Working as a Healthcare Assistant

So I have written a post about how I am working as a healthcare assistant at Bristol, but haven't followed this up with anything really on my blog. I have been doing this job properly now for around eight months and am loving it more and more, shift after shift.

The best thing about being a HCA is that you are learning so much about patients that lectures just cannot deliver. The lectures at uni are all about the physiology and scientific aspect of different diseases and conditions. You can learn about congestive heart failure down to the cytokine, but it presents itself differently in every individual.

Working as a HCA, I have met so many patients. Each of them completely unique in their own way - with the way they wanted their care delivered, the way they view their disease and their own prognoses.

I am also learning lots of practical skills. I actually found that I am becoming more confident in the way I speak with patients and help them out. At the beginning, I found myself quite reluctant to touch and get hands-on with my patients, and I think this was down to the fear of hurting or harming the patient. Now, I am much more confident. I can knock on the door loudly before entering and introduce myself with a smile (and not mess up my introductory lines!). I am yet to get to the level of the other HCAs I work with, but I'm hoping that will come with time.

As I now have a long summer ahead of me, I'm working as many bank shifts as possible. Not only am I earning money whilst doing so, but I'm keeping my head in the medical world so I won't get a shock in September when I start my year in Taunton's hospital!

OSCE Exams!

This was an abbreviation I had seen so much of during my research into studying medicine at university. Now, this was going to be my main assessment for second year!

An OSCE is essentially similar to the MMI stations that you will (have) sit to get into uni. The stations are made up of a number of sections and each OSCE will have a certain number of stations in total. For my exam, there were three stations with each being divided into three sections.

Each station would test an aspect of the content that had been taught in both years 1 and 2. It would involve a history or an examination on a patient with a presenting complaint, so like chest pain or breathlessness. It would then be followed with an interpretation task. So this could be looking at an x-ray (to test anatomy), processing lab data (to test practicals and lecture content) or interpreting graphical data. Finally, would have to explain something to the patient (ie. what they have, how to use an inhaler etc) or activate them to change their lifestyle (ie. stop smoking, stop drinking alcohol etc). The station could also have a clinical skill which we would’ve learnt In our clinical encounters, like dipsticking urine or doing a manual blood pressure.

But there were three of these stations to break it up (eg. One on chest pain, one on breathlessness and one on abdominal pain).

The examiner would sit there with a clipboard and tick as you were talking and working with the patient. The patient was an actor pretending to have the condition, or real patients who had what they were actually describing (eg. Psoriasis).

The whole exam lasted an hour. (Each station was 20 minutes)

It was great how the exams were so practical and you actually felt like a medical professional whilst speaking to the actor patients. It was very pressurising, like any exam, as the trick was to look both confident and friendly. In these examinations, you're being tested on both your person skills as well as your knowledge!

I got my results about a month later and was over the moon with a pass! Roll on Year 3...

Moving onto Symptom-Based Learning!

With Christmas term over, we now begin the second term which will take us up to Easter. In this section, we are doing symptom-based learning.

As I mentioned previously, the teaching is usually done by individual systems. So we are taught about the gastrointestinal system, the cardiovascular system etc. However, now, we are being taught about particular symptoms that patients could present with. This is really helpful for marrying that content that I had mentioned earlier. For example, “chest pain” can be caused by many things. It could be caused by the respiratory tract, it could be caused by the cardiovascular system, or even caused by upper abdominal organs. Pain can be referred so even if you have a pain at your shoulder tip, it doesn’t mean your shoulder is hurting but could be an organ towards the back of your upper abdomen!

Surrounding each symptom, we are being taught all the relevant details. So with chest pain, we are learning about cardiac problems and red flag symptoms of dangerous conditions like heart attacks. Each of the red flags we learn are fundamental in our history taking when we ask patients to describe what brought them into the GP or hospital.

Southmead Hospital at night, on the way home from a night shift on the wards as a healthcare assistant.

With the system involved, we are being taught the examinations as well. So we are able to examine a patient and be able to link up what we have learnt. For example, in abdominal pain, gastric malignancy can be shown by an inflamed lymph node above your collarbone called the Virchow’s node. In lectures, we learn about how malignancy will cause the node to be a clinical feature of gastric malignancy, whereas our examinations teach us how to feel and locate this node, as well other associated symptoms we may be able to observe, palpate or percuss.

The symptom-based learning is far more interesting as the answer is not as direct as before. We still have our tutorial discussions based on cases that represent real patients. Whereas before, during say the respiratory case, we could exclude the chest pain of endocarditis because ‘we wouldn’t be taught this in this case as we are not doing cardiovascular’. However, now we have a broad scope of what the cause of the symptoms we are giving is. This is much more like real life and makes it more enjoyable in our tutorial sessions.

Back to Lectures...

The main clinical block was now over, meaning we were back in lectures. After having a summer away from it, I couldn’t wait to get stuck in again. There’s something about getting up, grabbing a coffee and spending time with your mates in a lecture on something that confuses you by the fifth slide.

