My First Real Patient!

This week was the first of my clinical skills sessions in the hospital. Along with 3 other students, I’ve been assigned to a consultant who will act as our tutor for the rest of the term. I thought that the first week would just be induction – health and safety and what not, but after a brief induction and then an overview of general examination with my tutor, our group were taken to the ward! Only two of us were able to practice the examination on a patient, but as I ended up being stood closest to the first patient we went to, I got to have a go first! It was quite nerve wracking. The patient was this really sweet elderly lady who was still working, despite being nearly 20 years past retirement age! I’m fairly confident at carrying out a general examination on a stimulated patient, but doing it on a real patient was very different. First of all, she was sat in a chair next to her bed in a cramped space which made it a bit difficult, but she also seemed pretty frail so I was really cautious when doing things like palpating her lymph nodes, as I didn’t want to hurt her. The patient was really lovely and friendly which I appreciated. I think it’d be very difficult for medical students to learn if all patients were reluctant to have medical students practice on them. Being on the ward and talking to real patients made me feel a lot more like a medical student than I did last term.

Other than that, there’s not much to report. Our timetable is definitely busier this term, but I’m really enjoying most of the modules and I feel like I’m learning a lot. Like most people in the UK, we’ve had quite a bit of snow over the last week around here. On Friday we had lectures at the hospital all day and by the time we’d finished there was so much snow that the buses were cancelled which was a pain, but thankfully my boyfriend was able to come pick me up as it would have been a long walk otherwise!

The snow in my back garden! It got even thicker than this the next day as well! (photo taken by me)

Apparently we get our exam results back next week. I’m impatient for them, but also pretty nervous! (at first I spelt impatient as inpatient and couldn’t remember how it was actually meant to be spelt…)

Exam 2

Exam number 2 went far better than my first exam. The questions were on things I knew about, and the few questions I wasn’t too sure about, I felt that I at least could put down a sensible answer. I don’t know why this exam went so much better than my first exam; maybe I just got lucky with the questions or maybe the extra day and a half’s revision actually made a difference. For this second exam, I actually felt as though I might have passed all 4 questions on the exam, which would mean that I might actually pass the exam! I would love for this to happen, but I’m not getting my hopes up as I’m not sure how picky they’re going to be with their marking.

I came out of the second exam pretty happy, thinking that the second paper was far nicer than the first, but most of the people I spoke to afterwards seemed to think the exact opposite! I think it might be because the majority of the people on my course seem to have some sort of Bioscience degree, and therefore find the bioscience molecular questions pretty easy, of which there were more on the first paper than on the second. I’m the opposite however, my degree involved a minimal amount of bioscience, and in much less detail than we’re covering now, and therefore I find the bioscience questions the hardest. The bioscience people seem to have a slight advantage at the moment, but I’m hoping that come the clinical years and our pharmacology module, my degree will be of benefit!

I’m currently typing this on the train. I went home for the weekend to do a locum shift today. It was quite a nice shift, not too busy but not too quiet, but there were a few things I found a bit more difficult. I had several people requesting my advice about various ailments, including two mothers with young children. One of the children had what appeared to be conjunctivitis, and the other had come out in a horrible rash with no obvious cause. I think I gave sensible advice about treatments and made sure to tell the mothers to go to the doctors if things didn’t improve/symptoms got worse or certain symptoms appeared, but giving advice is still really stressful, especially with young children who can decline really quickly. I realise that this is pretty much what being a doctor entails, but I’m hoping that with practice comes confidence.

The first day of second term is tomorrow. I think it’ll mostly just be introductory stuff to our new modules, but I’m looking forwards to it. Some of the modules that we’re doing this term look really interesting (and difficult..) and I’m excited to start them J

Exam

So. The exam.

Bleurgh.

I (and others) think parts of the paper were pretty difficult, but I'm also kicking myself for not being at the required standard. I've realised that the way I revised for these exams doesn't work. I wish I'd realised this earlier, I should have done considering how much the med school have gone on about it.

