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/