The lectures from now until Christmas will involve the foundations that were taught from first year and help guide us into the symptom-based teaching of after Christmas.

In comparison to first year, we were taught about every system individually. Now, we are being introduced to more complex physiology, like the turnover of skin, and how this process can be disrupted and present clinically as a disease. This year is more disease-based than normal physiology.

Our labs contain more interesting practicals, such as understanding what flow cytometry is and how it can be used to work out which cells are in a sample to the metabolism of aspirin. This is definitely a more sciencey block which is quite nice after just finishing clinical placements and times on the wards.

The knowledge we have developed this year can help us work out what tests and investigations we may want to do. Using the results from investigations, we are able to work out a possible diagnosis of particular patient cases.

In our clinical parts, we have been taught greater details on taking a well rounded history. For example, how to explore the different components of a drug history to make sure you don’t miss anything out. Like how people sometimes forget to mention their contraception drugs when giving the list of their current medications. Furthermore, we are completing system examinations on patients in the hospital and the GP after taking a history which is helping to marry together our findings!

Paediatric Placement!

With my first lot of clerking completed, we then move onto the second part of the year’s beginning: Student Choice projects.

I chose my student choice project last year from a long catalogue of different options. These options ranged from laboratory based research projects, research into behavioural sciences and ethics and loads of different clinical encounters of different specialities. I had chosen from the list that I wanted to complete clinical work on the Children’s Unit at the Royal United Hospital in Bath.

Playing and creating are two things children love doing! So as part of their care, we are encouraged to interact with the children to help combat boredom and fear of being in hospital.

We caught the coach each morning to Bath so that we would get a handover from the nurses and care assistants about the children who were inpatients on the ward. It was a fantastic opportunity to be able to meet such positive children and see how the diseases we had started to learn can manifest and present differently in younger children. We also had the chance to walk around NICU and see the neonatal care delivered there.

My favourite part was meeting the Play Therapists. These amazing individuals are responsible for using fun activities and toys in their delivery of care for the young patients. Play therapy can be used as a distraction, with one therapist saying that the mobile play machine (a contraption on wheels with a disco ball, flashing lights, mirrors and sticky-out twistable colourful things) can be used to make the child look away from something fearful like a needle.

It can also be used to help teach the patient and engage them with what is going on. For example, I saw a play therapist explain what an MRI scan would involve to a child. The therapist and the patient both acted out what it would be like, by pretending to put on the headphones, making the loud “brrrrrrr” whirring noise and where the child is required to lay still and flat in the machine, they “shook all the fidgetness out!” by wriggling around in their chairs. It was fascinating to watch the child so engaged and understanding what was going on.

Lastly, the play therapists told me about how it brings together the family through bonding. I sat with a family who said that the hospital encounter has brought the family closer together. Mum and dad would be at work, so having their child in hospital had brought them closer than ever before and they were able to paint together, produce clay artwork together and play with hundreds of different toys in the playroom - “something we would’ve never been able to do usually at home” the mother told me.

The ward had also been given a brand new innovative idea called the ‘Magic Carpet’. This was an interactive machine which used a projector that took shadows as touch. This meant the bulb would project a massive area of leaves onto the ground, and as a child ran across them, the leaves would disperse. There were loads of different interactive projections, from fish that run away when you touch them, or fun games like acting as a goalkeeper in a penalty shoot out.

At the end of this section, I had to write up my experience on the Children’s Ward as a reflective essay and comment on the findings I had made through my research into whether the hospital provided good support for the parents whilst their children were inpatients.

The biggest take home reflections I made from my placement was how amazing (and fun) the play therapy on the wards is. I had my face painted and got a different glitter tattoo each day of the three weeks!!

Consulting Placement!

We all have returned back to university! And by "we", I simply mean the medics! All of my friends don't actually start their lectures for another two or three weeks, so as they enjoy their final bit of summer, I'll be on placement.

Placement began at Southmead Hospital where we got involved in hands-on experience. Like I have said previously in a historic post, it's the most "doctory" we have felt so far on the course!

We were in hospital for three weeks. Each one was dedicated to a particular system: cardiovascular first, respiratory second and then the final week was gastrointestinal.

Waiting in the staff room!

The teaching was structured like this:

• We had tutorials and small hospital-based lectures that taught us how to take a full medical history from a patient.
• We had a practical tutorial which taught us the clinical skills for each individual system during their case week. For example, we learnt how to perform an abdominal examination (from keeping an eye out for tremors and visible clinical indicators on the body to being able to auscultate and percussion of the abdo). 
• We learnt how to perform other clinical skills such as taking a manual blood pressure and completing a full cranial nerve assessment.
• Each of the weeks had a dedicated 'patient' case associated with it. This was very similar to the case-based learning we have embarked all year. However, there was more information provided with these cases: from radiology findings (X-rays, MRI scan images etc), blood results and examination findings. This provided a more 'clinical' feel to the teaching we were receiving.

