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/ 

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."

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.

Exam Results

When I left you before Christmas, I described about my stresses of exam revision over the holidays but also the structure of the exams I took part in.

I can happily say I have passed both exams! Thankfully, I have clearly revised what I had needed to for my advantage and have managed to somehow score greater than that pass percentage so that my grade sits in "green".

We were sent a generic email prior to our exam release time (which is set at a certain time and date, so we had to wait until 1:00pm for our results to be released). In the email, it was detailed what the pass mark was for both exams, and a general average. As it appears in the email, on average everyone has passed which is great for the year group!

But now that these exams are over, we get to move on and knuckle down more into the case-based learning aspect of our course.

A small side note though, I did take part in a fairly difficult consultation while completing my GP placement. While sat in the GP surgery, the GP I was shadowing met a patient who was battling with depression. He had progressed to a serious stage, where he contemplated ending his life and his value in this world. I found it very interesting to observe how the GP approached the patient's feelings to help break down the presented complaint in a comfortable matter.

To be honest, the appointment really hit me as I sat there. Hearing how the patient was describing his own worth, I realised how important mental health and wellbeing really is. Its significance is often suppressed. I, myself, have battled with mental health issues in the past with low mood (but I am grateful for the prescription medication which helped me get back on track). But today I witnessed when medication isn't the answer as the complaint is far more serious.

My partner and I from the placement then went home to discuss how we felt. Sometimes it is very important to speak openly but privately (respecting confidentiality) if you are struggling to cope. Many universities, including mine, have specialised student support which is readily available for you to approach and seek help if you do need it.

I feel for the situation you are going through right now, as I have experienced it myself. Whether it be application stress or exam stress, you can pull through this! Don't let it affect your mood, and if it does, monitor it closely. If you notice your mood deteriorating fast, whether it be a personality change (for the worse) or your attention/concentration being very weak, seek help and support and you'll be back to normal. Remember though, talk and use these support networks.

It was nice to sit down and enjoy a bottle of wine with a friend in the bar conservatory, talking about our results.