Results and still no time!

So results came out… (they actually came out a while ago but I am too unorganised and didn’t write a post about them!)

I imagine you’re curious to know how I did?

I PASSED! With pretty good marks actually, averaging 83% on Neuro and 70% on Respiratory, Cardiovascular and Renal (not bad considering I did next to no revision for that particular paper).

So I’m really pleased. All my friends also passed which is wonderful and we had celebratory wine/ice cream night but are yet to go out to celebrate because none of us have any time at the moment. (Though we did go to Turtle Bay for lunch and cocktails the other day so I guess that mildly counts.)

I have also confirmed details of my project and am pretty much sorted for my return to America which is incredibly exciting!  There is still so much going on at the moment though with the medical school piling on the deadlines, the usual burden of a medical degree and the two shows that I am involved in, I am metaphorically dying under the weight of my commitments. But I’m also having so much fun at the moment! In rehearsals we have a lot of banter and moral boosting things like all dancing to the Cha Cha Slide in the middle of a rehearsal for no other reason than because we want to. Lectures are also pretty interesting at the moment. We’re looking at reproductive function so all of the gags and innuendos from our lecturers vastly lighten the mood on those days when it’s just lecture after lecture. I cannot wait for clinical years now, lectures are getting a bit tiresome and it’s always nice to get out on the wards/gp surgeries and meet actual patients and learn skills that we’ll be using in the future.

On that note, I have another rehearsal to go to so I’ll be leaving things there – I hope anyone else who had results in Jan/Feb was happy with them and for those of you with impending deadlines/midterms – all the best!

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!

Graduating from Medical School and Hightailing it to New Zealand.

I’ve recently been looking towards the future and have come to the conclusion that as much as I love the UK I will want a change of scenery by the time I graduate. Hell, I’d be happy for a change of scenery right now.

It’s a long way off, and I imagine I will complete my foundation years here in the UK to allow me to return should I want to but I am sorely tempted to head off to NZ once I graduate.
I have looked into the USA and Canada but from things I’ve heard it seems incredibly difficult to get a training post out there. In NZ things are apparently easier and to be perfectly honest who wouldn’t want to live in a country that seems to have its work-life balance way more sorted than most other places.

Obviously this may be subject to change as I may meet someone and decide to settle down here in the UK, but I can’t help but be tempted by the more peaceful, less crowded and frankly beautiful country that is New Zealand.

It’s a dream and probably a wild one which will never happen but at the moment it is something that I’m really considering. If anyone has done this, what was it like? How did you find the process? I’m struggling to find clear, concise information about the requirements and how to go about moving over. It would be wonderful to hear from someone who has done this and who could shed some light.

Enough daydreaming for one day. I should really hit the books to make sure I get to graduation let alone to NZ!

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!

Our Future Specialty: Getting ahead of the game in medical school?

What specialty we will practice for the rest of our careers is a discussion that frequently crops up amongst my peers at medical school. We have even decided it will be quite amusing and interesting to write down the specialty that we see ourselves in and the specialty that we see each other in and open them in 6 or 7 years time to see how they match up. Could be entertaining. I honestly have no real idea what I would like to put down at the moment though.

Currently, I’ve just picked my area of interest for my BMedSci intercalated degree and have decided to do a project in something related to surgery. I’m currently in the process of chatting to supervisors and coming up with a specific project. Surgery appeals to me because of the idea of fixing the problem that is in front of you, as you see it. I have my misgivings about surgery mostly because of the sexism that still unfortunately exists around this career choice but I cannot deny my fascination with it, and no not just because of Grey’s Anatomy (though I absolutely love love love Grey’s on another note!). I hope that by conducting my research project in this area I can gain more insight into surgery and the demands of this career, because undoubtedly it will be a tough road should I choose to go down it.

It is extremely difficult whilst at medical school to know how to go about gaining the necessary evidence to show your investment in a particular specialty. These days we are told that because competition is fierce we should get ahead of the game and start getting some relevant experience and go to relevant conferences. On the other hand though you can’t go to conferences for every subject and specialty and I don’t want to narrow down just yet. Interestingly a lot of people in their foundation years who I have spoken to have said not to worry about it too much at medical school and just to try and get exposure to specialties that you feel you would be interested in. But then again, having experience such as a publication in your future specialty must surely be a boost?

I recently (I say recently, I literally just) read this article in the student BMJ about what some people had said they would have done differently to smooth out their career paths with hindsight.

Here’s the link:
http://student.bmj.com/student/view-article.html?id=sbmj.g7554&locale=en_GB

(You may have to register for free to be able to read the full article, but if you are interested I’d recommend a read.)

For me at the moment I think the most relevant points are to:

– Take more opportunities to experience different specialties

– Ask more questions about different specialties 

So I will take that into my project and my chats with supervisors to try and gain some experience to see if surgery really is for me and if it’s not then I’ll take a look at some other specialties.

