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......

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.

Finals
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!!

OSCE-ness.

They came, they went, they happened. Probably because the OSCE doesn't count for me this year (formative only), I didn't really get too stressed about them. They seemed to go ok, despite having very little practice this year. I guess I will wait and see. I know I messed at least one of the 26 stations up, but thats life I guess.

The night out to celebrate the end of exams was a good one - with many of the year tehre, and a couple of the old year (class of 04).

Exams

Well I am still to write this post, so I haven;lt jumped off the Kingston Bridge yet, though the bells in the chapel ringing this morning did drive me mad as I waited for my exam. At first they just made it seem like across between Hogwarts; a posh public school (or rather what I imagine one of those to be like); and Oxbridge.

Anyway to the exams. They seemed to go ok. I'm saying no more about how I did until mid June!

Paper 1 was a romp through most of the course - cardiology, depression, rheumatoid arthritis, pharmacology, TB, HIV and blood films.

The MCQ bit as ever wandered here and there through anatomy (just what is trigone...) and LFT's, Immunity, cytology and an interesting trip to haematuria.

Paper 2 today was more detailed and visited respiratory (COPD vs asthma), Genetics, alcohol addiction, colorectal cancer, breast cancer, melanoma, optic neuritis, epilepsy and something I have forgotten.

All in all a fair and good test of knowledge not to see whether I passed.

Because I sit tomorrow (and Thursdays) OSCE formatively, I really couldn't give a stuffed monkeys. This means I will be more relaxed and possibly even do better than I did last year, but since it is formative that won't matter. Still 11.20 on Thursday and it is all over!

D-day -1

Sorry for the lack of input the past few days. Like many med students (though not all - dundeemedstudent) this week is exam week. I am less worried about the OSCE's since for me, they are formative this year. the written tomorrow will be the 3rd sitting for me of the 3rd Year exam and I am left feeling that if I can't do it this time, I never will (and won't get a chance to) so tomorrow & Tuesday decides my career, and whether I have wasted 4 years of my life. So all I need to do is to get nice questions and stay calm and write everything I can in answer to the questions. I know I still have gaps in my knowledge, but this year there have been several large hints from lecturers, especially in the last 2 weeks of teaching.

Anyway, here are some pictures from the last few days.

End of term feeling?

Today was the end of the timetable.....my life is technically empty from now until May 19th, which is kinda scary. I am thinking of getting together with some others for some brainstorming and clinical skills practice stuff. there is a minor issue that the Clinical Skills area is closed due to flooding this week, and the Year 5 final OSCE for the next 2 weeks.

I now have all my exam details - candidate number, OSCE locations (Victoria Infirmary * Med School), OSCE times (Wednesday 21st 3.30-5.20pm and Thursday 22nd 10am-11am), written exam location - Kelvin Gallery - no idea where that is though!

I also bumped into the head of year yesterday after the lecture, and we had a quick chat - she thinks I will be fine in the exams and that I should have words with my family about their decisions to die near exams! It was all said in a nice way though. So everyone is telling me that I can do well and will do well.....

Do you mind if I examine you?

As mentioned here and here, today was my first day on my easter holiday clinical skills placement. It was bright sunny morning, if chill, and the train was even on time. The walk to the GP's was nice, past a park and sports ground and not at all what I expected that area of the city to be like. Maybe my exposure to UPA's in Edinburgh has coloured my views on what they are like?

The format of the clinical skills bit is that there are 2 students, and we get 30 minutes with each patient. We take it in turns to lead each consultation, and take a brief history, then do an appropriate examination, then the other person does the examination, then we get feedback from the tutor.
I was observing consultations 1 & 3 and leading consultation 2.

The first one was a man who was diagnosed with lung carcinoma 4 years ago, but the tumour has not developed in 4 years and the GP thinks it maybe carcinoma in situ. Either that or this was one of the 5% that deos respond to chemo and radio therapy and survives 4 years. He was breathless at rest, but surprisingly mobile for his age (80) and breathlessness!

The second one was one I was leading. The man had had breathlessness on holiday, then 7 days later woken feeling funny, and was admitted to hospital with an MI. He was also found to have a calcified aortic valve and AF (the 3 main causes of which are heart ischaemia, thyrotoxicosis and valvular problems - see I do listen in plenaries sometimes). Hew as quite difficult to pin down on history and was quite vague. On examination he had a quite striking ejection systolic murmur.

