Stretchy days

Today has been one of those elastic days.

This morning time was flying an nothing was getting done, but as the day has gone on, someone has stretched the day and allowed me to get more done in the afternoon. It has also been nice and sunny and warm (though I;m not sure that matters when you are indoors all day - except for making the computer screen impossible to see between 4pm & 5pm, which aided my productivity).

I have managed to thoroughly revise 2 PBL's today and am about to start on a 3rd, though I may not finish it until tomorrow. I have also managed a load of washing, to clean the kitchen, re-shelve all the book, sort the pile of Uni work that needed filing, write two letters, fill in my student support finance form, and photocopy it, clean the bathroom and hoover the flat.

However I did forget to eat and I am now starving!

Easter........a time of new growth

Easter is traditionally seen as a sign of new life - both religiously, and also with its position in the year, near the start of spring (though to be fair with it being so early this year, and the northerly winds and snow, one could be forgiven for wondering if it was Winter).

Thus it is a time when one is supposed to think of pruning back deadwood and clearly out some of teh rubbish to create room for the new shoots. So today I did a load of filing - bank statements, credit card statements, O2 Bills, Electricity, Student Loans Rubbish, BMA stuff, Bectu stuff, old Somerfield pay slips etc. Now my 'to do' tray on my desk only has Uni stuff in it. that means a fair intensive 10 days of uni notes and such like to do before Uni starts again.

My first challenge therefore is to actually make it into the Library most days this week fairly early in the morning, possibly even before 9. Let's see how I do....

Tea breaks

On Monday, when we arrived at the hospital, the new parking charges were in force and we spent ages going round and round, then parked in the staff car Park....well actuallym, the new shiny signs said 'Staff Permits Only' but teh smaller yellow plastic temporary sign said 'Patient / Visitor parking'. Similar yellow signs all round teh site are covered in moss, so they may not be the most recent.

Upon getting to the Education wing, we discovered that the decorators are in, and have requisitioned the med Students computer / PBL etc room as their own, as it has a code lock on the door. Thus the med students are displaced into a seminar room, which we can't use all the time, has a key lock, and which to be fair doesn't put up much resistance to a firm shoulder charge.

When we get there, the decorators are drinking tea, and have a tressel table with lining paper on it out in the hallway.

When we come back at the start of our break between teaching and PBL, they are still drinking tea, or maybe coffee, and a tub of wallpaper paste has joined the tressel table, but no obviously new bots of lining paper have appeared on the walls.

When we come back for PBL, having spent the intervening break in the canteen, as we can't use the library or computer room (the computers are piled up in the lecture theatre with no net access), the decorators are again drinking tea and moaning about no where cold to keep the milk....and asking us if we know where there might be a fridge they could use. We all resist the urge to suggest the mortuary......

By the end of PBL, in a freezing cold Lecture Theatre - after pressing lots of buttons i eventually found the heating controls and got the PC to turn on, one painter was painting the ceiling, and the others were packing the lining paper and wallpaper paste away as it was nearly 4, or as we might call it, 2.55.......

Meanwhile the teaching had a distinct cardiology bent to it this week, with the first half spent in CCU, talking to a patient who had had a stroke last year and an MI at the weekend, and the looking at many many ECGs and trying to ID an inferior MI of the posterior descending artery (ST elevation in II, III and aVf I think....) and then up in a Cardiology ward, seeing patients with murmurs and listening to them.

My turn to do the examination in front of the group came, and showed how rusty I am, and how nervous I am. According to the SpR, I was too 'questioning' and not definitive about my findings, and was doubling back to things I had forgotten rather than leaving it until the end and saying "I would also....".

A quiet week

It has been a fairly quiet week at Uni, though I still seem to have the same pile of work still to do this weekend that I had on Monday.

On Thursday I was at my first clinical practice session at my new Hospital. The change from my previous hospital was like chalk and cheese. This one had a proper programme for the morning, with 2 different members of staff teaching us, and covering two topics of clinical teaching.

The hospital is in a state of flux, moving from being a DGH to become a campus with ACAD unit, outpatient clinics, day surgery, minor injuries unit, hospice, care of the elderly wards, reference lab, adult and adolescent Psychiatric units, and the West of Scotland secure psychiatric unit. Thus the site looks like a builders merchants! The new units are all being built at one side of the site, thus leaving the site of the current 1900's hospital ripe for housing developments and thus paying for the modernisation. The current hospital is a maze of corridors, ramps, temporary corridors between buildings and then the ore recent units which are a nice 5 minute walk across the site. There are many mature hospitals, and I can see how it would be a bit scary at night, especially with so many entrances, a site over a large area, and 3 400yard driveways to get to the hospital from the nearest roads. '

The new hospital.....according to the Health board....