I think that for the most part that is the most important thing we can do in medical school, ensure that we really want to do said specialty for the rest of our careers. By all means if you are certain that being a GP is your calling then gaining relevant experience and publications/presentations in primary healthcare will help you no end but for the rest of us just working out exactly what we want to do is the first, and most important hurdle.

Anyone else reading who is currently in medical school, what are your thoughts on getting ahead of the game?

Revision… WA WA WA

Oh revision, my old pal. You never cease to visit me every Christmas do you? And every Easter, you are so thoughtful that way…

Yes this is another revision angst post and yes this is mostly a procrastinatory revision angst post. I seem to spend my entire life plonked down at our kitchen table, books spread like margarine all over said table precariously adding to the teetering tower of coffee mugs that gets gradually taller throughout the day.

It is more than a little depressing to have nothing more to do with your life than sit and learn neuroanatomy from day to day. On the bright side, one of our anatomy tutors is frankly hilarious and his emails/ e-learning resources brighten up revision considerably. For instance:

I asked him a question by email and I get this response:

Correct!

Scott,
Sent from my IPhone: Android is for suckers.

I probably laughed more than I should have at that, but in my defence revision does send me mildly insane and delirious.

Does anyone else have the need to consume endless chocolate when revising? I do. I’m convinced that over exams I should put on more than half of my body weight again from the number of Smarties that I eat. Smarties are particularly good for revision motivation as you can make a to-do list and put a Smartie next to each item so that when you complete it, you get to eat it! What could be better? My issue is that I just eat them all after achieving one thing on my list, and then move onto the biscuits.
I am of course completely exaggerating. Though I am partial to a packet of Smarties here and there when revising.

To be fair, this year I have drastically cut out my procrastination. I used to be a queen but I seem to be flunking my procrastination class this year. This is, of course, wonderful for my marks. I used to do anything to get out of revision, including pulling out the fridge/freezer to clean behind it something that never otherwise gets done. I also pick back up old hobbies whilst I have no time for them, such as writing. I am in the process of writing a book but I am useless at writing with any regularity and yes, you guessed it, I suddenly get the urge to get writing regularly again when the revision season comes around… typical. Still I’m much better these days and can survive most of the day without procrastination.

She says…. writing a procrastinatory blog post.

Well on that note, I will leave you and return to the coffee cup mountain covered with worksheet snow.

Farewell, see you on the other side of exams. Best of luck with any of your revision everyone.

Thank you for reading!

Professionalism

It’s a funny word.

A word that is completely drilled into us over and over at medical school. Even before we get here we are told that from now on we must behave in a professional manner, not do anything that could compromise our fitness to practice and stay on the straight and narrow.

Yet there isn’t actually an accepted definition.

It’s a very difficult word to define because it means different things to different people and relies heavily on context.

I generally judge professionalism by looking back on things that I or others have done and to think if there was a way to do that that would have respected the dignity of the patient more, that would have been less painful for the patient or that would have been easier on my colleagues?

But still it’s hard to know if I’m hitting at the right ball park. For example last week when I was on my HCA shift – this is a thing that the medical school are making us do at the weekends now, it’s an annoying amount of time to lose from studying and other stuff that I want to be doing but I think I’m learning, though how relevant that learning is, is another matter.
So anyway, I was on my HCA shift on an elderly care ward. I love this ward because although a lot of the patients are confused there are patients with some wonderful stories who’ve been in hospital for a while and want nothing better than to sit there and recount all their travels to you – it’s lovely. I was in a bay this time with a few distressed and sometimes aggressive patients I had been warned.

I had another HCA and a staff nurse working with me. One of the patients was on a mattress on the floor as they had no more low profile beds and he was a falls risk. He was due to be moved but I also questioned that – is it better for him to be on the floor, what about infection risk? Or do we risk putting him in a normal bed and him falling? What’s the right thing to do here? In light of the following events I’m glad he was in a mattress on the floor but I remember questioning it at the time. We got on with the morning work and at one stage I was in the bay alone. This man had been distressed all morning and tossing and turning trying to get up and out of bed despite being unable to stand. I turned my back for a minute and heard him cry out. I spun round and he was half way across the bay on his front with blood all down the front of his hospital gown. Turns out he had pulled his catheter out and was running away in the only way he knew how because he was disorientated and felt like he wasn’t safe. I yelled for help and got down beside him to reassure him and calm him down. I took his hand, looked him in the face and spoke to him calmly and he did begin to calm down. However then the nurse and HCA arrived and he riled up again.
Both this nurse and HCA were incredibly professional all morning, maintaining brilliant dignity when bed bathing patients and talking to them well but I think the nurse at this stage was frustrated with this patient. He had been distressed all morning and we had kept going back to calm him down. He had already pulled out cannulae and catheters before all of which had to be replaced and by this point I think the nurse was done being calm with him. THe nurse didn’t snap but was quite short with the patient and was just generally portraying a frustrated exterior – now this meant that calming the patient down took a lot longer because he picked up on the frustration and amplified it in himself.

Was the nurse being un-professional to outwardly direct his frustrations at the patient?