These exams are different from my undergraduate exams, in that the papers are integrated, so that the separate modules aren't examined separately = cramming doesn't work. My problem is though, that I really struggle to learn large quantities of material. I did a lot of revision before Christmas, but come this week most of it had disappeared from my brain and I had to try to re-learn it all. I definitely know that next term I need to make revision notes and learn the material week by week. There were 4 questions of several parts, each worth 20 marks. You have to get approx 12/20 to pass each question, and to pass the exams you have to get 5/8 questions right (out of today's exam and my next exam). The first question was nice (and lulled me into a false sense of security), but after that the exam went downhill. On the next 3 questions I could answer parts of each question, but there were also sections were I struggled to write anything sensible at all. I'm pretty sure that I've passed the first question and failed one question. I'm hoping that I may have scraped a pass on the other 2 questions, but I'm worried that I'm deluding myself.

I think I'm being quite hard on myself, as other people seem to have found the paper the same as myself and don't seem to be overly stressed about the possibility of not passing, but in my mind I think that maybe they're just being modest and they'll still scrape a pass. I'm a perfectionist and really don't like not doing well on things. If you fail you also have to go in front of a group of people from the med school to get grilled about why you didn't do very well, and apparently this isn't very pleasant.

I guess the point of these formatives are to kick you up the ass (and boy, it's worked) and to show you what works revision wise, but I just can't stop feeling shitty about them, and myself, right now. I guess I'll just have to try to put this exam past me and concentrate on my next exam on Thursday.

Exam stresses

I'm really stressing out about my written exams right now. The information isn't that difficult, but I'm just struggling with the amount I need to remember. As soon as I memorise one piece of information, I forget something else which I memorised half an hour earlier. Argh. Why can't I have a photographic memory? I'm pretty cross at myself for not starting proper revision earlier. I'm definitely not going repeat this mistake for my next exams. I'm just trying to remember that these exams are only formative, if I fail them, the worst thing will be the embarrassment, I won't get chucked out of med school.

I always get really stressed during exam season and my health often seems to suffer. I often get colds and migraines before exams, and on several occasions in the past I've come down with bad tonsillitis. These exams are no different. I'm feeling pretty run down at the moment and last night I got a migraine which restricted me to bed in a dark room all yesterday evening, and having one evening's revision taken away from me really didn't help with the exam nerves. Gah. At least they'll be over soon. Good luck to anyone else undertaking exams at the moment!

OSCEs and review of 2012

Happy New Year! I had a really good New Year's Eve. I went to a party with my boyfriend at the house of one of his family friend's. They'd obviously gone to a lot of effort decorating their house, it looked really pretty and there was copious champagne and other drinks and some awesome fireworks at midnight. I had a really good time, but I didn't drink too much and went back to my boyfriend's mum's house to sleep at 2am (much earlier than anyone else at the party), because I had my first OSCE exam on the 2nd and I wanted to spend New Year's day revising. Despite my good intentions though, I woke up on New Year's day very hungover! I didn't even drink that much, it was so not fair! I did get some revision done, but the morning of my OSCEs came and I still didn't feel fully prepared. I think I'm normally quite good at the practical skills, but because I didn't have a chance to fully practice and go over all the questions they could ask me I went into them really nervous and stressed, which I think affected my performance on the day.

I don't think that I failed my OSCEs, but I definitely didn't do as well as I know I'm capable of. There were 6 stations; history taking, abdominal examination, general examination, taking BP and BMI, CPR and searching a medical database. I think that 3 went well, 1 ok, and 2 not so well. I had the medical database searching station first and I just messed it up. The search itself went ok (not perfect though), but when the examiner was asking me questions my mind just went totally blank and I couldn't answer half of the questions even though they were things I knew.  I felt like such an idiot sat there going "I'm really sorry I don't know" and the examiner just sat staring at me. The other one which didn't go so well was the general examination. I thought that it had gone well and I did all the things that we were taught to do in our clinical skills sessions, but the examiner gave me loads of negative feedback. He scored me a 0 on examination of the hands, even though I checked for everything accept for arthritis pain (which we've never been taught to do, and the actor pretending to be a patient was younger than I am). I could see the mark sheet and he also gave me a 0 for radial pulse check even though I did this and I told him I was doing it in my running commentary. I really don't know what I did wrong, and I couldn't ask him because we're not really meant to see our mark sheets (even though he lay it right in front of me). Despite his negative feedback, I only got 0's on 3 of the marking points out of a whole page of marking points (you can only get either 0 or 1), but then I saw that he judged me as being borderline (unsatisfactory, borderline, satisfactory and excellent available), so I'm really confused about that station. I thought that my abdominal examination went worse than my general examination, but that examiner said that he was struggling to give me any negative feedback and scored me as excellent! I also didn't think that my CPR station went brilliantly, but again I got really good feedback, and after I'd got my feedback and we had time to spare, the examiner asked about my background and when he found out that I was a Pharmacist he asked my advice about how to get stock items of some drugs. It was so surreal having the examiner asking me for advice during an exam! All in all, I don't think that I've failed my OSCEs, but I don't think I've done brilliantly in them. I think that now I've got a bit more experience of how OSCEs work and how to go about doing them I'll be less nervous for the next ones however, and hopefully do better.

