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/