This was so far the highlight of the degree because of how 'medical' we felt. The teaching was more clinical which showed us the important of different disciplines when it comes to both diagnosing and treating a patient. For example, one 'case' was a female with pulmonary embolism. Her X-ray appeared normal but her CT scan showed the 'polo-ring' mass occluding one of her pulmonary arteries. Her blood results further supported our potential diagnosis and her history. This is why we were taught such greater detail about taking a history from a patient, because this can help support a certain hypothesis you may have (and help you exclude others).

The best part of the cycle was being able to go onto the wards and actually apply what we had learnt in the clinical skills room and our own independent learning. I was able to go on the wards and perform a cardiovascular examination and sit with patients and understand their full story to why they had been brought into hospital.

The hardest part of the cycle was probably trying to come up with differential diagnoses. These are the 'back-up' ideas you may have about a patient's condition but you may want to run more tests to help support for or against your other diagnoses. At the end of the day, there is a million and one things that could cause breathlessness - so you can't just jump on the first thing that you believe is the strongest diagnosis.

In case you are interested, this was the kind of clinical work we were completing in our tutorials before going to practise on real patients: https://geekymedics.com/cardiovascular-examination-2/ 

Summary of Year 1

Let's do an overall summary of Year 1...

• I arrived at university and met my flatmates. I had to make all new friends from my course and my student accommodation, who thankfully remained by my side throughout the whole year!
• I did house viewings and decided on my accommodation flat for next year!
• I learnt soooo much! From anatomy, to law, to sociology, to ethics, to histology, to biomedicine to biochemistry! There has been so much content on each individual system in the body which you can't help but feel excited to turn up to lectures.
• I have handled a lot of cadaver specimens and have been exposed prematurely to death. I have also taken part in shadowing a pathologist during a post mortem.
• I have taken part in clinical shadowing at GPs, where I did some clinical skills and did individual home visits. Here, I learnt how important communication is when it comes to talking to patients.
• I have also shadowed doctors at Southmead Hospital and have been taught by both patients and the teaching fellows about body systems and some clinical skills - such as taking blood pressure, blood glucose levels, auscultation and palpation.
• I completed an essay project, as well as an art project. This is based on medicine being both a science and an art.
• I have worked as HCA as part of the course, where I worked four shifts of 7 hours and one 12 hour shift.
• I loved being a HCA so much, I then went on to apply for a job as a healthcare assistant in Bristol. I went for the interview and then received my job offer. I then attended the training and now awaiting some shifts to sign up to!
• I have completed my exams, January and Summer and passed to progress into Year 2!

I can't believe how much I feel I know ever since starting just less than a year ago!

Year 1 has been filled with some very exciting moments and I have enjoyed every second of university life. You are so independent and have so much fun which is incomparable to any other experience I have ever had! I would say I would love to do it again, but I'm really excited to go into Year 2!

I hope all of your exams go well and you receive the results you both want and deserve. Have a great summer, and I will speak to you in September if not before!

...and the results are in...

Guess who is 20% a qualified doctor??? ME!!!

Yup, somehow, I passed my exams! I feel like it was a huge reward for all of the hardwork that I put in towards the end of the year (from the beginning of May up to the exams) even with the circumstances going on.

I will use this chance to say about the grading with medicine as well! I'm not sure if I mentioned it in the last posts so I'll say here, medicine does not have the standard first, 2:1, 2:2, third etc. scale which is used to measure and assess other courses.

So you will hear that a lot, "Did you get a first or a second in your exam?" around the university. But medicine is simply a pass or fail. This then determines your next progression into the following year. So because of this, I have completed Year 1 and will progress to Year 2 next year!

I'm progressing into Year 2!

Thank you to everyone that supported me, especially the past month. I am truly grateful for everything.

Summer Exams

Preparing for the exams has awful and sadly not because of the stress of exams. Whilst at university, I was informed by my friends at home that a close dear friend of mine had passed away at his university. This came as a great shock to me and I wasn't prepared to process such news as devastating as this. I was fortunate enough to attend his funeral and speak my eulogy that aimed to portray his fun and exciting character that I miss dearly. His funeral was the 6th June, whereas my first exam was the 5th June and my second exam was the 7th June. So sandwiched between the two examinations, I had to travel home promptly within the time to ensure I would make his funeral.

...

But the main question - what were the exams like?

Short answer: Difficult! Haha.

It's nothing like A-Level testing. The exam MCQs give you five possible answers to a question that could be a one line to a whole paragraph describing a patient's history. You guarantee that you will find yourself deciding between two answers and then it's pot luck if you aren't confident to the answer!

The exams were also weighted massively on the delivery of teaching. The majority of the exam was on physiology and function, closely followed by anatomy and then broken up into questions on the sociological, behavioural and ethical aspects of the course.