The 3rd patient had MS, and so we did a neurological work up, where I managed to miss quite a few of the reflexes...

Then we had 2 normal patients on whom we did BP while they were in seeing the gP. These were not planned patients, and so teh history was often very short - History of Presenting Complaint, a bit of local enquiry, and social habits, then hand them over to the GP.

The GP tutor is very friendly, so hopefully these sessions will mean that I go into the OSCE more confident than I feel now. Especially as I passed last year with a satisfactory, and this year the OSCE is twice as long as it was last year, and although I only need a formative pass, I would hope to do better than I did in 2007.

Block 12 week 1

The first week of this block was quite nervy really. I was a wee bit scared about being in hospitals - always am - I'm convinced that I will put my foot in it, mess up an examination or dry up completely. So much so that on Monday I couldn't eat any breakfast and felt nauseous until I got to the hospital.

I was also nervous about meeting my Clinical Practice/PBL group for the first time. In the event, the clinical practice group seems ok. They all seem so much more confident and smarter than I feel, but once we came to feed back, we all seemed to have got stuff at about the same level, which was good.

The afternoon PBL was interesting, especially in comparison to my 2 PBL groups in Year 3 last year. This year's group seems to have 2 or 3 groupings and is less homogeneous. This leads to interesting bits in the discussion of people ignoring each other (politely) and a general sense of chaos, as the questions end up not being in the correct order. We muddle through the scenario though.

On Wednesday, we started the day with Lectures at 1 (I hate early starts like this!?) which was a standard afternoon with a plenary on Statin's and one on Medical Statistics, focusing on likelihood ratios. We also had an OSCE briefing (its longer this year) and an introduction to the block, and exams. Focussing on teh exams now already has me feeling very nervous. Oh well.

Terms and Conditions apply

As mentioned below/above, they have let me back into do Year 3, but on a few conditions!

• I do not have to do the SSM's (so term runs from end of October to mid-May)
• I do not have to do another Junior elective (so i have all next summer off)
• I do have to do the OSCE in May, but it will be formative
• No one is sure whether I have to do the coursework, but if I do, it will be formative.
• I only get one chance at the Year 3 written exam, next May.
• I have to meet regularly with my Adviser through the year
• I have to go and see the Effective Learning Adviser for advice.

None of which is too bad.

Back in the big city

Well I'm back in my flat. It is funny how a week away can make even simple things look totally different. Firstly the hall was covered in post from Banks, magazines, Unions, BMA, Power companies (more on that later), Student loans and my P45 form being an OSCE model in June. I have to say that my heart skipped a beat when I saw another University of XX franked envelope!!

Then I discovered that i hadn't set the dishwasher off before leaving and thus had to do that as it was awful inside. I had however remembered to shut the fridge and freezer doors and turn the power off to other things (but not the fridge and freezer!)

My week away was a strange time - a time of contemplation, thinking, reflection and some relaxation - as much as you can have when with your parents and dragged out to various places to stop you 'moping'....ok activity is good, but sleeping would also have been nice!

We walked the coast, along rivers and went by Train to Settle, from Carlisle...it was fairly scenic... I also drafted my written statement to the Progress Committee (of which more later) and saw my sister who was down fleetingly for wedding planning. This allowed me to hitch a lift back as far as Linlithgow with her, before catching the train back home, and arriving just in time to discover that tomorrow morning is the Fresh n Lo 13mile race and it starts outside my flat - what fun! The last 2 years i have been working in East Lothian this weekend of the year and managed to miss the race!

Results day

Well it is now official, for the second year running, I am a failure. Admittedly technically only 33% failure and even then only by a little bit. But even so, it means that both the last two summers I have done badly in the written exams despite passing the practical OSCE and doing quite well in the coursework.

It all seems a bit of an anticlimax, considering that:

• I was worried that this might happen after I ran out of time to finish paper 2.
• Most of my friends passed
• 3 of my friends became Dr's last Friday.
• I was looking forward to a holiday
• I still have to complete and essay and presentation
• The resists take place on the final 2 days of my elective (need to tell my supervisor that)

Still onwards and upwards etc.

Modelling

Today I made £30 doing topless modelling.

