping for breath for 8-9 minutes, answers to simple questions taking 24 different tangent. Think, vacant stares, auditory hallucinations, messages of suicide, completely mute patients, patients that require restraining in a 5:1 ratio - it's very hard work. 
It's interesting because you get so many patien…

Well this is intense

Another very busy week for me. I am scheduling private study very intensely around university commitments. Rheumatology is freakin nuts, there are so many possible diagnosis' all with overlapping symptoms and signs that actually nailing a diagnosis is fucking hard!

It's also come to my attention that as I failed the last progress test, if I fail the next one, I will be kicked out of medical school. So if I wasn't stressed, under pressure, or seriously fucking worried before, I am now.

Found the day case centre for Rheumatology this week where patients with chronic conditions perhaps having a flare up or whatever come in and have some treatment. It's really really good for getting histories and I so wish I had found it sooner. Also met the rheum reg's who are really keen on teaching - it's always that as you just begin to find your feet you know you'll have to up and leave again which is so annoying!!

Bit behind on my learning of examinations if we are to fo…

Revision Plan Year 4

Weeks 1-3 = learn 4 examinations / week Review previous examinations every weekReview all 12 during week 4Schedule 30mins - 1 hour / week for Year 3 reviewComplete all cases every weekReview previous week cases (1hour)Review previous fortnight cases (1hour)Review previous month cases (1hour)

Year 4 Week 1

I can't remember the last time I felt this shattered.

I get up at 6am, I train (75 minutes weight training), I walk to placement to get there for 9am (40 minutes), I walk back (40 minutes), I eat, I study, I sleep. Rinse and repeat. There's not enough hours in the day. I've had my tired eye twitch all week.

I'm finding it more difficult than I thought having an additional friend stay with us. I'm going to bed later, I'm having to be switched "on" a lot more... she works full time, she doesn't get my whole training and diet or I-really-just-need-to-study-thing. I'm really, really looking forward to being on my own this evening. I really, really value my peace and quiet and at the moment, i'm not getting any. Not before i go to bed, not when I walk through the door, not all day when i'm a headless chicken on placement....so i'm quite excited how i've got my evening all planned out.

Today, as I had such an early start, I didn'…

Reflecting on my SSCP

At the end of third year, your final placement is a 4 week Student-Selected block. You rank your 7 most preferred along with every body else and you are matched to the highest one, depending on how many others have ranked them in a similar fashion. I really, really wanted neonatal HDU, but ended up getting Paediatric Anaesthesia.

Unbeknown to me at the time, I would be spending a fair amount of time with neonates anyway! Anaesthesia appealed to me for lots of different reasons; it's very hands on, lots of one-to-one teaching, it can be quite varied. Saying that, working with young children rather than neonates didn't really appeal to me, spending a humongous amount of time in theatre also didn't particularly lavish me with enthusiasm and so I was fairly apprehensive about this placement.

I needn't worry. I've had an absolute ball. I learnt how to bag and mask tiny tiny babies, attempted (unsuccessfully) cannulation, spent time with some of the most fantastic consul…

Reflection on juggling a job and third year

Recently, i've been going round and round in circles, trying to figure out whether it is worth keeping this job throughout fourth year. I have just finished third year and as the intensity of fourth year dawns upon me, I am weighing it all up.

When I first started working at Waitrose in November 2015, I don't think I envisaged keeping the job throughout my third year. Knowing full well, I would be on placement and unsure of how structured the timetable would be (but imagining 0800-2000 shifts ha ha!), I blindly just thought i'll see how it goes.

When I first received my timetable, it was clear that I couldn't work 1200-2000 every Wednesday like I had been before. I needed to reduce my hours.

For the first two months, I only worked on Sundays. This was not strictly allowed - the rules were, you had to work at least 2 days a week. So eventually they put my Wednesday shift back in, but halved the hours so it was now just from 1600-2000. I managed to keep this up all year.…

guess who's back, back again

Dear all, sorry for my long absence - I got busy and to be honest, I knew I had to do a whopper of a post addressing how I did in the year 3 osce and just felt so daunted and exhausted by the idea that I just stopped writing.

