End of GP Block

Sorry I haven’t updated in a while. When I last posted I was doing my research project. I’m glad to say that I’ve since finished it and passed it with good marks!

At the beginning of January we started our first specialist clinical placements. My first block was in GP. Last year on clinical placements we weren’t placed on any particular speciality, but instead rotated around lots of different random areas (geriatrics, ortho, paeds, O&G, derm, ophthalmology etc…) and basically had to learn a bit about everything. We did 3 of these 10 week blocks from January until August – the 1^st one to concentrate on history and examination, the 2^nd to focus on diagnosis/investigations and the 3^rd to look at basic management. We also did 1 day a week in a GP surgery. At the time these blocks felt quite unstructured, but I appreciate that they’ve given us a good grounding in basic clinical knowledge. This year however we have 8 speciality rotations, a revision block and then final exams (which take place this time next year – a scary thought!). The order of rotations I have is:

• GP
• Paediatrics
• O&G
• Medical
• Surgical
• Acute
• Psychiatry
• MSK

So basically, by the end of each rotation we need to have enough knowledge in that area required to pass finals. So even though finals are a whole year away, we have to start preparing for them now. We got given a massive list of learning objectives we need to know for finals and it’s pretty scary! Thankfully though, as GP is so broad and covers a bit of most specialities, all of the GP learning objectives are covered again in other blocks, which took the pressure off a bit for this first block. This turned out to be a good thing as GP block had a load of extra pieces of work and sign offs which most blocks didn’t require. Over the 6 week block we had to do a minimum of 18 consultations, 3 OSLERS, 1 assessed case discussion, 1 mini-CEX, a therapeutics presentation, an end of life presentation, film and get feedback (from our tutor and student group) on 2 consultations, multiple SIM sessions with actors pretending to be patients (including breaking bad news where I had to tell a lady she had incurable cancer), 1 piece of written reflection, 1 end of block OSLER in exam conditions and an end of block written exam. Add onto that the fact that the GP surgery I was placed at was a 56 mile round trip, meaning that I had to leave the house at 7:20am and didn’t get home until 6:30pm, and I’m pretty tired by the end of this block!

I have enjoyed the block though. My GP surgery was really well run and everyone was lovely. I feel that I’ve learnt a lot and that I’ve massively improved my consultation skills. For some of our consultations the GP allowed us (myself and my clinical partner – one person doing the consultation, the other observing) to do the consultation independently, and the GP just came in at the end to hear what we’d found and to make sure that they were happy with our diagnosis and treatment. This was rather scary, but also exciting as it meant we were doing actual doctor stuff by ourselves rather than just observing!

This week was our last week of the block. I’m pleased to say that I’ve had everything signed off for the block, and so next week I’ll be starting my paediatrics block. I’m slightly apprehensive as I haven’t done a lot of paeds so far and I’ll have a lot to learn. I’m also getting married this year, so on top of all of my uni work I’m also trying to organise everything for the wedding and our honeymoon!

Report Writing

I'm currently finishing off writing the report for my research project which we had to undertake as part of our SSC2 block. I'm finding it really hard to motivate myself to do it though. I was quite lucky with my project in that it is a pretty straightforward project, my supervisor is really supportive and helpful, and I'm nearly certainly going to get published from it (which is good as it means an extra point for my F1 application). I could also do it from home (some projects required people to go into the hospital or labs), which has meant I've been able to plan my own time, sit in my office with the cat, and drink tea whenever I want to. So in the majority of ways I've been pretty lucky, but the one downside is that my project is really boring. Like I tell people about it and their response is "oh, that doesn't sound very interesting", and it's not. I'm finding myself longing for the time of learning clinical medicine, and yesterday I even revised knee anatomy as a way of procrastination. This project wasn't my first choice (we had to rank about 30 projects and then we got assigned to one of them), and I'm looking forwards to getting it finished and out of the way. The deadline for handing it in isn't until 5th December, but our allocated time for the project is ending and we're back in lectures/hospital next week (something I'm actually excited about!). I'm aiming to finish my first draft to send to my supervisor for Monday which will then give me time to make changes and submit it in plenty of time. So I really need to get on and finish it!

