About Me

Larbert, Scotland, United Kingdom

Saturday, February 27, 2010


After butcher boy doing me a favour yesterday, he emailed yesterday - I suppose it saves him having to do any real work, and asked if I was free to help with a short trip to Costco today to buy exciting supplies.

We also took his flatmate, who used to work with us all in the days of supermarket land and is now working in another branch of the public services. The summary:
  • huge tin of pretzels,
  • lots of juice
  • random foodstuffs
  • and of course tasty pizza and coke in the canteen whilst we divide the bill
All in all a good Saturday morning.

Friday, February 26, 2010

The Will to carry on

It seems I am a hard person to get hold of.......last Summer - Augusty time, I drafted my will and poewer of attorney, as advised by the solicitor when I bought my flat in 2004. Anyway, having gotten round to it, I have at various times since been on Bute, busy, and studying, so it was today before the completed Will and I coincided for a signing. Now I just have to get a doctor to sign to say that I am of relatively sound mind, and get my sister to sign the Power of Attorney and it's all go.....

Opticians at 11 as well.

Because the will guy, and Butcher boy as the witness of my signature on the will, were coming round at 9am today, after yesterdays OSCE, I spent some time tidying the flat - well tidying as in putting all notes in a big pile; and hoovering and mopping the floors, doing all the dishes and wiping the benches, and moving anything to big / annoying / strange to be tidied easily, into the bedroom, which now looks like the storage yard for a junk shop.... Can't decide if I am running out of room, or just running out of sensible storage ideas. There is a big yellow storage place not far away.... I wonder......

Tuesday, February 23, 2010

Scores and next year

Well, last week the UKFPO published the jobs online. I got my 6th choice - moral don't choose popular choices because with a mediocre score you should not aim too high! So next year I shall be in Glasgow and Lanarkshire. I thus spent the end of the week ranking in order the 18 individual rotations (this is the 3rd or 4th level of ranking to get a job!) and thus know that I will be doing a combination of medicine and surgery and very little else.....

Then later in the week they published the scores breakdown for our questions (each section scores out of ten points:
1 - List previous degrees, papers, posters etc
- 8 points

2 - Describe a case from your clinical experience that you have observed in the first 24 hours from hospital admission. How did members of different professional teams interact and how did this contribute to effective patient care? What did you learn from this that will influence your future practice as a new doctor? (200 words) - 8 points

3 - Describe a case from your clinical experience that you have observed in the first 24 hours from hospital admission. How did members of different professional teams interact and how did this contribute to effective patient care? What did you learn from this that will influence your future practice as a new doctor? - 4 points

During a ward round on an ICU placement, a consultant was teaching me about ventilator function and the various modes available for use in a patient with pneumonia. The consultant organised a tutorial where, having established my background knowledge of respiratory anatomy and physiology, he used diagrams and patient scenarios and asked me to explain the pathophysiology of each patient, and choose a method of ventilation, justifying my choice. I found this tutorial approach very helpful.
As a middle grade doctor, I could be called upon to explain some of the clinical features of a disease, such as diabetes mellitus, to some junior colleagues. I would adopt the above approach with the colleague in a one-to-one situation and start by establishing the level of the colleague’s understanding of the relevant disease. From this, I would then lead them through any areas of poor understanding, before reviewing a number of selected cases so they can see why the disease leads to the presented clinical features, and the effect these have on a patient’s life. Finally I would present them with new cases to establish their understanding after the teaching, reviewing their answers with them.

4 - You are one of two foundation doctors on a ward round. The registrar identifies a minor error made by your colleague and makes inappropriate critical comments in front of the patient and the healthcare team. Your colleague is visibly distressed. What actions would you take and how would you prioritise these? What actions do you believe your colleague should take in relation to these comments? How might you address a minor error made by a more junior colleague in the future? - 10 points

As this is a difficult situation, taking place in a semi-public arena and involving a senior colleague, I would ask my distressed colleague if they were alright to continue or if they needed some time out to compose themselves. Before moving on I would reassure the patient regarding the minor error, and would check that the ward round notes were written up correctly, such that patient care was not adversely affected by this incident. After the ward round, I would approach the registrar and politely suggest that whilst errors need to be corrected, they should consider how they present their comments in front of patients.
My colleague should discuss this error with the registrar in order to learn from it, and request the registrar to discuss any failings with them privately rather than in front of others.
Were I to be the registrar, I would correct the error to ensure patient safety and good treatment. After the ward round I would discuss the matter in private with the foundation doctor explaining why the error could have caused problems. I would offer appropriate help e.g. individual training or tutorial to improve their understanding and prevent recurrence of the error.

