Exams are done and I’m no less busy! Typical!

Exams have been and gone for over two weeks now and yet I feel much more busy and swamped with things to do than during revision time!

Whilst we’re on the subject… exams went fine for the most part as far as I can tell. I felt good about all but one of them and so we’ll have to see how that one goes. I didn’t get a chance to revise that much for it as I focussed a lot of my effort on the other content which was more challenging so if I have to retake it, I have to retake it. I’ll find out soon enough as results are literally a week today! It’s come around so fast, I can’t quite believe it. For those of you interested in the structure of pre-clinical medical school exams – certainly for my medical school anyway – we tend to have 3 each sitting. We normally have a multiple choice paper, a written paper and a practical anatomy spotter paper across two modules covering broad system areas of basic science. It’s alright actually as the exams are done within 3 days though the period of revision leading up to them is not particularly fun. Generally the pass rate is 50% but it is adjusted based on difficulty of the paper. To most people who aren’t yet at medical school that sounds astronomically easy as I’m sure you’re used to getting at least 80% for your A grades but it can be quite difficult to achieve due to the amount of content that theoretically can be covered in each of these exams. Anyway, I’ll let you know how results pan out. If they’re alright I’ll no doubt be bouncing off the ceiling!

Now that exams are over though I’m more stressed than I was before, oh the irony. It’s because I (rather stupidly) have got on board with three different productions of musicals with my students union. One of them finished last week and went so well but I still have rehearsals every evening for the other two. It’s madness! Still it is good fun, I am a little bit concerned about the lack of time that I have to do work however. The module that we’re currently doing is thankfully extremely forgiving (we’re doing a gastrointestinal module which after a nervous system module focussing entirely on the central nervous system is a nice relaxing step down!). We move on in a weeks time though to a module about endocrine and life cycle which is going to be much busier and more conceptually difficult so I will have to keep on top of that.

Other exciting news (sorry this has now totally turned into a mega splurge update post) is that I will be returning to America this summer to work at the summer camp I worked for last year! I’m so excited I can’t even contain myself! For those of you unaware – which is probably everyone as I don’t think I’ve yet mentioned this on this blog – I went to Virginia last year with Camp America to work at a summer camp for adults with disabilities. It was THE most fantastic thing I’ve ever done and a couple of weeks ago I decided, screw it, and have decided to go back despite the costs etc etc. (The picture at the top of this post is a snap from my travels after camp from Santa Monica beach in LA) So immediately after the end of the semester I’ll be flying out to see all the wonderful people I met last year again. I think my medic friends are already getting bored of my over excited anecdotes from last year and the constant updates on the progress of my visa and flight booking escapades but oh well! Life is for living, you have to grab it by the horns and I won’t have a summer long enough to ever do this again so I’m going for it.

Anyhow, I will let you know the outcome of results and if anything else interesting crops up I’ll be sure to write about it.

Speaking of which I have just remembered – I had a bizarre almost out of body experience today in the anatomy lab. I was looking at a dissection in which all of the abdominal fascia and peritoneum around the spleen had been removed, hence the spleen was free enough that you could pick it up still attached by its vessels and hold the whole thing. I picked it up without really thinking and was having a conversation about something completely irrelevant with my friend when it occurred to me how casually I was holding this spleen without finding it at all strange. It’s bizarre because, however horrible, as a medical student you quickly become immune to the anatomy lab and the fact that you are looking at dead people who have kindly donated themselves for your education. There are moments in the lab when you look at the situation as though from outside eyes and realise how weird it is. I had one of those moments today whilst holding that persons spleen and found myself wondering about the person who the spleen belonged to. It’s unfortunately far to easy to forget that once it belonged to a walking, talking complex human being. I was reminded today of the importance to take a minute to be grateful to the people who have agreed to donating their bodies for the education of medical students.

On that reflective note – until next time!

Another Professionalism Debate

Professionalism is something that I personally reflect on a lot. I want nothing more in my medical career than to do no harm and to be professional so that I provide the best for my patients.
At medical school I always seem to be coming across situations in which I question the professionalism of the doctor/healthcare professional I am working with. I understand that in stressful situations when there is a lot to do and think about sometimes common courtesies get missed, but there are times when I see things that make me question professionalism and how we come across as medical professionals.

The case that got me thinking about this issue again this time was on our hospital placement. Each fortnight we go around the wards and practice on unsuspecting patients our history taking and examination skills. For patients this must be a really daunting prospect anyway. Our hospital tutor goes to the patients and asks them if they would be willing to talk to, and get prodded by the medical students in advance of our session and  if they say yes in we go. There are six of us and you can see the shock and mild panic at the number of students on every patients face as we file into the bay and crowd round them, hemmed in by the curtain. And then our hospital tutor introduces them and we take a history/do our examination. The poor patient has to sit there whilst 6 of us go through the motions one after the other. Nothing we are subjecting them to is painful and I think some of them enjoy it as a way to pass the time but there are occasions when we go in and it is clear that the patient wants to go back on their previous ‘yes’ to being a guinea pig. For example there are occasions in which the patients family are there and they clearly want to spend this time talking to their family member and not to us.
In this situation though what is the right thing to do? Should we be quick (this is often the option that our hospital tutor goes for, allowing only a couple of us to do the examination or taking a rapid fire history himself) or should we recognise that the patient doesn’t want to be examined right now and leave them be. I personally would prefer the latter. Whilst it is important for us to be able to practise examinations, none of these patients actually have signs, we are more just looking at normal at the minute so we can practice on ourselves. I don’t see that there is any need to disturb them when they clearly don’t want to be disturbed. I wonder how we come across if we don’t pick up on these signs and act accordingly and I worry that we come across as rude to the patient.