I will address the year 3 osce in more detail perhaps at some point in the near future but the long story short is that I scraped a pass. I would have been more pissed off because I worked my god damn ass off, but some of my close friends actually did fail.

Also I was unsure about how to continue writing while still claiming anonymity. It's important that I do remain anonymous, but I worry that this might all come right back round to bite me so I'm aware of how careful I have to be. This anxiety made me less keen to write. At the same time, it's been a real pity to see the number of other medical student blogs have disappeared / removed. I remember what a joy they were for me to read when I was applying...

Over the next few weeks, i'm going to wri…

Dolla dolla bills y'all and on ode to my mama

Student Finance have done the almightiest of fuck - ups. It turns out, they are saying I have a received a £2000 ish overpayment in the form of grant money. And to get it back? They are withdrawing my funding for the rest of the academic year.

This has left me knee deep in shit basically. There isn't anything I can do about it either, from my research - every year, we sign a declaration confirming that if they overpay us we will return it. Happy Days eh?

It's also been a week since the OSCE last Thursday. I celebrated the relief of it being all over and proceeded to be very very unsure about what to do with myself. I was so used to being in bed by 9pm and up a 6.30am that I couldn't snap out of the routine. It's not a bad routine, but it's certainly a little bit boring when you're saying good night to your mates on a Friday night at 2045 because everything in your body is telling you need to be up in 10 hours ready to chant those freakin examinations through.

I…

Year 3 OSCE

So, i’ll do this the way i’ve always done it. Talk you through what I had and how I got on. Originally I tried to give myself a score out of 7, but quite frankly, that's too hard. 
Station 1.Data interpretation 4/7 - a scraped pass.
CXR + ABG. 
ABG showed low oxygen, low carbon dioxide, but pH was was within normal range (7.37), HCO3- was in normal range, and so was base excess. 
PMH: Asthma. 
There was some consolidation in the lower right lung but as far as I could see the trachea wasn’t deviated - apparently it was!! The pneumothorax was pretty obvious. But I basically spoke for about 5 minutes straight chatting complete shit and making one diagnosis and then changing my mind to the point where all I really wanted to say was JESUS TAKE THE WHEEL.
Station 2.History taking - Angina. Pass.
So there was I was, revising away, thinking you know what - there is no way that they are going to give me the same station I had in my mock and THERE YOU GO. Literally the exact same situation. She wa…

What the week has looked like

Image
To give you an idea of what my weeks have looked like this is it. It's me getting up at 0630, run through all the possible examinations (e.g. Thyroid, Cardio, etc) and plan every single minute from then on until I go to bed at 9pm. You'll notice I take m y time at the gym and try to have a leisurely lunch to give myself a break from the onslaught of it all. + going to the gym wears me out so it takes a while to build back up again!

Occasionally, e.g. Thursday = rest day, I give myself a few hours to do sweet f a. I really needed it too because I had hit such a strong mental block that a few hours to watch Gogglebox and have a couple of non-dietary-included biscuits was just what worked. When you plan your days like this, there is no level of spontaneity - when you call your mum, when you get your eyebrows done, when you eat and what you eat is all completely planned out. It just means thats a shitload less for me to worry about. I can't tell you how easy it would be to do…

A week to go

So at this point, I've been getting up at 0630 every day now. By some sort of miracle, i've learnt not to snooze on snooze on snooze, I actually... like, get up. It's very strange and satisfying. I get up at 0630, I work work work till about 6pm, but with at least 4-5 hours of that being made up with going to the gym and having snack breaks. Gotta get dat protein.

I spend the first two hours just running through all of the examinations. Cardio, respiratory, peripheral vascular etc - all 7, and then I write down on my whiteboard what I missed from all of them and i'm like OK - can't miss that next time.