5 - Describe one example from your medical training when you received feedback on an aspect of your performance. Explain how that feedback altered your subsequent practice. How will you use this experience to develop a specific aspect of your foundation training?- 6 points

Having observed the procedure several times, I was, under supervision, taking my first blood for culture, using aseptic technique. My setup was less than ideal. I contaminated equipment and had to replace it and start afresh. The supervisor took me aside and discussed the problem, emphasising the need for thorough preparation. They suggested that I plan carefully, listing the equipment required and checking I had collect it all prior to starting. They also demonstrated techniques for putting on sterile gloves without contaminating them. Overnight I read up the procedure and consulted the local protocol. The following day, the registrar asked me to repeat the procedure on another patient. I referred to my notes and the protocol, collected the required equipment, double checked it, and completed the procedure successfully without wastage or contamination.
I adopted this approach of observation, pre-reading, reference to local protocols and making notes for common procedures in this and subsequent placements, and have found that it increased my confidence and success at performing procedures. In foundation training I would continue with this approach to new procedures, consulting textbooks, familiarising myself with local protocols and carefully observing senior colleagues practice and amending my notes accordingly.

6 -
At times, the patient and the medical team have different ideas on the management of the patient’s illness, because of personal, social or cultural views held by the patient. Describe a clinical case where you have observed this. Identify the factors that contributed to these differing views. Why is it important to understand these differences in your practice as a foundation doctor? - 4 points

The summary of this is that I am rubbish at questions I work hard on and quite good at ones I drafted once.

Interestingly, due to an academic score of 34 (repeat a year) I made my academic score almost with part 1 which brought me to the same score as many of the academically gifted members of my year who did not have a degree. Thus the scoring discrepancy, and thus the first choice is jobs is based on ability to answer those questions.

The questions for 2009-10 were quite different to previous years and I am not sure if that helped or hindered.

Oh and as a PS - I know what to do if someone shouts at me - I got 10/10 above for that!

Monday, February 15, 2010

Theoretically half way

The written exams were Thursday & Friday and featured a bizarre selection of questions old and new - STI's, testicular masses, febrile convulsions, pelvic fractures, postural hypotension, hair loss, and more.

The Short Notes were again unusual - the ethics one being absed around adults with incapacity and the rights of relatives with 'welfare guardianship' rights; the public health one related to smoking prevalence.

Either way they are now both finishged and OSCE revision starts in earnest tomorrow!

Monday, February 8, 2010

The hoodies are gathering

I am surrounded by hoodies, most of whom look as if they'd happily receive a hug......though not from David Cameron.

Yes, on level 5 of the Study area in the med school, the buzz of tension mixed with the swish of pages turning, the click of keyboards and the hum of the aircon is stifling conversations. The neat piles of empty coffee cups, M&S sandwich boxes, salad tubs and fruit salad trays are growing near the bin, and the dress code is heading from normal to comfy and homely - started with hoodies and jeans, now slippers are creeping in.

The earphones are in, and a selection of online music sources, podcasts etc are providing the soundtrack to our lives. Yes, we're heading through exam season, and as we all struggle with the same past papers, and identifying which antibiotics cause cholestatic jaundice; and debate the answer to mock EMQ 1.8 from the XX past paper etc, we are heading towards a camaraderie - those of us who choose to revise here and developing something of a bunker mentality/ blitz spirit.

And when it all comes down to it, we are all in it together.

Wish us luck!

Thursday, February 4, 2010

Pivotal month?

Far be it from me to declare any month as more important than it's colleagues, but.... Feb 2010 is pretty important to me - career-wise at least.

These pretty much fill February - writtens w/c 8th and OSCE w/c 22nd & 1st Mar. Nuff said - they decide if I graduate, if I have resits etc etc etc. This means that much of the rest of the month is built around revision.

Last Med Student Block
.........................Hopefully! This should be signed off tomorrow, again hopefully with a 10/10 pass. The coursework is all uploaded so everything on that side of things looks ok.

Programme details
Hopefully I find out which programme I will be on next year for Fy1 jobs. This is step 2 of the 3 stage 'find me a job' process. Step one assigned me to Scotland Foundation School, and Step 2 will allocate me (hopefully) to one of my top ten choices of programme (or I go into 2b where I have to re preference the remaining vacancies).

Much of the above is tentative and 'hopefully' and just to tempt fate I am planning as if I will pass!!