It's really cold today and there's still frost on the roofs. I've got the heating on and the cat's currently asleep in my office with me, pressed up against the wall below the radiator. She's so so fluffy, so if even she's cold it must be cold! It's not helping with my motivation, instead of sitting in my office I'd much rather be curled up on the sofa with a blanket and a cup of tea, watching TV or reading a book!

A long overdue update

Sorry I haven't posted on here for so long, I didn't feel much like blogging for a while. I didn’t pass the 2^nd year resit exam, which was really shitty. And it was made worse by the fact that I only just didn’t have the marks to pass.

After the results day I was in a unique situation due to fairly big changes to the structure of the course, which had been made for the year below me. Normally it would have been a simple case of repeating the year. The exam board clearly stated that they thought I was capable and should be allowed to resit the year due to my mitigating circumstances. One other person wasn’t so lucky and after failing the exam she had no option but to leave the course. However, the changes to the course meant that there were no Christmas exams in 2^nd year any more, just big exams at the end of first year (which mostly include everything that was previously examined in first year and the 2^nd year Christmas exams on the old course), and then the next set of exams aren’t until the beginning of third year. I had several meetings with the head of the medical school and they kept me waiting for almost a month whilst they decided what to do with me. In the end the medical school decided that it would be unfair of them to put me back in with the year below as that would mean I would have to sit their end of 1^st year exam. By this point it was February and the exams were in May, and the medical school thought that that wasn’t enough time for me to be prepared for the exams and that it would just be “setting me up to fail”. This meant that my only option was to restart first year in September, effectively dropping me back 2 whole years, which was pretty rubbish to say the least. The only comfort was that by way of recognition of it being so shit making me restart the course from the beginning, the uni waived my fees for my repeat first year so I didn’t have to pay anything/no tuition loan for that year.

I had about 8 months out away from uni before starting the course again in September 2014. It was quite nice to have a break from Medicine and the intense studying for a while. I worked a lot of locum pharmacist shifts and managed to save quite a bit of money.

So I started the course again in September with the first years. It wasn’t much fun. I felt like a bit of a fraud being with all the new students when I’d already completed first year previously. At first I was fairly open with people and told them about my situation, but after a couple of unpleasant responses from people (including one girl who immediately turned round and told everyone else around her “Did you hear that, this girl failed and has to start again haha”) I now only tell people if it comes up or if they ask. I got through first year though, made new friends and passed the exams pretty well.

I worked a lot during the summer holiday between first and second year, and combined with the money I’d earned on my time out from the course my partner and I were able to buy our first house last year! My boyfriend also asked me to marry him that summer (I said yes!), and during first year we also got a cat J. I feel in a much better position now than I did previously, and a lot of that is due to the time out from the course when I was able to work. We’re in a much better position financially, which makes things a lot easier as I’m not constantly stressing about money and working all the time like I did previously. This house (which we now own) is also much nicer and warmer, and the mortgage is actually cheaper than what we were paying in rent for a much worse house! So that’s one good thing that’s come from repeating the year.

Second year was fairly enjoyable. In the first term we mostly had lectures that built on year 1 work with more of a clinical emphasis. After Christmas we were then based in the hospital for the majority of the time. We weren’t on specific specialist placements, but instead we went around different areas of the hospital, and one day a week at GP, building up our clinical knowledge and skills and getting used to learning in a clinical environment. It’s difficult at times, especially when you have a disinterested consultant and just feel in the way a lot of the time, but I still really enjoy being in the hospital, opposed to sat in lectures, and feel that I’ve learnt a lot this year.

I worked really hard for the exams we just had in September. We had a few weeks “summer holiday” off before the exams but I just used it as revision time. I was really happy with my exam results. I got 79% on the SAQ (short answer questions) exam (pass mark 67%(which was really high, normally it’s around 60%!)) and 72% on the MCQ (multiple choice questions) exam (pass mark 62%). I also passed 15/15 OSCE stations (pass mark 11/15 stations). I don’t know what decile I am as they haven’t released the decile information yet as the resit exam results are only being released today.

