Drift to Shifts!

Stress from the exams are now in the past and now I drift to concentrating on my shifts as a healthcare assistant on the ward of a hospital I have been allocated to.

That is the best thing about the course structure at the university I'm studying at, we have the opportunity so early in the year to be exposed to the work on the ward! We have completed the training and the induction in December before we broke up for Christmas, which meant we learned many important skills for working in the hospital as a HCA. This included how to make a bed, the importance of safeguarding, what is dementia and the correct communication skills required.

I have had two shifts at the hospital I am in, working as a HCA. I am on the Stroke/Neurology ward, where I helped care for patients who have had strokes or suffer from neurological diseases.

I'm trying to work out the best way of writing this post without writing a long chunky essay that's saturated with paragraphs. Therefore, I'm going to break it up into the typical cheesy questions you usually get on a feedback form that school gives you:

What was it like working as a HCA for the first time?

• Very different, it is nothing like volunteering at all!
• As a HCA, you are allowed to handle patients where you have completed manual handling training. This is different to volunteering, which means you are allowed to help move patients from beds to chairs, help move them into comfortable positions or help manoeuvre patients while they are being cleaned.
• It is true, as a HCA you do help clean patients who may have soiled themselves or need aid in their daily washing routine. I didn't actually realise this was the case until I was on the ward.

What did I enjoy?

• It was probably the most "doctor"y I've felt so far in the course ... and ever!
• I did enjoy helping the nurses take observations of patients and learning how information is collated, kept and stored in the hospital setting in more interesting.
• In a way, you did feel a sense of reward after you have cleaned up a patient as they were grateful and you could now see they were happier and more comfortable. This is what made the cleaning job.

What were the challenges I faced?

• I will make it clear for you, as a volunteer you are not expected to handle body fluids at all. I know in my training as a volunteer, I was told that if a bed was soiled I wasn't allowed to touch it. As a HCA, you are exposed to the different body fluids. In my shifts, I cleaned up vomit, faeces and urine - but in my opinion thinking about it is definitely worse than when you're actually doing it. And you'll realise that. It isn't that much of a great deal and you do adapt to it after a while.
• As a volunteer, I found myself speaking mostly with the nurses and the other volunteers as we made the teas and distributed the meals. After this, I was sterilising medical equipment or help cleaning the ward. As a HCA, you are more patient-facing, meaning you do see pain and discomfort on a greater level. You are in situations that do make you feel uncomfortable, I was saddened by the news on my later shift to how one patient I had became close to and exchanged great chat and laughs with had unfortunately died the morning of my next shift.
• You do feel quite nervous when you are allowed to carry out observations on patients. For example, one nurse let me carry out a pupil examination on a patient, where I would shine my torch into their eyes to hopefully see a change in pupil size as a response to the bright light. I will admit, my hand was shaking as I did it. You are nervous, but by the end of the week I was more confident and did it more 'naturally' if you like.
• The long hours?? In fairness, as I groaned about the seven hours I was enduring, the nurses laughed as they were doing the hardcore twelve hours! You do need to realise that the shifts are long, and that there isn't always something to do. But it gives a great opportunity to speak with other members of the team or learn from patients.

Working as a HCA, it was interesting to observe how the ward was structured. I found that the healthcare assistants and the nurses were the main members of the multi-disciplinary team on the ward who were responsible for the primary care of the patients (providing comfort, meds etc) and recording the observations. The doctors made brief appearances throughout the day, analysing the observations and speaking with nurses about the progress or reviewing medication. This was quite an eye-opening observation, as you learn how the 7 or 8 patients that the nurses and HCAs are allocated each means they have more time with the patients so more of a presence, whereas the doctors could have around 30-40 patients on this ward, the next ward and maybe another ward in the hospital so their encounters with these patients can be more confined and brief.

Working four hours, I was dying for this cup of tea!

The nurses I was working with were absolutely amazing. When there was nothing to do, the nurse went through my handover sheet with me and explained the conditions to me. For example, she explained what a "thrombectomy" is and what "abx" means on the sheet. So I would recommend that as you complete your shift work (if you do it), do speak with your nurses and gain a better understanding of the patients you are dealing with and you can apply this knowledge to your studies!

The best thing about working as a HCA though is that when you're talking to a nurse about yourself, you're no longer saying "I hope to go to university and study medicine" as you did whilst volunteering, you're saying "I AM at university STUDYING medicine"! The dream has come true!

Exam Weak (Yes, that's intentional!)

So, the Christmas holiday is over and we have returned back to university to complete the next term. All my friends have some exams, but they are sitting them and then going back home. Me on the other hand, I'm here for the start of the term. After my exams, I start my shifts as a health care assistant for a week before everyone returns and lectures begin. As I write this, I sit alone at the kitchen table in my empty flat with a tea.

January has come and Christmas seems a lifetime ago. The pleasant happy season feeling has somehow dissolved into fear and anxiety for the exams. The majority of the Christmas holiday involved sitting at my desk day-and-night reading the same notes over and over again - with the occasional glass of mulled wine and a 'drag and drop' quiz on "Muscles of the Upper Back".

This is my dog, who did make it challenging to revise at times when he would lay across my notes...

How did I revise? Well, I began by reviewing the learning outcomes. In A-Level, I lived by the course specification and read it like the Bible. I had it printed in my Biology folder, annotated around each outcome with slight more detail than what was presented. At university, you don't get an 'as guided' list of learning outcomes that I am used to. You get a long list of fairly broad learning outcomes, that you definitely couldn't annotate with 'slight more' detail. Farewell to the days of "Candidates should be able to explain the role of the diaphragm in inspiration" to "Define what health is, from different perceptions of Lay definitions to agreed definitions from health professionals." as an example.