Here is an example of a medical MCQ! (And how I would approach such question in an exam situation)

Which cranial nerve is responsible for the abduction of the eye?
a) CN II
b) CN III
c) CN IV
d) CN V
e) CN VI

So... the breakdown on this question. You could either work out each individual cranial nerve and what it supplies, but I found it was always quicker to just dissect what the exam question is both asking for and looking for.

I'd begin with a quick sketch of the eye...

A small sketched diagram I would draw next to the question that I've annotated. The line on the left represents the nose, showing that this eye would be the left eye.

On the sketch, I would quickly drawn on the eye movements and the name of the muscles that are responsible for this. I would have learnt this mainly from my anatomy sessions when I located these muscles on cadavers and learnt their functions. Then, in the neuro case, I would've elaborated on each individual cranial nerve and what motor supplies they have.

I would then draw the names of the eye movements:

Another small diagram showing the names of movements of the left eye.

This is important because I need to be able to understand what movement I am trying to identify. In this case, abduction is the lateral movement (meaning the eyeball moves away in a direction away from the nose). Comparing the diagrams, it is clear that lateral rectus is the muscle responsible for abduction of the eyeball.

Then, I would just have to either remember from my revision that the lateral rectus muscle is innervated by CN VI. Or, I could've looked at the answers in turn. Cranial nerve six, CN VI, is actually called the abducens nerve. So this would've saved me time if I had remembered the common name of this cranial nerve! Or I could've worked down the functions and remember that CN II is the optic nerve which provides sensory information of sight etc. Or, remembered that CN VI is the only cranial nerve to supply the lateral rectus muscle ... which causes eye abduction!

It may not make sense now, but you'll be laughing how easy this is to understand when you complete your first months of medical school - trust me!

If you are looking for my opinion of the exams, I would say they were very difficult. They were quite confusing and used a lot of application! I know in the example, I gave an MCQ which would be structured similar to how the teaching would be delivered. But there were a lot of questions on symptoms and a list of possible conditions which we had touched on throughout the year.

I found the second paper a lot harder than the first. Obviously, the circumstance of my friend's funeral being present during my revision time didn't help either, but I will confirm that I did apply for extenuating circumstances. Results day will tell me more!

Good luck to everyone else who has exams at this time!

Preparation for Exams

At the moment, I still attend university in the week because we are still learning content. We are still learning about the Neuro system (which involves the brain, central nervous system and peripheral nervous system) and the Endocrine system (which involves the glands and hormones around the body). As mentioned before, this content is being delivered through lectures, facilitation sessions (because we are doing CBL), laboratory sessions and the clinical placements at the hospital and the GP.

How the majority of my days were spent throughout May!

Between these hours at university, I have been finding the time to balance revising for my exams. I have two exams this year which are both written multiple choice exams. Whereas in my January exams, if you can remember, I had to complete a written examination of MCQs (multiple choice questions) but also a 'spot' function exam (which involves cadaver specimens with pins labelling structures we should identify / explain their function fully) - but in my summer exams, I just have two written papers! Both of these exams are MCQs, 80 of them, which will test all aspects of the course from the beginning (Yes! ... from September 2017!)

So, I had to revise all of the ethics, all of the behaviour and social sciences (including sociology), some of the law content and the biomedical parts. Alongside this, I had to revise anatomy, histology and the function of each of the structures I could identify from a variety of photographs.

The worst part about revising for these exams is that I love working from past papers! They were my 'go to' resource which helped consolidate my knowledge. But unfortunately, I have no bank of past paper questions to go by! Some of our lectures though did give a small example of what a multiple choice question concerned with the lecture would look like, so I did stick all of those into a document that I printed and made an attempt at.

I did find quite a few online MCQ flashcard applications which had pre-made Year 1 medical questions which were composed by other medical students. Obviously, there were a lot of questions I didn't know because they weren't part of my curriculum. Therefore, I broke up the content and searched for questions on those individually. For example, looking up quiz MCQs on 'Anatomy of the Thorax' or 'Histology Images of Epithelial Cells'.

My exams are in the beginning of June which is very late in comparison with my friends. My friends finish their exams mostly in the middle of May, where they will be heading home for summer. So, I will be revising in the flat alone! Some of my friends from other universities studying other courses had a few exams at the end of April and were done for the summer! I'm very jealous.

To revise, I found the best way to learn anatomy was to study myself! I drew on my body quite a lot, highlighting different areas which were important to remember. For example, remembering the palmar arches in the hand, and whether it is the radial or ulnar artery which supplies them mostly individually.

With all of the other notes I had typed up based on attending my labs and lectures, I practised writing them out by hand in a notebook. It was quite good practice to consolidate my learning in this way, as I was reading my notes and then testing whether I could reproduce the information on a blank page. If I made an error, I could learn from such mistake.

I drew on my arm to try and get an idea where the structures were located on myself.

This was also during the period of the heatwave that hit England! You can imagine how horrible it was to sit in the library as the scorching sun shone through the window and burnt your arm. It was more of a killer getting invited to join mates in pub gardens when you know you should be studying hard!