I don’t know, I know it didn’t sit right with me and I preferred to personally take the calm exterior approach however frustrated I was internally. But I can understand the reason for his frustration. The patient eventually calmed down, the catheter was re-fitted and he was calm for the rest of my shift even as he was hoisted and moved to a low profile bed. So the nurse getting frustrated had no repercussions – so was it unprofessional?

I can’t give you the answer and I don’t think most people can either, its more down to personal opinion. Professionalism is subjective and the most important opinion on whether or not you are being professional is that surely of your patients and your colleagues. If they perceive to be professional then you are, aren’t you? Even if not so much in your personal life?

Well that’s another debate right there. I’ll leave you with this thought:

‘Medicine is, in essence, a moral enterprise, and its professional associations should
therefore be built on ethically sound foundations. At the very least, when physicians
form associations, such occasions should promote the interests of those they serve.
This, sadly, has not always been the case, when economic, commercial, and political
agendas so often take precedence over ethical obligations. The history of professional
medical associations reflects a constant tension between self-interest and ethical ideals
that has never been resolved’

Thank you.

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!

An interesting case…

Fortnightly we at our medical school take the afternoon to go to a local GP surgery and get some teaching from current GP’s and meet a few patients.

We’ve been going for a few weeks now and I must say our GP is a fantastic teacher, one of those highly enthusiastic people who is ready to tell you absolutely everything he knows about a topic.

Back in our first week we were learning initially about general end-of-bed observations and taking an examination of the hands and face. We learnt first and then to practice what we had learnt on a few patients who had some interesting signs.

One of the patients had psoriasis which on examination of her hands was hardly noticeable but then she rolled up her sleeves and we saw that she was covered. From this I learnt not to just take the surface of things, to dig a little deeper and you might uncover something that you’d otherwise have missed. This would obviously have come out in the history but as we just examining the patient today we could have easily missed it.

By far the more interesting case for me, however, was her husband who just came in the capacity of taxi to bring her into the surgery. He had however had a pretty obvious and extremely interesting operation that I had never seen before or knew existed.

Before he even entered the room we could hear him chatting to our GP in a gravelly, very hoarse voice which at first I just thought was his voice until he walked into the room. It was immediately obvious that he was talking through a valve in the middle of his neck which he pressed in order to make sound and let go of to breath. I had truly never seen anything like it.

He told us that he had had a tumour of his true vocal cords and that in order to be cured he had, had to have a total laryngectomy (surgical removal of the larynx (voice box)). This obviously removed his power of speech however surgery can provide a solution to this. He had, had what is known as a tracheo-oesophageal puncture performed and then a prosthetic valve placed in to allow him to regain a form of speech known as oesophageal speech.

Apparently his degree of speech is very good in comparison to the normal outcome for these patients and I must say that apart from the gravelly tone of his voice his speech was entirely normal. He has learnt to use the valve very well.

The principal of the operation, from my understanding, is that a patient who has had a complete laryngectomy needs to breathe permanently through their neck. A hole (fistula) is made between the trachea and the oesophagus and the voice prosthesis is inserted which does not allow food down the trachea but does allow air into the oesophagus.
Air in these patients enters and leaves through the valve in their neck but when the patient occludes the valve and prevents air escape by this pathway air enters the voice prosthesis and enter the oesophagus and escapes through the mouth. As the air passes through the upper tissues of the oesophagus it vibrates replacing the vibrations previously produced by the vocal cords.

This is what it looks like in the flesh:

Oesophageal speech, I’ve been told, is hard to master especially initially but there are clinics for these patients to go to where they can learn to speak well using these prostheses and the result is truly astonishing.

There are of course implications on this man’s life, he will never be considered in the same way and there will be a prejudice that comes from the sound of his voice. He said himself that children are scared of him now and he does resent that, but for him the ability to still communicate close to how he used to succeeds that and once people get to know him they understand and there is no judgement.

It amazes me everyday the things that modern medicine can achieve and this man and his surgery reminded me why I decided medicine was the career for me in the first place.
Very cool!

Just to show those of you who haven’t seen this – here is a patients story:

https://www.youtube.com/watch?v=SaREnCLP3RM

Care, Compassion and Commitment…

To me these are the things that make up a good medical student and a good doctor.And of course you need to have a little bit of charisma and personality as I hope to demonstrate with this frankly glorious photo if I do say so myself.
10632615_10153048019553368_6711124906583021730_n

This is me, little bit exuberant at times but I like to think that I possess the qualities to become a good doctor. My name is Lydia Edge and I’m just starting my second year of medical school in the UK. Having just completed first year and finding that the more I progress through medical school the more I need somewhere to share the experience I’ve decided to start a blog where I can do just that.
Expect to find posts not just about medical school but about university life in general, about my summers and how I’m spending my time away from studying. I’m still learning about myself as well as about medicine so there will be an element of reflection about decisions I’ve made, paths I’ve taken. Let’s see how it goes!

Ask questions, get involved, I would love to hear from all of you!