The first exam was an anatomy exam. There were basically specimens positioned at different stations with a sheet of paper in front, asking us a question and to select the most appropriate from five answers (in a multiple choice way). You had a minute per station and roughly 80 to complete, so the exam was approximately an hour and a half long (counting the rest stations). In the anatomy practicals, it was very independent and self-led, which is why I was dreading the anatomy exam more than anything else. I felt that I was quite familiar with the 'majority' of body locations. So, if you asked me to draw out the gastrointestinal system, I probably could. I could point out the major organs, as well as the accessory organs. I could explain some of their functions, and even small extra detail like how the major duodenal papilla is where the pancreatic duct enters the duodenum. But I can not explain this using cadaveric specimens. Therefore, I decided over Christmas to completely redo my notes and update them with not just pretty coloured diagrams from an Anatomy Atlas, but to also incorporate images of cadaveric specimens that are readily available online.

I'm definitely more of a visual and creative learner, so I made this model of the cranial nerves and incorporated the cranial foramen names so I could revise both of these at the same time.

Personally, I feel this paid off. But I don't want to jinx it to be honest, because I really hope my hard work over Christmas pays off for anatomy. It took a lot of blood, sweat and tears - and I still can't point out where those tears come from because I can't identify the lacrimal gland. I believe this would be quite a handy skill to grasp before you come to medical school, or as a good skill to practise whilst "you've got nothing to do" while at university. Look up some cadaveric specimens online, or possibly use an Anatomy Atlas which includes labelled photographs of cadavers, as this will help you identify structures more easily. For example, learning that the trachea obviously has the C-shaped cartilage rings that keep it open and that the oesophagus has a thinner wall and isn't 'as open'. This means when you are given both and asked to identify which is the trachea, you'll be able to identify the 'open' structure and which one feels like it contains the slightly "soft/hard" cartilage rings (you're able to feel the difference!).

But in the exam, you're testing on a few parts of anatomy PER question. Let me give you an example. You have a table at this station, with the pelvic girdle of a male situated in the centre. The pubic symphysis (the joint which joins the two hip bones at the front) has been represented by a solidified clear resin with a pin pierced through it. You look down at the sheet of paper accompanying this stand and see the question: "The structure being identified here is classified as what type of joint?" with a list of different types of joints: from primary cartilaginous joint, to secondary cartilaginous joint and named synovial joint types. But that is an example of how the one question actually asks quite a few: "What is this structure?", "What type of joint is it?", and you could even argue that it asks "Where is this joint?" and "What's the movement at this joint?" as it could help determine the type of joint this is classified as. Or you were given a radiography image, where you would have to quickly identify how the X-ray was taken (ie. from the side? from the front?), what is in the image, what structures are available, what does the white represent (ie. could be bone, could be fat) and then finally what is the answer to the question being asked? This is a lot to do in the short period of time at this station before you move to the next. However, it was just like in the MMIs that if you messed up one question and did not have a clue at this station, that dreaded buzzer declaring the end of the minute was a sign to suck up and move on, put it in the past and pray the next station provides better hope.

When the exam finished, my friends and I hit the nearby pub to discuss our answers over a coffee and large breakfast. The coffee helped us recover from the nervy-sleepless night before the exam, but to wake us up in preparation to go home and revise for the written exam tomorrow...

The written exam tested us on the behavioural, sociological, ethical and biochemical side of medicine. The paper consisted of multiple choice questions again, but this time asking questions that directly link to the lectures and tutorials we have had. I found this paper more difficult, mainly because I had stupidly spent my whole time allocated to revising anatomy. I was tested on genetic transcription, consent, what imaging should be requested for a patient presenting a certain condition, manipulating data from a graph I had to plot, what is epidemiology and so much more.

I will use this opportunity to describe how exams at university differ to how you may be used to it! GCSEs and A-Levels, you sit in rows of desks, are given the paper, started at the same time and then all finish at the same time. This is different to university! In university, you all start at the same time, but you can leave the exam hall when you've finished - just like what you've seen in the films! The only exception is that you cannot leave in the first half an hour of an exam or the last fifteen minutes, but as soon as you're finished (and hopefully proof read your answers), you can put your hand up, get permission from an invigilator and then you can leave!

I get my results in the first week of February, so who knows how I did. If I'm perfectly honest with you, I'm proud of how I did and know that I couldn't have tried any harder. I redone all of my notes in preparation for my anatomy exam and hope I see the result I really worked hard for. But you can never tell. We all have (especially me!) worked so so so hard for an exam, only to be devastated when opening that results sheet. I'll give you an update when the time comes, ay?

Happy New Year!

Luckily, it snowed which made Christmas even Christmassier! Mine involved a lot of bubbly, cheering, a sore throat (thank you to whoever gave me the Winter's cold!) and of course revision.

Thank you Mum and Dad for buying me so many medical instruments! I'm so grateful for my manual blood pressure monitor because I can now practise that dreaded clinical skill that I am far from perfecting. I would recommend asking for those fairly pricey necessities you need for birthdays and Christmas!

The best thing about living in a flat, you get to have an amazing Christmas dinner that you cook yourselves without any parental influence! We felt so grown up and ... merry!! And believe it or not, but that is the starter I prepared for our meal! That definitely makes an improvement on the burnt oven chips.

My holiday so far has consisted of finishing all of my anatomy notes in preparation for my exam at the beginning of the term, but also reading over and condensing all my other topics for next week.

So I am approximately 14% (or whatever) a doctor now! Thank you for following my journey, and I hope to keep you posted throughout 2018.

I hope you had an amazing Christmas and New Year!