Caffeine overload! To stay awake, I found myself turning to Red Bull and coffee for the boost I needed!

I did give in though, I cooked a barbecue for my flatmates and we sat on the field drinking ciders and soaking up the sunshine while it was here!

Barbecuing on the downs!

Completed Art Project!

So this was the final project for my Year 1 creative piece. Yes! My very first art project has been completed and submitted - what do you think?

On the backboard that I stuck down the prescription medication to, I used empty tablet packets and some packets containing ibuprofen and paracetamol to add to the 'pharmaceutical' effect I was aiming for.

This was the reflection that I submitted alongside my creative piece:

Following the experience of meeting a kidney transplant patient on a home visit, I was profoundly affected by their dependency on such a wide range of treatments and drugs. It made me question whether the independence of home care has any great distinction from treatment on a ward. Due to how overwhelmed I was by the number of medications required for this patient’s basic survival, I decided to explore and emphasise this by use of an assemblage art piece constructed from mixed media.

The patient I have based this piece on suffered from two polycystic kidneys, hence why she had a kidney transplant. After the encounter, I went home and researched exactly what a polycystic kidney was and a brief explanation to its causation. When I saw how the polycystic kidney can become filled with large infected cysts, I thought this would be a perfect condition to replicate using clay. I have previous experience with clay and seek enjoyment in portraying ideas in a 3D and visual form.

This is the final product. The clay piece was mounted onto the board and the 'No Nails' set, I added pieces of string to show the connecting vessels and tubes! The red represent arteries (especially the superior mesenteric artery and the renal arteries), the blue represent the veins (being the renal veins) and the white represents the ureters that connect the kidneys to the bladder.

This three dimensional representation of how this ongoing treatment could be experienced by the patient, demonstrates how, even after the completion of a renal transplant surgery, the patient will never truly regain their independence from the medication. The patient did exclaim her dependence on the medication and did give an explanation to each of the tablets’ mechanism of action and its role in keeping her alive and preventing the rejection of the kidney. I couldn’t remember each tablet individually, so I found the NHS leaflet on renal transplantation which gave a run down of medication that is prescribed to a kidney transplant patient. I made the designs of the medicine boxes myself with a quick easy explanation on each of them (similar to how the patient described them to me).

In my piece, I have assembled the anatomy of the urinary system (including other abdominal organs). One thing that really stood out for me was the fact that they still keep both of the original polycystic kidneys in the patient’s body. I always assumed they were removed during the surgery, but I was told by my GP that they would only do this if the kidneys posted a further risk to the health of the individual (eg. It became cancerous). So, I wanted to educate the viewers of my piece that they do keep the kidneys within your body and that the transplanted kidney is placed into the iliac fossa.

Here are all the tablets I also made for the project, but didn't end up using!

Small tablets, pills and capsules that were created using clay.

Art Project...in progress

If you are interested in how the art assignment is working out at the moment, I have so far finished making the centre piece which is the anatomical representation of the abdomen. Being clay, it needs to dry out before it is fired and can be painted.

I'm thinking at the moment of painting the whole abdomen in its true colours (ie. slightly pinkish stomach, purple-like spleen, dark red liver etc) or painting them in paler pastel colours and the three kidneys in darker colours to bring attention onto them.

I plan to make small pills and capsules out of clay to represent the medication, and to stick this in some areas of the abdomen to show the reliance and dependence to keep the system working.

The holes in the hilum of the kidney and the major vessels in the centre (inferior vena cava and the abdominal aorta) will have coloured piping stuck into it which will connect them up. The clay was too fragile to roll thinly and connect as blood vessels (and the ureters), therefore I will do this after it has been fired.

The two kidneys have polycystic kidney disease, which meant I could use smaller pieces of clay rolled into balls to produce these cysts that are growing all over the kidney. I even scooped some clay out to represent burst cysts. The transplanted kidney is located at the bottom left.

As mentioned, the main purpose of my piece is to represent the dependence on medication (I was overwhelmed by the number of drugs transplant patients are administered after their operation!). So as the background of the board which my clay will be mounted to, I have designed these drugs based on the actual medication.

Example, I have found the name of certain immunosuppressants which are prescribed to renal transplant patients and have designed these on my computer (some based on their actual packets I could find online) and then printed these out and stuck them as a montage on the wooden board. I have also measured up and printed some of my own medication packets to stick to the boxes of over-the-counter medicines I had bought for this project. By doing so, I also have spare medicine packets that I can stick to my work too.

The montage of different medications that a renal transplant patient may be taking. I designed the packets online and stuck them to the board as a montage background for my clay piece.

Assignments.... science vs. arts!

At the beginning of the year, I remember laughing with my flatmates how great it is that we don't get as many essays compared to other subjects. One of my flatmates who does biology is always complaining about another essay or report she has to do.