The PBL group seems quite good as well, with a good mix of people and attitudes, as well as a facilitator who a) is a subject specialist; and b) encourages us to think outside the box and develop our thinking around the PBL problem and not just the presenting complaint.

Time...........

Have you seen the Virgin Atlantic 'Upper Class' advert? The one with John Hannah in it, where he talks about the importance of time, and how being able to have your own check in gives you more time to play Pool while waiting for your (delayed again) flight. Well today i had a lesson in time as well.

Lesson 1 - Carry extra stuff cos you might need it

For the second time in a week, and I think only the 4th or 5th time in Med School, no-one showed up to take our session this morning. It was to have been a 3hour session on Mental State examination, mental Health History taking and such like. But it didn't happen. After 20 minutes the course secretary came down to say that the lecturer was a no-show and he couldn't be reached at work or on his mobile.

I hadn't brought any work to do today in an effort to now end up like the hunchback on Notre-Dame when I had my rucsac on. So I now had 3 hours to kill.................which I did, semi-productively reading sBMJ, printing off some useful looking bits from it, checking emails, and having a longer than planned lunch break (the planned break was eat a sandwich while going to the hospital for PBL - this way i ate my lunch sitting down).

Lesson 2 - If you have a plan remember it!

On Monday, some of my PBl group had discussed that since the tutor was missing on Monday, we would ask our Thursday facilitator to let us feedback both scenarios today (being the end of a teaching block, there were no new scenarios this week), however we all forgot until we were leaving today. Thus I found myself at 2.35 with 55 minutes to kill until my driving lesson, and even less work to possibly do.

Martini: the Beautiful people.

My PBL group this half year is unusual IMO.

Some background. My previous cohort at Med school was fairly friendly and most people got on with most others and there was a good mix of people and experiences and very little cliquiness. PBL groups worked quite well most of the time because people were willing to contribute, and listened to other people before speaking so their contribution added to, instead of repeating what had been said.

I was tipped off by some staff at the start of the year that my new cohort had a few more cliques - including the self-named "Team Beautiful". I think I have identified a few of the above.....fashionable, impractical/inappropriate clothing in hospitals/labs, as well as some wealth related factors which most of the old Uni's get and were at Edinburgh affectionately known as Yah's. They tend to have very nice new cars, go abroad for weekends during term, and have been to very nice private schools and have a 'sheltered' view of the real world, especially the world of the socially disadvantaged in Glasgow.

Anyway back to my PBL group. My PBL group is formed of 2 clinical practice groups, which means one day a week 6 of us spend the morning together on a ward, and then after lunch meet up with the other group and we do PBL as a group of 12 or so. It is interesting to notice the changes in behaviour of some members of the group between the morning and afternoon.

My clinical practice group is 6 people: me, 2 fairly normal people, one nice yah, and someone who is perhaps a wanabee member of Team beautiful but is fairly normal when with us. However in the afternoon at PBL, he clicks in with the other group, which seems to have a majority of Team beautiful members, and only 2 normal people, who say they end up talking to each other mostly as they get ignored.

Thursday was quite bad, the seating arrangement seemed to have worked out with the Team Beautiful (TB) members at one end and the 'normal' people at the other. Due to saome people being late due to parking chaos, I was chairing the feedback from the previous week's PBL, which had been on Duchenne Muscular dystrophy and also aspects of genetic counselling of potential parents. The facilitator is an anaesthatist who does obstetric procedures, and she was giving us some non-textbook background as to the options and the factors involved in making decisions to do with genetic counselling, termination etc. The TB people had been talking over, and repeating what the rest of us had been saying at the start of feedback, which really un-nerved me as chairman, and then were having small jokes themselves. Suddenly they all started talking about House, and ignoring the rest of us....then one complained at how long PBL was taking, and started yawning...when they were the ones talking and going down tangents instead of sticking to teh discussion. A couple of other things happened too which made it a very odd PBL, but for sake of preserving their anonymity I can't go into that yet.

It was all quite bizarre, and on the walk to the train station, a few of the 'normal' people in the group were saying how dysfunctional our PBL group is in danger of becoming. Thankfully only another 3 weeks until we reach halfway and are mixed up again into new groups at new hospitals.

First Day back...

I wish it had been like this...........

The first day back after holidays is never fun, especially when everyone else is still on holiday, and the Bank/Public holidays have only just finished (the 2nd January is a Public Holiday / hangover recovery day in Scotland).

But today about 3/4 of us traipsed through freezing gales and blizzards (assuming that snow being blown around = blizzard) up to the hospital. One man had managed to drive his car straight through one of the fences at the side of the hospital internal road system and seemed to be trying to dig it out using the broken fence posts.

Once there we tried to think Medical as we mashed our brains around possible causes of Anaemia, then left after the brainstorm to go and think somewhere warmer.