My written exams are next week. I'm starting to panic about them slightly and just how much information I still have to learn. I really want to do well in them, but at the moment I think I'll be happy just to pass. I heard someone say the other day "what do you call the person at the bottom of the class at med school graduation?", and the answer was "doctor". Which is true I guess. The most important thing is just to pass.

In happier news: I got a Macbook Air 13"!!!!! It's my new baby. It's so shiney and pretty! It's also incredibly light, it doesn't make any noise whatsoever and it works so so fast!

(photo taken by me)

My Review of 2012

A lot has happened over this past year.  A year ago I was working in a London hospital as a pre-reg pharmacist, and I was pretty unhappy in this job. I had applied to medical school and made the (what seemed at the time) risky decision not to apply for any Band 6 Pharmacist jobs. Thankfully I got offered 2 places at medical schools, 1 of which I accepted. In May I went to Paris with my boyfriend and had an amazing time, that's one of my best memories of the past year. 

Eiffel Tower! So pretty (photo taken by me)

In the summer I passed my pre-reg exam and became a fully qualified Pharmacist (I really thought that I'd failed that exam!). Myself and my boyfriend uprooted our lives and moved away from London and our beautiful apartment to a new flat and a new town. I started medical school and my boyfriend started a new job (which he's finally settled down into). The last few months have flown by and I have now completed my first term at medical school. It still seems alien to introduce myself as a medical student, but I'm slowly getting used to it. We've had our first patient contact and I'm slowly gaining competence in the basic medical skills such as venepuncture and taking BP. I still find medical school incredibly exciting and I'm very grateful that I'm at this place in my life. In the last few weeks I've worked my first shifts as a Pharmacist, which were incredibly scary, especially when people asked to speak to the Pharmacist (me?!) for advice. But again, I'm slowly starting to feel more competent and confident in this role, and glad to be finally earning some money. In November my cat Daisy died. She was more than just a pet to me, and literally the most intelligent, best cat in the world, and my family home seems incredibly empty and lonely without her. Recently one of my other cat's Jasper was also seriously ill, but thankfully after an operation he's much better now. To end the year, I had an amazing Christmas and New Year at home with my family, my boyfriend, and his family and received far more presents than I felt I deserved! In the last few weeks I've also finally learnt (after years of trying) how to bake good, just gooey enough brownies!

My new year's resolutions

1. I really wish that this last term I'd reviewed and made revision notes of all my lectures week by week. I can really see the importance of this now! Next term is more full on than this term, so I'm going to consciously make a big effort to try and keep on top of this, and I think that now I've got my Macbook, which I'll be taking to uni, it'll be easier to do as I'll be able to make notes in down time inbetween lectures.

2. Get fit and lose weight! I know that pretty much everyone pledges to do this, but this is something I've been meaning to do for a while so I'm going to make a proper effort to get into shape. I worked out my BMI yesterday and it's only 21.5, but over the last year I have put on a bit of weight and some of my clothes don't fit so well any more, so I just want to lose that little bit of weight and tone up. I also think it's important not to be hypocritical as a medical profession, telling people to exercise more and lose weight, if doctors don't follow their own advice.

3. I want to get my finances in order! Pay off my credit card and start saving money. Now that I'm getting locum Pharmacist work this should be pretty achievable, especially if I manage to get a lot of work over my summer holidays.