But, we were set an awful essay on discussing *something* and its impact on human health and wellbeing. The *something* had to be appropriate and from a certain list we were given (ie. diet, exercise, loneliness etc). I decided to do how owning a dog affects human health and wellbeing, which I thought initially would be very interesting. Was it? Of course not. For every paper that said owning a dog lowers your blood pressure, there was a study that proved that wasn't the case.

My essay based on the impact of owning a dog on human health and wellbeing. One of the hardest parts of writing this essay was actually trying to reference using the Vancouver method as opposed to Harvard, which is what I'm used to!

It was very complicated and repetitive, but I ploughed through. I lost out on a really good night, but I guess it was my fault for leaving it until the week it was due. Literature reviews and breaking down medical scientific journals is a talent that I really don't think I have compared to my friends.

My uni though is trying to promote this concept of medicine being both an art and a science. Therefore, we have also been set an art assignment. We have to base this on a clinical encounter that we have had or observed.

I have decided to create a reflective piece based on a patient that I met whilst doing a home visit in my GP placement. She has polycystic kidney disease, and her poor kidney function led to her having a kidney transplant. I was very shocked to learn that unless cancerous or posting a serious threat to life, they keep the kidneys inside you! I always thought they removed it during a transplant, but no!

The patient told me about how she believes it's the medication that is keeping her going. So I have based my art project solely on the amazing concept of a renal transplant, but also the dependence on medication to stay alive.

The plan for my art piece: an anatomical representation of the abdomen with the transplanted kidney (from the posterior abdominal muscles, to the bladder, major blood vessels, two PKD-affected kidneys, a transplanted kidney, to the liver, the stomach and the spleen). This will be moulded out of clay, dried over the holiday and fired in a kiln in the final week and ready for the deadline of the 20th April. Surrounding my clay piece will be the tablets a renal patient will be taking to prevent rejection or any infection post-operation. I have researched these drugs online, and through the use of NHS renal transplant information leaflets which are given to patients before or after their transplant operation.

The beginning base for my anatomical representation of the abdomen, crafted out of clay. On the paper is my rough plan of how I plan to lay out the structures.

I will keep you updated on how this turns out!

Term 2 Done, One to Go!

...and shot to that!

That's another term completed, with just one more to go! This year is going so fast, I thought the teachers in my sixth form were exaggerating when they said it'll go this quickly.

This term has been full of the more sciencey anatomy body stuff which has made it 10 times more interesting and gripping! The labs have got more interesting definitely with an extension on the histology content, looking at how the epithelium of the bladder allows it to expand and return to its original shape etc.

This is what the typical student kitchen looks like - piles of washing up that "will be done tomorrow, I promise"

I have somehow survived on the amount I've drank and the fact I've probably eaten twice my body weight in pasta and jarred tomato and basil sauce. But one day I did cook for myself and my flatmate by surprising her with my steak-cooking skills!

The steak meal in discussion - including the homemade peppercorn sauce that sounds revolting on paper but tastes and smells perfect in person.

I made my own peppercorn sauce out of Vodka, gin, pink lemonade, ground pepper, baking powder, gravy, milk and butter - and it tasted like it had been made in a top restaurant (if I say so myself). If anything, it was very peppery and if it wasn't eaten fast enough, it would solidify and slide off your steak! If you want the recipe, just private message me!

I gave a talk to aspiring medical students for Villiers Park based on my experiences.

I've had the honour as well to be invited back to my school to give a talk regarding future aspirations post-18. Before this though, I was invited back to give a presentation to aspiring medical students at Villiers Park (in MedSoc that I was once part of) and explaining what it's like to be a first year medical student, how to get in and if medicine does seem what I expected! The students that attended (30+ I think!) asked some great questions throughout the slides and I can't believe that this time last year I was sat in their seats listening to a guy give a talk in MedSoc.

I recommended they read this blog, so they could be viewing this article with you!

Until next term, have a great Easter!

Getting the job as a HCA!

Prior to finishing this term, I had to complete some more hospital shifts as a healthcare assistant. During my week, I had the opportunity to work on the ward for complex needs. This allowed me to develop experience working with patients with high dependence and little or no independence at all. The majority of my shift involved taking observations and speaking with the patients and nurses, or helping patients feed or go to the toilet.

On break...with a disgusting cold cup of coffee...

I have recently really enjoyed working as a healthcare assistant so decided to apply for the job at the hospital as a Band 2 Healthcare Assistant - which I am happy to say I got the job! It could possibly mean I could stop commuting to my hometown to work in my retail store (where I have been working now for three years) and live permanently in my new city and work at the hospital there.

In this article, I'll describe some of the questions I was asked in my group interview regarding working at the hospital as a healthcare assistant...

• Why do you want to become a Healthcare Assistant? What are you currently doing?
• Have you had an experience which demonstrates your excellence in quality of care you deliver?
• Have you had an experience which demonstrates your respect for the patient and their dignity?
• What characteristics should a Healthcare Assistant have? What characteristics have you listed, do you demonstrate? (And provide some examples)

I also had to take part in a 30 minute numeracy paper and a 30 minute literacy paper in the assessment centre.