Flying through term...

Well, it's Wednesday already. Which bizarrely makes me 66% through my Uni week, despite having Tuesday totally free this week (it is the time when my quarter of the year are on Community Clinical Practice).

Monday
Monday was nice - Clinical Practice in Hospital in the morning, followed by our PBL debrief/briefing. I was shattered and slept very badly on Sunday night, so I was on the black coffee - 2 before Uni, one at coffee time and a 4th before PBL. We only examined / history-ed one patient in the hospital, and she was a confused old lady who had broken glasses and had no teeth, and was slightly deaf. We managed to get a fairly good story along the way, covering most of the main points. We missed a few social factors about her home care and family support, but managed ok on the medical bits I think.

Sadly I didn't eat breakfast, so I was full of nice black coffee all day, which probably made me feel worse. I headed back down to Uni to do some printing then met Butcher Boy for lunch.
He'd been working all day, so we both had lunch about 3pm.

Then I headed home to complete some more of my anatomy colouring book, and also to read through today's communication skills scenario's.

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.

One down

First exam was today - this one had:

• 60 EMQs - like a long MCQ - 5 clinical scenarios on one topic and then 15 possible answers at the bottom - match them up. Seemed to go ok, but there were some nasty results interpretation questions.
• 3 Short notes questions - Rheumatoid/Osteoarthritis comparison; Alcohol misuse - communication issues, treatment and chronic effects; Breast Cancer screening & pathology
  
• 2 Modified Essay Questions - the ones which are a bit like a PBL Scenario - Coeliac disease and osteomalacia; Asthma and COPD.

So it looks like tomorrow will focus on Cariology, Renal, Neurology, Psychiatry...or maybe not.

If I was going to revise for the exam, I wouldn't start here

Hmm with less than 48hrs to Exam 1, I started makinga list of teh areas I was worried about

• Bones (Always hated bones)
• Haematology
• ECG
  
• Cariology
• Renal
• GI / Liver
• Respiratory
• Psychiatry
• Neurology
• Ethics
• Antibiotics
• Infectious diseases
• Ethics

So basically the whole curriculum.

Argh!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

Elective update (2)

At last, after firing off lots of emails, I have an offer of an elective, working with an anaesthesia team - it is nearby, and I have met the supervisor when he was a PBL facilitator, The one fly in the drink is that he is on holiday the first 3 weeks of the elective block, so my summer holiday will be split into 3 weeks between SSM and elective, and 2 weeks after, This also means that the Year 3 exam resits are in the last week of my elective!

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 *****************.

Meeting an old-style consultant.

Today we had an old-school consultant for PBL, in fact we will have him until the exams. He wasn't there last week because he hadn't been told that term had started again. He was only free today until 2.30. The session is timetabled for 2-4ish. He swept in at 2.10pm, and spoke for near enough 5 minutes without breathing or interuption to tell us why he wasn't there last week, the fact he to operate somewhere else and had to leave at 2.30, and that the person with him was his Specialist Registrar (SpR) who would finish our PBL session today, but had never taken a PBL tutorial before.

The SpR did not speak while the consultant was in the room, and the consultant called him "Mr ...." and indeed asked that we all address him as "Mr ...." which all seemed a little odd, in these days of first name terms around the NHS.

Even during the PBL briefing, he kept moving us along and saying "Well you would have asked for ...." and "The results for the tests were ..." without giving us time to explore which investigations we wanted, or the chance to interpret the results we were given.

We got through everything, but it was a very unusual PBL, though maybe the first of many.

Frustration

Now I'm not superstitious at all, in fact I think it's a load of bunkum, but yesterday did have a character all of its own.

Firstly, upon arriving at Hospital for PBL, no one arrived to facilitate. No problem we thought and did our feedback. Since most of us have or have seen a bootleg copy of the Fac notes, this wasn't a problem as we covered all we had to on MS. However, although we knew our new Scenario was on Breast cancer, we didn't have the scenario sheet to do a brainstorm or main issues list from. Someone went to see the sub-dean, but he's off on holiday and his secretary had no idea, so session over after 35 minutes.

Later at work, 3 cashiers were posted missing, so muggins got relocated over to help out for 60% of my shifts (thus doing the rest of my work in the remaining 40%). Then at about 7.15, the card machines failed. No card transactions at all were possible. Cash only. Not only have I not handled so much cash through my till in many a year, but customers were ignoring our large signs and having to go to the cashpoint after passing through the checkouts. High stress levels all round.

We also still have no hot water, no working baler and no working pizza oven at work. One day they will be fixed we are assured. Ok so in a food hygiene environment where we prepare food from raw, we have no hot water for cleaning....that has got to break some food regulations......

Time for my next valium I think!