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/ 

A-Level Exams Results Day

Hello everyone!

Hope you are enjoying the summer as much as I have been! But, it's come to the dreaded month of August which contains the fortnight of results weeks. It is the most dreaded day of the year... even exceeding that stress you experienced when you sat the exams.

So in the summer period, you have sat your A-Level exams, hopefully one of them being Chemistry and usually the two others being another science and/or maths etc. I really hope that they went well for you and now your results will shine through.

As I think I mentioned in one of my earlier posts, throughout the year I did shockingly bad in my mocks. I could never achieve my target grade and my motivation was constantly being knocked. My school did for some bizarre reason use a method of collating extremely hard exam questions into a bank that we were tested on pretty much monthly - this of course screams "You're not gonna pass." whenever you got the results of another B, C and sometimes even U.

But you can imagine my astonishment on results day, a year ago, when I opened my envelope to see that I had achieved my entry requirement to get into the University of Bristol.

The main message I am trying to convey here is that sometimes exams don't go exactly how you plan them. You need to remember that you will only remember the BAD from the exam. Why didn't I put that? I can't believe I ran out of time to answer that question... Why on earth did I put that AS THE ANSWER? But you never think of the possible 50-60% of the answers that you did really well on! And sometimes, your 5/6 mark answers will still bag you half marks! These marks all add up and hopefully will give you the result you are looking for.

What if it all goes wrong? Well, getting into medicine has no deadline at all (apart from the application deadline in October!). So, if you open up those results and you didn't achieve the AAA, oh well! Either call through to Clearing and see if you are able to go into another university to study Medicine (where I believe they give a short interview on the phone. so I've heard?) and you may still be able to bag a place. However, if that isn't available, then I would certainly recommend to consider retaking.

By retaking, you can have another attempt at achieving the grades required.

• Some universities are rumoured to 'not accept retakes' by students that failed the year before and then apply again the following year. This is not particularly true. What I can gather from open days, if you didn't achieve the exams because of extenuating circumstances, there is a chance you could be shortlisted for an interview the following year.
• Some universities will not accept a candidate reapplying the following year after failing exams without extenuating circumstances.
• Through my own research and recommended by open days, universities will not accept a candidate who is applying after applying previously, being accepted and getting the grades but then doing a late deferral for no extenuating circumstance = eg. "I want to take a gap year, despite not putting on my application that I wanted to when I applied."
• If you are going to retake, do you want to stay in the same school? Do you think college would be better suited for you this year? Or possibly transferring to sixth form if you are already at college? You need to take chemistry, but what about the other two options? Maybe drop Maths and pick up Physics? Or drop Physics to pick up Biology?
• Finally, remember it is not all in the schooling to why you may have failed. Consider in your retaking year what may have led you to slip. Did you go out too much? Did you prioritise your time incorrectly? Did you not concentrate, slip behind work, stop attending? Maybe you hadn't mastered your revision technique correctly? This year, make sure you build on this 'mistakes' to ensure you achieve those results for next year!

I hope this post has provided some ease and I promise this time tomorrow you will be much more relaxed no matter the outcome. I hope you will be sat with your family having a nice meal celebrating your success in securing a place in medical school.

Massive good luck to you all!