I even had 55 people put their hands round my neck...... ok, only 53 (but the other 2 dropped marks by not doing so).

I was an OSCE model for the Year 2 OSCE. there were 4 test centres, and I was allocated to the PFI hospital about 25 miles away. It was an early start - 0710 train getting there at 0810 for an 0830 start.

Because it is PFI it look like a cross between an office block and a hotel - lots of potted plants and white walls and glass and lots of cleaners! We even got free coffee and scones in the morning and a lunch on top of our travel expenses and £30 payments (all tax free).

In the morning I was the model for the respiratory exam and in the afternoon for Cardiovascular.

Sexism point 1.
The male volunteers do the respiratory and cardiovascular examinations, where you have to take your top off and the female ones do the GI (pull t-shirt up) and musculoskeletal (wear shorts) ones. And the heating wasn't on and it was a touch chilly after 2 hours sat topless on a bed.

Sexism point 2
Why do girls always have cold hands??????????????????????????????????????????????
All the girls today had cold hands, as did some of the guys........some were like ice!

Selling my body

I am selling my body, well technically I am renting it out, to the Medical School. Having last year volunteered to be a Guinea Pig in a research trial, my altruistic action this year is to be a model for the second year OSCE (in second year, all the patients are 'normal' and the OSCE assesses examination technique). I have been assigned to a DGH about 25 miles from home which means leaving the house at 6.55 to get there by 8.30am.

I get paid £30 for the day, thus valuing my time at a little over £3 an hour!!!!

Being male, I will be doing any of the examinations:-

• Cardiovascular
• Respiratory (front & back)
• Abdominal
• GALS / Musculoskeletal
• Blood Pressure

Resuscitation

Oh well, I failed this station in the OSCE ( a stand alone station0 and thus have a retraining and re-assessment day in mid June.

O S C E (to the tune of YMCA)

Exams are over!

Well for the moment, I might have a recall exam for my OSCE, if I was in the gap between PASS and (PASS + 5%). Hopefully I am not. I would like to think that the OSCE went well

1. Ethics station - a man with a sickline which says Alcohol (10 min)
2. Blood Pressure measurement
3. History of a jaundiced patient
4. History of a suicidal patient
   
5. Peripheral vascular examination of lower limbs
6. Respiratory examination of the back
7. GI examination of a jaundiced patient with hepatomegaly
8. History of a rheumatoid patient
9. Difficult circumstances with pregnant woman drinking alcohol
10. Comms Skills station - woman with a cough - followed by information giving for bronchoscopy. (10 min)
    
11. Neurological examination of upper limb
12. History of a woman presenting with headache
13. Resus with a Defibrillator
14. History of a woman with weight loss.
15. Breast examination of a manekin.
    

And another 1 I have forgotten since this afternoon, and 2 5-minute rest stations.

If the wiggly line is flat, it's bad.........

9 stickies = 12 leads......
Number one difficulty is learning where all 9 leads go - for a 12 lead ECG. 3 are easy - the limbs (well, except for th Right Leg) - no-one mentioned how you do an ECG on an amputee though...... The other 6 go on the chest - in an inverted tick formation from just in from the right armpit to just in from the left armpit. Arghhhh!!!

Why are they so difficult to understand?

I think it is because we get taught it as one nice line which has all the waves at the correct timings, amplitudes and orientations. Then in the assessments they give us all 12 leads, with a pathology and my mind goes to grey jelly. It all makes sense when I read it in the textbooks, but come the real deal and it's back to grey goo.

Oh well I have some nice sBMJ printouts and some lecture notes, and an online game - I might understand this soon, then we move onto Bones........

Comms Skills / OSCE

Today was our final year 3 Comms skills training - on ethics. With OSCE's 13 days away, we were all nervous, but everyone seemed to do quite well, even the one person who through nerves seems to do the opposite to what seems sensible. We discussed each scenario beforehand so we have notes in case we get that scenario in the OSCE.

My case was a woman whose mum was in a nursing home, aged 86, and had had a recent attack of pneumonia, and she wanted her mum to be allowed to die next time she was ill. The matron had refused to allow this. The mother was confused since her hospitalisation for pneumonia, and I as GP* had to explain about 'powers of attorney', 'legal duties to preserve life' and was supposed to check what other family there was (I forgot this one). I am convinced that in the OSCE I will probably wash my hands before and after the communication skills sessions as well as the examinations.