I feel in a much better place now than if I had scraped through the exams back in 2014. I feel like I know a lot more, I’m passing everything comfortably and I can hold my own when being quizzed by consultants on the ward. So although it was rubbish having to start again at the time, now I think that it was probably for the best.

I was a bit sad seeing my original year graduating earlier this year and all the “I’m a Dr” posts on facebook. But then I found out that a high amount of people didn’t pass the exams. 14 people are needing to retake the year and 5 people aren’t even being allowed to re-take the year and they’re just out, after 4 years work with nothing to show for it. I’m pretty certain that had I just scraped through the exam I failed, that could have easily been me, so I’m very glad that I got the fresh start and feel like I’m doing pretty well currently, not just scraping by.

So now I’m officially a third year medical student. I’m over half way through the course. I’m currently finishing off my research project, and then we’re going back into the clinical environment, which I’m looking forwards to. We have 3 week’s worth of consolidation lectures and some time in the hospital, and then after Christmas we start our proper specialist clinical placements. I’m getting there, slowly!

A bit more optimism

Apologies for the outpouring of self pity the other day. I've perked myself up and accepted that whatever will happen, will happen and there's no point moping about it. I've pretty much come to terms with the fact that I could be resetting the year, so if I do pass it'll be a pleasant surprise, but if I don't hopefully I won't be too disappointed, although it would suck a lot.

I'm currently working another 15 hour locum shift today. It's been pretty busy up until now so it's nice to have a bit of quiet time. If I do pass the exams, then I've found out that my first proper clinical rotation will be in Orthopaedics and Anaesthetics. We have a 3 week community learning placement and then we go straight into proper rotations. Orthopaedics is probably my most dreaded speciality, probably because I don't have a massive interest in it, and MSK is my worst topic. If I knew that I'd passed exams I could be revising in preparation for it now, but I can't help but think that I'll be jinxing myself if I did now, so I'm refraining. I really wish that I have passed the exam as I'm so looking forwards to the time where I can go into the hospitals instead of lectures. Going back to lectures and group work full time again will be so hard.

As an aside, why do people leave it until 10pm on a Saturday to take action after running out of their prescription? Last Saturday at 10.30pm we had a flurry of people coming from the GP on call centre awaiting faxes of their regular prescription to be sent over. Except that the fax machine was broken, but as the patients all kicked up a fuss about needing their medication tonight, I had to try to contact all the different on call GP's to organise emergency supplies. If their medication is so important, why didn't they order it a week ago when they saw they were nearing the end of their supply, or even ask the Pharmacy to sort it for them on the Friday, or even come in on Saturday day time. Most of the medications were things that the patients took in the morning, so why didn't they take action on the Saturday morning, when we may have been able to get a script from their GP? Why Saturday night at 10.30pm????? It reminds me of when my sister (who's a nurse in A&E) had a patient call up an ambulance on a Friday evening and came into A&E by said ambulance because they'd run out of their regular medication..... Patients drive me crazy sometimes.

Giving up

I feel like a bit of a train wreck at the moment. As you might of guessed from my recent silence, I didn’t pass the exam. I did well in the OSCE, but failed the written, not by much but still a fail. Despite spending my whole Christmas holiday revising (new low – revision on Christmas day), I’m not confident that I’ve passed the re-sit exam either.

Today was our first day back at uni. We had an induction day in preparation for the clinical phase we’re about to enter. Except, I might not be allowed to enter the clinical phase but as we don’t get results until next week, I still have to attend the induction. The day also involved everyone asking how the exams went and our group supervisor greeting us with “congratulations everyone on passing the exams, except for anyone who didn’t’”. Pretty much just constant reminders of my failure, so today was pretty rubbish.