Then I flick between doing history taking, explanations, etc using the pomodoro technique. I was recently given a list of the past stations - and I'm feeling a lot more relaxed by it. I also feel a bit like a cheat. I am going through every single example station from previous years and making sure I can nail it, using flashcards and tings. There's a running …

Is this the OCD kicking in?

So as of this morning, i've got 10 days till my OSCE on Thursday. There is something about being filled with high panic and knowing i've got a lot of work to do for an exam, that kicks me into the land of crazy revision weirdness.

The night before,  I try to plan my next day as clearly as I can with an hour-by-hour run down of everything I'm going to do. I use the pomodoro technique so have a timer on every minute I am working or not working. I get up at 0630 because I recently watched this ted talk. I know I work better in the mornings and in the evening, I can't seem to function. So whether i'm sat in bed or asleep - it doesn't make a difference, i'm still not working. However, if I was to be sleeping, than I am getting some good quality rest in and I'll be able to rise earlier. That's a win. So, I go to bed no later than 10pm too.

I schedule in some gym time as a priority. I stopped going for about 5 weeks over February and I began to feel really…

PLACEMENT IS DONE

I almost failed this block. I've not seen my consultant lead since the day I met him - this, I now know, isn't uncommon. I also now know, he doesn't have a clue how to use the eforms app. He seemed to believe that the procedural skills was something that he needed to look at to decide whether or not we pass or fail the block. That's for the medical school, not you.

Next he went through every single e-form. Now these past two weeks have been a real step back for me. I've not been attending the things timetabled, nor have I ever attended a clinic; this was because as we ran up to OSCE's I basically decided, ain't nobody got time for tha'. This decision was assured further when it became clear that my consultant doesn't run any Urology clinics. But essentially my summary for this block looked poor - and now I was about to be failed for it. Rightly? wrongly? - it's a bit annoying when there are some people people (boys, i'm looking at you) don&#…

Final Week of Final Block

[Sorry, I can't seem to correct the format of my last post so may be whip your binoculars out for a read!]

This is my final week of my final placement for the year. My god it has flown by. It's also 2 weeks until the real OSCE and that's what I'm gearing up for. Placement commitments have definitely taken a back seat as I spend every day trying to nail everything I can for OSCE's.

Today I went over Cardio exam (which actually took a lot longer than I thought1). Murmurs seem to go straight over my head too so that took some time. I looked at IBS explanation and treatment. I did a bit on history taking but was absolutely knackered by the afternoon. I practised a cardiology exam and thyroid exam on my friends after dinner too - and am getting a bit more confident that I should finish the exam within the pressured time but this is bearing on mind i'm practising on normal people!

I also went back to the gym today for the first time in 5 weeks. God it felt good. I ha…

Formative Osce

So a few weeks ago, I had my sweat drenching formative OSCE. You can see how that went here. 

Overall, I have gotten 64%..

Marking of the Year 3 OSCE's are as follows:
In order to pass the OSCE, students have to fulfil all of the following criteria:
gain a mark of 57% or more overallhave no more than 4 stations with a mark of less than 4have no more than 2 stations with a mark of less than 3. Moroever:
A grade of Satisfactory is equivalent to a score of 4/7 for 50% of the stations and a score of 5/7 for the other 50% of the stations (i.e. >64%) This would suggest, I have literally scraped through yet again, I have literally just met that criteria.
The examiner marks you on various aspects of the station out of 5. This scale ranges from “uses no elements” to “uses all elements”. You are then given an overall global mark which is the examiner’s expert judgement of your overall performance on the station. The global score is not simply derived by aggregating the domain ratings but inste…

1 week to go

So that's my third week of Surgery done and yet, ironically, I have seen no surgery this week. I was meant to be driving up to Scotland with my friends (mid-week, brave, I know) but had to cancel last minute as it began to snow here. I didn't want to risk being stuck, but had already taken a morning off by that point.