I got the results two days later, saying my job offer is conditional on a reference from my current line manager which was successful!

All of the nurses I have worked with have said that the perfect doctors have been healthcare assistants once in their life. Apparently, it creates great doctors who sympathise with the rest of the team and respect all the staff on the ward as you understand everyone's role, stresses and job role. This reduces the chance of a "pretentious doctor walking down the ward like they're better than everyone else."

Strike and Snow!

You can't escape it. I'm sure you've read it for yourself in the news, but the majority of university lecturers are currently on strike due to changes in their pension.

Some of my friends have been massively affected by these strikes! One of my friends who studies politics at my university has lost out on around four weeks of teaching. They have stated there will be some amendments to the end-of-year examinations to cater for this loss, but he has still had to pay for nothing for the past month!

Caption says it all really - bored students with their lecturers on strike have nothing better to do than try to score their teabag in a cup.

For us medical students, we weren't affected! We had one lecture on diet and nutrition which was cancelled, but the majority of our lectures and tutorials are delivered by actual NHS doctors. Therefore, they have the NHS pension so are not affected by the striking conducted by university lecturers across the UK.

But we were affected by the Beast from East! The university deemed it unsafe for students and staff to attend university so it closed its facilities. I lost out on a tutorial and a lecture, but I had managed to get to my placement in the hospital that morning!

I loved the university's response to the snow... they shut the university for the safety of the students. But the students retaliate by sledging down the steep hills in the uni accommodation on just trays from the catering cafe or recycling bin lids. I feel to be honest that closing the university put our safety at risk!

There was a massive bread crisis in all of our local grocery shops - how on earth will we have toast in the morning?!

Snow settled all over the university accommodation and the city. It made waiting for buses (if they ever arrived) harder when the benches are covered in snow. The Beast from the East forced you to buy that cappuccino from the cafe, otherwise you'd freeze to death!

Birthday Blues - away from home!

All of the cards I got to open on my 19th birthday at uni.

I don't know whether you guys are in the same boat as me, but I am a March baby. Therefore, just like other years, my birthday has always fallen in the centre of a school term so I'm used to having to spend the day at school before I come home and celebrate my birthday. But for the firs time, I was actually away for my birthday at university!

I was dreading it, but my flatmates made my birthday great! I enjoyed every second of it! They threw a surprise party for me when I got home from university with presents and a collection of photos of us all and they also posted embarrassing photos and videos of me on social media for my birthday!

I video messaged my family from my halls, which wasn't the same but as good as it gets. I took all of my cards to uni so I could at least open something from home, but I really did enjoy spending my 19th birthday with great people.

I love fish (and am a fishkeeper myself) so my flatmates made me a sea themed cake! And it tasted amazing!

We then went out, dressed as the Spice Girls for the themed night at the student nightclub. My birthday was a Monday, so it's student tradition (like a religion!) to go out and we celebrated my birthday! My flatmate, who has never gone to a club before and doesn't usually drink alcohol, came out especially for my birthday which made it even better!

Case-Based Learning

CBL = case-based learning; this is the type of teaching which my university is using to deliver its information to us medical students.

I find this such a great way of learning and it's very useful because it keeps all the information together. Each cycle is the same, just with a different system. So far for this year, we have studied the musculoskeletal system, cardiovascular system, respiratory system, gastrointestinal system and the urinary system. After the holiday, in term 3, we will be studying the neuro system and finally the endocrine system.

The cases are taught in two week cycles. These two weeks contain three facilitation sessions, one day of labs (and one session in the anatomy dissection room), one day of placement (GP or hospital, these are rotated) and ten lectures that deliver information on this section.

At the beginning of the cycle, we are given a case (of around 500 words) which will introduce us to a condition or complaint being presented by a patient regarding the cycle. So for cardiovascular, we had a patient with high blood pressure. In the musculoskeletal case, we looked at the use of anabolic steroids to develop muscle mass. In the urology case, we looked at two people who drank a certain amount of water before a marathon and the effects of dehydration etc. The problems described in the case will then be explored in our lectures for this case.