If I have to re-sit the year, I really don’t know if I’ve got it in me to do so. I really just feel like quitting everything right now, not just medicine but the world, and refusing to leave my bed and self-destructing. I would resit the year obviously as Medicine is the only thing I want to do but the thought of going back a year is completely soul destroying. I genuinely worked so hard last term, and yet other people passed no problem, so what’s wrong with me? Why are my brains so shit?

I’m also exhausted from a hard 15 hour locum shift I did at the weekend, and idiotically I’ve agreed to do a 15 hour shift every weekend bar two until the end of March. But, I’m poor so I don’t really have much choice.

Sorry for this torrent of self-pity. I’m just really tired and demoralised and needed to have a rant. I'll get over it, but I just need to mope for a while.

Exam Review - Written Exams

Our medical exams are weird. We sit 2 written papers, each containing 10 questions (with each question having 20 marks). The pass grade of the papers is based on how many questions you pass rather than your overall percentage, and across the 2 papers we have to pass approximately 13 questions to pass the exam overall. Each question has a variable pass mark (ranging from 10-13 out of 20) based on the difficultly of the question. As you can imagine, this makes gauging your performance on an exam extremely difficult – you could have a really high percentage, but due to the spread of the marks still fail the exam, or vice versa.

I found these papers easier than my first attempt of the summer exams, but that’s not saying much considering I had to retake that paper. Many people said Tuesday's paper was more difficult than Monday's paper, but I thought it was the other way around. I guess it just depends on what bits you’ve revised well! In the exam I estimated that I’d got about 9-13 marks out of 20 on every question, with a few higher, a few lower, but looking back on the exam I think that I’ve done worse than I initially thought (although I do have a tendency to concentrate on the answers I know I’ve got wrong and forget about all the answers I did answer correctly). There’s a chance that I could pass the exam, but I’ve resigned myself to the fact that I’ll be resitting. It’s not the end of the world, but it would be nice to pass…

There were some silly questions on the paper, which annoyed me. Eg. there was a question on the gate theory of pain which we were told in lectures was an out-dated theory and that it wouldn’t come up in the exam. There were also a lot of social science questions which were really ambiguously phased so you didn’t know which exact module the question was from which made them hard to answer. I put logical answers down, but whether they corresponded with the exact lecture slide points (and therefore, whether I get any points or not) is unlikely. Sometimes it just feels like exams are just lots of rote learning and jumping through hoops rather than displaying our understanding and knowledge of the subject matter, but I guess that’s the nature of most exams. It's still annoying though!

If I pass these exams then I get to go onto the clinical phase of the course after Christmas, which I’m really looking forwards to! This involves being mainly based out on placement doing rotations in different areas of the hospital or with GPs, learning on the wards and actually doing things rather than being sat in a lecture theatre. I know that the science basis is important, but this is what I joined medical school for and the job I want to do, and being sat in lectures/group work full time can get pretty boring! I really hope that I pass these exams. I’m trying not to get too excited about going into the clinical environment because to fail exams (and the re-sits), and having to go through this year (or possible back to the beginning) again would be so de-moralising.

Since the exams I haven’t really had much recovery time. After the last exam everyone else went out drinking, but I had to get a train back home as I was working a long shift the next day. In the last few days I’ve worked 2 locum shifts, done Christmas shopping (which I couldn’t ignore anymore after exams) and helped my sister with decorating her flat. Tomorrow I’m visiting my gran to help her de-clutter her house, but hopefully on Monday I’ll be able to have a proper chill day and a lie-in! I'm looking forwards to it.

Exam Review - OSCEs

My exams are finally over! My OSCE was on Thursday and the two written exams were on Monday and Tuesday. I’m locuming in the really quiet pharmacy until 11pm again tonight so I thought I’d write up a review on the exams whilst it’s still fresh in my mind, starting with the OSCEs.