On Monday we had a clinical skills day at another DGH. We learnt how to catheterise a man, a woman, subcutaneous injections and intramuscular injections. The idea of this clinical skills day is to teach us how to do these basic skills nice and early, so that we can go onto the wards and practise them on real patients. What then, is the use of giving us this day in our penultimate week? I have no idea. I also don't know why they insist on sending us to an even further away DGH to do this but I'm going to take a wild stab in the dark here; money, resources, people.

Tuesday, Clinical Debrief and Wednesday began the onslaught of trying to find people to get t…

2nd week of surgery done thank christ

The remainder of last week was fairly uneventful. I had work on Wednesday, went to see a nephrectomy on Thursday morning and left swiftly avoiding waiting for teaching I wasn't convinced was happening. Joke is on me though as it did happen and apparently it was very good.

As the pressure gets higher to revise, the more disinterested I am in actually being present at some of the teaching sessions we're having. Last weeks case was CKD and while I'm sure the themed case discussion was very good, the lights were on but no-one was home for me. I then managed to somehow go out and socialise all weekend and do no work and then bang. It's Wednesday, I've got a million things to sign off and work to attend in the evening!

This week is my penultimate week of placement and indeed my blocks. Surgery placement hasn't been particularly thrilling thus far, i've found most of the seniors very difficult to approach and they haven't seemed particularly welcoming. I don&#…

Broke down

Firstly, a quick apology if this is poorly written - I'm typing it on my phone as I go to sleep.

Today, I was meant to have a clinic in the outpatients. Arrived at outpatients (late, because that's just who I am) - no clinic anyway. Right, OK, I can still make the most of my morning I think to myself putting on my best PMA (positive mental attitude) despite me having the worst PMS I've had in a while. (Seriously, considering getting back on that contraception).

I went onto the surgical triage unit, where I had a successful morning last week. Consultant ignored me, reg ignored me, great. Decided it wouldn't do me a world of good to try to shadow them on the ward round, so asked a CT about good patients to get a history from and off I went. Met two lovely people, go a really poor history and left. Didn't want to examine the First Lady as her mum was asleep in the chair next to her and the gentleman I saw after was pretty deaf and not sure if at all with it.

I then sp…

Mental block on a day off

OK, so I had another busy weekend which was fun, fun, fun. Really did not do much work, but on the positive side I did actually go to my part-time job for a change. Had lots of "How much longer are you really going to last?" conversations. Was absolutely exhausted because I'd been out all of Friday night, didn't sleep till 4, had to get up at 6 to drive my friend to the airport and then went to see my friend in Liverpool for the day. Then ended up not going to sleep till 3 because I had some friends round to chill and had to get up at 8 for work.

By the time I got back from work yesterday I had one of those 6 hour naps which really should have been me going to bed, but nope. So I did not get any work done over the weekend, which guys, is a direct result of me not being able to say "no" in many aspects of my life. Peer pressure kills me every time.

Today, I've (sort of, may be given myself) had the day off. I got up at a human hour, did some cleaning, sa…

Don't drop the ball

So yesterday I did a full day of revising pretty much. A friend came round in the afternoon and revised with me but I looked over the treatment and management of diabetes, hypertension, taking a cardiology history, taking a respiratory history, differentials for all of their different symptoms.

I'm not really sure what to do this morning. It's the first Friday i'll have my Patient Centred Consulting and Themed Case Discussion in the afternoon (so finish at 5, boo) so i'm not used to actually having the morning free. Normally I wouldn't do any work on a Friday.

I think I might look at the treatment and management of heart failure, counselling patients on warfarin and interpretation of x-rays. Then I need to look at how to perform a DRE and peripheral vascular exam.

It's so hard to know where to focus your energies. On one hand, I need to make sure I have examinations down as that is the only thing I can practise and know whats happening for. On the other hand re…