As an example, I will be using the respiratory case:

• Three facilitation sessions where we discuss the current case that has been presented to us. We sit and go through the learning objectives in the first facilitation session at the beginning of the cycle. We can identify parts of the case we don't understand that may not be or fully covered in lectures, so we will distribute and delegate presentations to each other and present them in the following facilitation session. We have another facilitation session mid-cycle to work out where we all are, and then a final session to conclude the case and clarify any final information we are struggling with or want help with (from the guidance of our facilitator who supervises us).
• 10 lectures - all delivered on the respiratory system but divided up across the two weeks. In these lectures, we learnt about the anatomy of the lung, how the lungs ventilate to provide gaseous exchange, what is gaseous exchange and the respiratory and metabolic responses within the body (at a cellular and organ level).
• One lab session in anatomy where we used cadavers to study the respiratory anatomy. In this session, we located the lungs, the pleura and other structures in the chest and mediastinum. But we also learnt about reading and interpreting x-rays of the chest and an introduction to taking a chest examination.
• I had placement in the GP, which meant I had the opportunity to do a home visit and meet a patient who had severe asthma. On the home visit, I was able to use my history taking skills to listen to the patient and understand the difficulties she experiences, but also apply the knowledge I had learnt in this cycle about the pathology and physiology causing her symptoms.
• People that had placement at the hospital for this cycle had the opportunity to practise percussion (banging your fingers on the chest to produce a sound which can signify hollowness [from air] or dullness [from a build-up of fluid]). There was also the chance to auscultate the chest (use a stethoscope to listen to the different lobes of the lung) and where to place the stethoscope.
• One lab session using the simulation patient to look at the effects of hyperventilation and climbing in altitude on the patient's respiratory rate, consciousness and oxygen saturation levels.
• One lab session on the effects of exercise on respiration (so doing an exercise activity and measuring the increase in respiratory rate etc).

This is the same structure for all of the cases.

Labs - about talking?

This might be hard to understand, but we do have labs...not in labs...and not a pipette in sight!

These labs are based on consultation skills. They are endorsed with our placements, either in the GP or the hospital, which in turn strengthen the lectures and tutorials on a particular aspect of the consultation.

The consultation is broken up into different elements. These elements obviously craft together to make the perfect consultation with the purpose of finding out what is wrong with the patient (by taking a history and an examination) and then interpreting your findings to come to a conclusion and then a plan of action (such as medication).

If we are given a part of the consultation, like examining the complaint which is being presented to us by the patient, we will have a lecture on this. In the lecture, we will be taught about the purpose of taking a history of a presented complaint, and the type of questions we will have to ask. We can even hear of examples of when this goes wrong, or poor practice in doctor consultations that leads to poor outcome for the patient.

After the lecture, we meet in our small tutorial groups of around eight peers and discuss what we have learnt from the lecture. These are our "labs".

These labs involve a lot of role play. Such as acting out particular consultation scenarios, structured by a plan that has been prepared for the session. For example, we could be pretending to be Mr Smith who has a family history of cardiovascular disease and I have just presented very high blood pressure and need to answer my peer's questions (as the doctor) to help them breakdown my presented complaint to build up a possible diagnosis and plan of action.

These lectures and tutorials can be delivered either in the university or the hospital I'm doing my placements in.

The labs also involve developing communication. My university's Medicine course was updated last year (I'm the first cohort) to provide more teaching on the communication aspect of being a doctor. Imagine having a doctor who didn't know how to talk to you or deliver the information correctly or understandably. Therefore, this year they are focusing on providing more teaching on this! So in the labs, we learn how to use vocal cues in our consultations to give better understanding (eg. the importance of paraphrasing to show understand and using it as an opportunity to make sure you've collected all of the relevant points).

For example, we ask patients "What is your past medical history?" and they often think only of diseases and illnesses. They'll tell you about their pneumonia or chest pain ... but they always forget surgery! So make sure you ask whether or not the patient has had any recent surgery, as this can explain symptoms. Abdomen pain can sometimes be explained by previous surgery in this region creating weakness in the bowel.

Postmortem?!

I had an amazing opportunity to observe a postmortem this week! I am lucky that my facilitator is a pathologist who works in a coronary court to carry out postmortems on patients who have died 'suspiciously' (not like forensic murder!)

So what is a 'suspicious' death? According to my facilitator, this is where a patient has died unexpectedly, but hasn't seen a GP in the past two weeks before their death. This tends to be when a body has been found at home, and the death has come as a shock.

I was really shocked to how the postmortems are carried out. They are nothing like how they are portrayed in the media. The body is examined in a brightly lit lab - there is no small light dangling in a dark room with four people surrounding the body with their tools. In fact, there are four bodies being examined at the same time with one person doing it.

I won't go into the details in my blog, as I understand there is a line. But I would recommend you look at how they examine the body. They remove every organ from the body before examining each organ in detail. This is important to identify any health issues which may not be directly obvious from the outside as you are after all identifying the cause of death. For example, it is hard to look at a body that has been found, and see that the person died of a cardiac arrest. A postmortem will reveal hard crunchy coronary suggesting atherosclerosis that could've resulted in a myocardial infarction that killed the person. I would recommend you looking at the method they use to remove these body parts as I found it particularly fascinating.

This is an experience I was delighted to have the opportunity to take part in. I feel it endorsed my anatomy, as it was the most recent view I have seen of the internal anatomy of a human. Especially when the organs were removed, it was amazing to relate them to how close they appear in standard anatomy labelled diagrams! The liver is that red/purple colour in real life, despite it appearing greyer in the anatomy labs.