*(why do they spend years telling us we are not Doctors, only for them to make us pretend to be Junior GP's in OSCE's???????)

The rest of my group had interesting scenarios as well - a drunk wanting his medical records kept confidential from his boss; a mistake by a hospital outpatient clinic resulting in a woman having a 10 month delay before being told her cancer was inoperable; a worried parent whose child had an allergic reaction to a first dose of amoxycillin, wanting to complain; and a man who felt he was badly treated by a fellow GP.

Of these, the misdiagnosis was the one I thought was most difficult, but it was handled really well by one fo the blonde female mature students, who really does have a gift for communication skills - she's really good at it. In fact I think we mature students sometimes are better at Comms skills because we bring different and more life experiences. However the younger students generally get the facts correct!!!

GP Visit (9)

The GP's this morning was a waste of time!

3 hours not getting to examine people followed by free lunch and a talk of anti-impotence drugs, and a free sample of drugs (from an anti-histamine company, not from the anti-impotence company!!!!).

Then this afternoon was a trip to see my patient who is subject of my essays - the flat was full of cats and dogs, and the stench ion the stairway up to it was awful. Once in the flat it wasn;t so bad but it was clear that the cats used the stairs as a toilet. Lovely.

Elective falls through

As part of our course we do junior and senior electives which take place after the end of years 3 and 4. Each is 4 weeks long. For various reasons both these elective periods happen at the exact same time of year, so there is certain competition as 500 students all want electives in the same 8 week period.

Basically my plans have fallen through. I emailed my potential supervisor in February and was told "Yeah. it is fine, we will email you nearer the time"; well we now need to send a form to the Med School Office proving that we have a supervisor etc. This needs to be in by 1st May to give them 8 weeks to check details etc before we start the electives at the end of June. I emailed my erstwhile supervisor on Tuesday and today got a reply from one of his colleagues saying that they already had a student working with them, and I should have made my application earlier than the end of April. So clearly they have had some internal communication issues(!) Maybe I should have pushed earlier, harder etc.

So now I have Friday and Monday to organise a replacement elective, around ******** - can't afford 4 weeks anywhere expensive, since this is viewed as outline the teaching time and thus not eligible for Student Loan / Student Support. Thus I need to be able to keep on my part-time job at weekends / evening as well as being on elective 8-5, since the mortgage and food bills won;t pay themselves.

So I need to find a specialty, supervisor and project within 96 hours, get agreement, get the form filled in and returned to Faculty and all this while writing two 2,000 word essays about community-hospital interactions in the management of a patient i have studied, and revising for the written papers, and the OSCE's.

Ain't life great, excuse me while I go for a long walk off a short pier!

Hospital teaching

Ok, so this morning was our penultimate hospital teaching session before the OSCE, and we were taking history and examination from patients on the surgical floor. My patient was a nice old guy who had Parkinson's and a history of prostate cancer, cataracts, atrial fibrillation (irregular heart beat) and probable bleeding from his 'back passage' which he was going to have laser'd. So this was all going ok, and I did the examination.

Come feedback time, we were all critiqued for not examining every system, not probing harder, not doing a full systemic enquiry - I don;t know if we have become to OSCE oriented that we try to do all histories in 5 minutes, and have parred each examination to the minimum.

We then had a masterclass on Jugular Venous Pulses (JVP)
starting with the normal pulse, and the items we need to describe about each pulse:

• Rate
• Rhythm
• Strength
• Volume
  
• Character
• Collapsing
• Can you feel the vessel wall?

When it came to JVP, we had to list all the ways to increase the JVP so you can tell that it is the JVP that you are seeing:

• Tilt patient's bed backward so they are lying at nearer 30 degrees than the recommended 45 degrees.
  
• Compare timing of breathing (JVP is higher on expiration)
• Look for bi-phasic nature of pulsation
• Increase pressure my pressing on abdomen over liver
• Check for landmarks - the two heads of sternocleidomastoid, carotid artery, external jugular vein

All in all it was a good session. This afternoon's PBL had a distinct end of term feel about it, with references to Crufts, prostatic discharges and revision avoidance tactics. But hey thats what you get for studying at *****************.