Considering that I got an Excellent (>75% on every station) in the summer OSCEs, I thought that these OSCEs were going to be a walk in the park, but they weren’t. It didn’t help that we only had 2 weeks exam revision leave, and the OSCEs were timetabled before the written exams, so trying to balance OSCE and written exam revision was difficult. They gave us 3 anatomy stations, which I didn’t like as being grilled on anatomy isn’t my favourite thing, plus I thought OSCEs were supposed to be for testing practical skills rather than just asking us anatomy questions or pointing to muscles on models! The stations were as follows:

Cranial Nerves II-VI – 5 minute station

This was the first station and I was really nervous. I think I could have done slightly better, but I think that I did ok and I could answer the questions.

Clinical Anatomy - CVS Surface Anatomy – 5 minute station

I’m pretty certain that I’ve failed this station. The examiner phased his questions weirdly and kept skipping backwards and forwards through questions which got me confused and in a muddle. Consequently, I ran out of time to answer all the questions.

Clinical History Taking - Respiratory – 10 minute station

This one was fine. I feel like I’m pretty good at history taking and I couldn’t remember anything I’d forgotten to ask about afterwards.

Abdominal Examination – 5 minute station

This station was also fine. It was just a regular abdo examination. I was an idiot and went straight from patient details, consent etc to palpation, skipping out inspection, but half way through I remembered and asked the examiner if I could do it then and he let me thankfully!

Clinical History Taking - Male Urinary – 10 minute station

This history was slightly harder than the respiratory history as you had to include a sexual history in it, but I’m happy that I asked all the important questions and I had just said “thank you” and “any questions?” to the patient when the buzzer went – perfect timing!

Clinical Anatomy - Spinal Column – 5 minute station

This station was fine. The examiner was this lovely old man who filled out the marking sheet in front of my eyes so I know that there was only 2 questions which I got wrong out of quite a lot so I’m pretty certain that I’ve passed that station. The questions were mainly about features of the spine and the vertebrae and naming different things.

Clinical Anatomy - Lower Limb & Hip Joint – 5 minute station

This station was a bad one. My mind just went blank on some of the questions and I just couldn’t remember the name of some things. Additionally, the model they used to test us on the location of different muscles and nerves looked a bit different than the images I’ve used to revise lower limb, which also threw me slightly. We also had to demonstrate a Trendelberg's test and a Thomas's test which I think I did ok.

Focussed History Knee Pain – 5 minute station

This station wasn’t difficult, apart from the fact that despite being called a focused knee pain history, we actually had to complete a full history, but in 5 minutes which meant that timing was very rushed. I managed to ask everything apart from the ever important ICE (ideas, concerns and expectations). In retrospect I should have asked ICE sooner in the consultation and missed out some parts of social history instead, but in my normal history taking format I always like to methodically work through questions and ask ICE last so that’s just what I did for this station. Oh well, I think I’ll have still passed, especially as everyone I've spoken to didn't complete this station in time either.

Thyroid Gland Examination – 5 minute station

This station wasn’t difficult but I’ve still got a suspicion that I may have failed this station. We didn’t have to do a full thyroid examination, just the thyroid gland itself and the lymph nodes, and then answer a few questions. I’m not sure why I think I’ve failed this station as I think I included everything and could answer the questions, but I just have a feeling.

Respiratory Examination Chest – 5 minute station

This station was ok. We only had to do an anterior chest examination, which I think I did fine, but I then didn’t say what extras I would do (eg. check for oedema, spirometry etc) as I didn’t even think about it as we were just told to do an anterior chest exam, but in retrospect I think that I should probably have included it. We then had to answer some questions and percuss a box and describe the sound. I think I did ok on this bit, but there were some bits I didn’t explain very well.

We can fail up to 3 stations and still pass the exam. Overall I think it went ok, and I think that I’ve probably passed, but I’m not 100% confident.

Now that exams are over, I don’t really know what to do with myself! I keep feeling guilty and thinking that I should be doing revision. Why is it that the internet and everything else is so interesting during revision period, but now that I don’t have other things to do, they’ve lost all their interest? Buzzfeed’s 30 Greatest Animal Photobombs of 2013 and the like just aren’t as entertaining now…