................and those chicken sewing pictures

Initially we made a wound

then started sewing in our aseptic operating theatre
it was an intricate job

some of us did some nice stitches

others need some more practice.

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).

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.

Holiday, what holiday?

As most of the medical faculty wind down slowly towards the easter holiday, which starts tomorrow or Friday, I am preparing for a short weekend off!

You may remember (see here, and here) that the GP Dept had decided that due to a shortage of GP's taking students this year, they would be not giving placements to those of us repeating 3rd year. thus we do not have to attend GPO Community Practice, nor complete the LCP.

However, we still have to sit the OSCE (albeit formatively), and thus in order to give us some refresher training in the examination etc skills for the OSCE, we get to visit a GP practice for 5 2 hour sessions. Due to GP and student availability, the only time we are all free, is Tuesdays and Thursdays over easter.

So my easter break from Uni will be spent partly in GP land doing clinical skills, partly in the Med School doing the same, mostly in the Library/SL trying to notify all my PBL scenarios thus far, and partly house-sitting for a friend (more later).

Oh and hopefully also meeting up with some friends for food or coffee.

Due to the cancellation of tomorrow's PBL session (facilitator on holiday), my easter begins at 12.30 tomorrow, and ends at 5pm on Monday, when I get back from a weekend away.

Clinical teaching

I seem to have reached Tuesday without me realising somehow that the week had started. Anyway. Monday was my usual hospital then PBL day.

We turned up at the hospital in bright sunshine (this becomes important later), and went to the room. No one came down to teach us, so we waited a bit then called the subdeans secretary. She told half of us to go to each of two wards. Two of us went up to the Cardiology, where we met a very friendly FY1 and a stressed out FY2 - the Consultant being in Egypt!

The two of them were doing the ward round on their own, so we followed bits of the ward round and stayed to see 'interesting' patients where there were some.

These included a man who had had a dissection of the aorta, and thought he was having a heart attack because of the pain, but the big teaching hospital had sent him home because his ECG was normal, only for him to re-present with breathing problems and cough 10 days later, and a trans-oesophageal Echo to show he had dissected his aorta. Hew as then rushed in for an emergency valve replacement and aortic surgery.


We also got to examine the visual fields of a man who had a stroke last year, and had a complete loss of vision to his right, although everything else about his eyesight was fine, and he didn't think he'd be a danger on the roads if they gave him his driving licence back. He is one of the many characters in the hospital, and indeed some of them are such good raconteurs they should write a book.

The FY1 was very nice, and invited us to go back whenever we wanted to see patients! They also gave us a good going over of reading ECG's and how to spot which artery is affected, and the patterns of LBBB and RBBB.

By this point the rain was very heavy, and it has continued to pour with rain for the past 30odd hours, including all through my driving lesson, and today the rain was joined by very strong winds. There was much discussion in PBl about how bad the weather was.

Tuesday morning saw a whistle stop tour of the mental state examination and how to do a psychiatric history and examination, in a session lasting 2h30. It was very rushed and a touch stressful, trying to get the concepts and their symptoms clear in your head. I was sat with shermanator, which is goo, because he thinks of lots of questions after most teaching sessions, and in our attempts to answer them for him, it makes you think more about the subject and you can cobble together a good argument - good exam practice, even if we talk in large concepts and not the minutiae that the medical school like in exams!

Tuesday afternoon was supposed to be an FRS on alcohol, but I remember it well from 2007, and since I was feeling crap, nauseous and tired, I came home and had an afternoon nap.

We live in interesting times...

...well not really, but we try.

This week has been fairly mundane at Uni - with some moments of brilliance.

Monday
Our consultant appeared - for the first time in our clinical practice on his ward (this was week 7 - we're there every Monday morning). He was nicer than we had been led to expect, and was more like a registrar in many respects than a consultant. NHSGG&C haven't yet adopted a bare below the elbows policy, but most younger medical staff have lost their ties and are looking decidedly smart/casual these days. Sadly the medical school do not give us the same options.

We went to clerk in and examine 2 patients, then report back to one of the FY2 who was ok, but liked to talk a lot and kept interupting our history's. Neither case was simple, but one was at least alert awake and 'with it'.

PBL in teh afternoon was just boringly normal.

Tuesday
This day started badly - my genetics workshop wasn't til 2, but I had to go to Cambuslang to get my camera from the courier company. In the case of this particular courier company, I know they didn't try my buzzer when they attempted delivery because I know I was in when they claimed to have called. they used to have a depot midway between me and Uni which was handy to go to to collect parcels, but the trip to Cambuslang took me 90 minutes and £4 on the train. i am less than happy at the idea of doing this every time I do an internet order.

At lunch time I met little miss P & the tattooed drinker for food before my workshop. The old work standard watering hole (midway between work and Uni) was closed, so we ventured a little further down to a 'Sports Bar' which opened about 6 months ago in an old snooker hall. butcher Boy and I had been here before and the Lasagne on that occasion was rather tasty.

Today we opted for the 'Homemade burgers'. The barman/waiter came over rafter 10 minutes too apologise for the delay as the chef was making the burgers. This sounded very promising. When they eventually came they were lovely - moist in fact as the tattooed drinker put it - with a great flavour and peppers and herbs running through it. It was the best burger I have tasted in many many a year. Sadly I had to wolf mine down in 5 minutes in order to make it back to uni for my workshop, which was Genetics and fairly straightforward.

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.