There was a specific situation during our hospital placement that made me particularly uncomfortable and after discussing it with my colleagues it was clear that they felt the same. There was a patient on the neurology ward who we went to see to practice respiratory examinations. When we entered his bay it as clear that it would be difficult to take the respiratory examination as he had his arm in a sling and a neck brace on and we were informed that we shouldn’t sit him forward. He also had external fixation on one of his legs and it was difficult to get in close to him. I was expecting our hospital tutor to leave him be and not let us examine him because none of use wanted to risk hurting him but he pressed on and let one of my colleagues have a go. As soon as we entered the bay it was clear that the patient wanted to chat, he was talking in confused sentences but appeared to believe wholly that he was getting his point across. What made me uncomfortable was that our consultant completely ignored him and talked only to us. All the time that he was talking the patient was trying to get his attention to tell him his story, from what I could gather, but our consultant continued to ignore him.

This made me uncomfortable. Understandably though we were rushed for time and I know he was trying to get the best for us from an educational point of view. I would have felt much more at ease if our consultant had spoken to him a little, even just said yes at the end of a few of his sentences to appear as though he was listening. This type of thing makes me question how we come across. In my mind that made him less professional but the patient, who was admittedly very confused, didn’t seem hugely fazed. Our consultant redeemed himself by talking to the patient very well after my colleague had finished her examination but it still grated on me that he had ignored him until that point.

It also makes me wonder about a larger problem. The NHS and medical care in general is supposed to put patients first and yet we as trainee doctors are constantly doing procedures which our seniors could perform better than us. How is that putting patients first? It is putting our medical education first surely? Of course new doctors have to be trained for the future well-being of patients and I suppose that finding the balance is the key.

Anyway enough reflection. I need my bed to have a productive day of revision tomorrow!

Neuroanatomy: #1 Extraocular muscles!

Any medical students reading this probably just let out an audible groan. Let me take a moment to join you… *groans*.

Neuroanatomy is, at the present moment, running my life. Thankfully I do have an interest in it and I do want to learn but even then spending hours upon hours in the anatomy lab gets a little tiresome.

SO!

With that in mind I have decided to share and share alike my resources for neuroanatomy for any medical students dropping by who this might be relevant to. Sharing is caring people, and it might save us all a little time in the lab.

Without further ado I present to you, a brief overview of the extraocular muscles. This might be a bit of a strange topic to launch straight into but it is one that I am confident with and so wanted to share.

Extraocular muscles:

The extraocular muscles are responsible for the movements of the eyeball. There are 6 (7 if you count the lovely levator palpebrae superioris which moves the eyelid) and they are:

Superior oblique
Inferior oblique
Lateral rectus
Medial rectus
Superior rectus
Inferior rectus
(Levator palpebrae superioris) 

What do they look like I hear you ask. Well let me refer you to the following beautiful diagrams

Now these muscles are very difficult to see in an actual specimen and are much more easily identified on schematics and in plastinated models. Initially it can be difficult to know which is which but once you have identified them the first time it is becomes a lot easier and their names help substantially.

Let’s hear a little bit more about these muscles:

Superior rectus: originates from the common tendinous ring situated deep in the orbital cavity, it attaches to the top of the eyeball.

Inferior rectus: is in the same plane as superior rectus and has the same origin. It attaches to the base of the eyeball and is difficult to see unless superior rectus is dissected away.

Medial rectus: On the medial aspect of the orbit, also originates from the common tendinous ring. It attaches to the medial aspect of the eye ball

Lateral rectus: Same as the medial rectus but on the lateral side

Superior oblique: originates from the common tendinous ring and passes anteriorly on the medial wall of the orbit, it becomes tendinous and it’s tendon passes through a structure known as the trochlea. By passing through the trochlea which acts as a pulley system the tendon turns 90 degrees to insert on the posterior lateral aspect of the eyeball.

Inferior oblique: does NOT originate from the common tendinous ring. It instead originates from the maxillary bone. The muscle belly passes up under the eyeball before becoming a tendon and inserting on the inferior posterior aspect of the eyeball.

We’ll quickly cover the innervation of these muscles and we’ll in a later post/ a revision to this post look at the action of these muscles. The reason I’m delaying this is because the axis of the orbit is different to that of the eye so the action of the muscles, particularly the obliques, may not be as expected and I feel I can best explain this with a video which I need to film.

So!
The innervation of these muscles is very simple. Remember this: Oculomotor (CN 3) does all except LR6 SO4.
LR6 = Lateral rectus is innervated by cranial nerve 6 which is abducens nerve
SO4 = Superior oblique is innervated by cranial nerve 4 which is the trochlear nerve. (Incidentally another way to remember this is that the superior oblique passes through the pully called the trochlea and is innervated by the trochlear nerve)

Thanks for reading, hope you are somewhat enlightened! I promise to cover the action of the muscles soon!