January Exams

January Examinations are over.

75 SBAs - Tuesday 5th January

75 questions on our entire medical clinical year curriculum so far. Some of the questions were really tough and even after a post-mortem discussion with housemates, didn't really seem much clearer.

I do feel I have recognised a couple areas of weakness - liver and kidneys. As much as I prided myself on learning haematology and endocrinology to weird and wonderful complexity, this exam was really focused on common management considerations.

2 OSCEs - Tuesday 12th January

After all the preparation on patient histories and examinations, it was two communication stations. One largely preparable on 'risks and benefits of AAAs' and the other a 'diabetic medication review.'

AAA station went largely to plan. Misheard the patient during one explanation but clarified it with a dose of ICE. Newcastle and proud. Viva questioning featured one curve-ball of 'how do we assess frailty?'

DM station was tougher. The temptation to avoid a full medical history was avoided by a mixture of supportive life discussion and elements of motivational interviewing before a brief discussion on medical therapies. I did not quite manage to complete succinctly within time. Viva questioning featured 

On reflection, empathy and good bedside manner probably helped but I could have definitely could have structured my consultations based on ICE and then focusing my lines of questioning, instead of trying to fulfill the written OSCE objective first. I also could have ended both consultations by asking the patients to repeat back to me what they'd to make sure it had been understood.

Overall a great learning experience in fulfilling the objective and tickboxes required of you in this station - structured ICE, clear chunk and checking and knowing relevant statistics. There are no simpler ways to demonstrating competence than by showing an understanding of taught communication basics.

Blogs, Projects, HLA and Principles of Learning

I don't think I've commented on what inspired me to make this blog.

Blog

But it was a blog called 'Grumpy Biomed' - diary of a quintessential Biomedical Science student dreaming of studying medicine. He also flirted with the idea of postgraduate degrees but eventually got into Warwick for the 2011/12 Academic Year. Around this time, there really wasn't anyone else who chronicled their feelings so regularly, beautifully and so relateably.

The blog has since sadly been deleted and his follow-up medical school blog has gone too. Until I came across Paeds Registrar who has just been awarded a Paeds Oncology Training Post. She has chronicled all her stories back to the penultimate year of medical school. She also did a Biomedical Science Degree. And boy, has her blog got me excited to start writing again.

Projects

I got the HLA Scholarship! Since then, my project on 'better understanding how prepared future doctors are to work with AI' picked up one of the Best Poster Prizes at the November Conference. I actually thought I missed the deadline to submit but it was a delightful surprise and a great boost of energy to continue to build my project. Lots of exciting themes to come soon - Surveys, Journal Clubs, Virtual Electives and hopefully an article that might be published one day!

Why you should join the HLA? - I'm not paid to say this - its just really good.

So many incredible people exist within this organisation - high output academics, publically vocal juniors and healthcare professioanls across seemingly every specialty and subspecialty. It is a really rich source of human talent. The educational sessions are unbelievably inspiring. They will give feedback on exactly how they see it, there's no veil of politeness, this is what you could have done.The opportunities within this organisation are plentiful. As one scholar once said, once you're part of the HLA, you never really leave. It certainly does seem true.

Principles of Learning

One of the other things the HLA has helped me appreciate is people's perspectives. How people think on the reverse or blind-side?

Reverse: Say you're trying to implement a campaign advocating for structured breaks in junior doctor shifts? We all agree it should occur but why does it not occur? Okay, there are issues beyond our control and even if mandated, why would we not take breaks? So the bigger question is how do we encourage breaks? This series of repeated questions of why turns eventually into a how - how can we improve.

Blind: Say you've got a junior doctor ward who are always busy and seemingly stressed. How can you improve their lives? Is it because they're short-staffed? Is it because there are too few nurses? Is it because they are unprepared? If it is because they're short-staffed? Why is this occuring? How can we improve this? What could be our plan? In this case, the solution is not obvious but be can help our cause by asking lots of follow-up questions and deducing a key question.

I think one thing I've learnt this term, particularly when at revision sessions for Finals, is taking things back to first principles 1) identifying assumptions 2) breaking down the problem 3) creating new solutions.

e.g. do Medical Students need to know about Coding skills?

1) Wait why would they even need to know?

2) Personal projects, research projects, they will not be troubleshooting big organisational software programmes.

3) How can we encourage positive uptake of coding skills as means of encouraging students to further their interest in particular careers e.g. oncology?

Interview

This morning had my HLA Scholar Interview. Barely got my application off - saved by a timezone switch to GMT.

"What are you on about?" to paraphrase my father. Ah so, this is an opportunity to work with the Healthcare Leadership Academy. An organisation keen on training skills in leadership, project management and networking amongst healthcare professionals. Dr Johann Malawana, a obstetrician, previous junior doctor representative and now social entrepreneur is responsible for the organisation. He's certainly heard his fair share of bullshit over the years but was he ready for mine?

Before I summarise my dialogue, this was an unbelievably tough interview and I absolutely did not sound as eloquent as when I wrote this up.

What evidence of leadership have you had before? 

Led an Undergraduate Academic Medicine Society. 

Yes, but how did this make you a better leader?

Recruiting a young and enthusiastic committee the summe before, placing them in positions of strength and hosting a record amount of events.

Okay, but what did you learn?

The importance of reflection and effective delegation.

What would be the one criticism you have of yourself - do not say being overly meticulous?

I can be overly conscientous.

Thats a bit like saying you are meticulous? 

Well, I have a tendency to want to perform in all activities whether that be providing refreshments at a conference to organising logistics to building social media campaigns. I learnt to delegate more effectively. 

15 minutes were over in a flash. As I walked off to Sainsbury's in an utter daze after such a grilling, I reminded myelf that I have built a project already - live survey and a website - DoctorX.co.uk. Irrespective of the outcome, I will build this project and prove that I can thrive in absence of formal networking and mentorship programmes.

I absolutely did not expect the level and depth of these follow-up questions. It seems that my lack of preparation for these types of questions could be rooted in possibly not speaking to previous applicants i.e. doing some networking and having that initiative already. Both great lessons for the future.

And we'll wait for the outcome - very unhopeful after such a grilling.

At Halftime

12th April 2020

Yesterday was my 25th birthday. Yep, 25 years on Earth - or a quarter of my life already up as my parents put it. Its a pretty good time to be at home. Spring has arrived. Sun is out. Plenty of chocolate in the house. It's also halftime for the degree. Lots of exciting things to look back on and build towards.

- Led the Academic Medicine Society in my Second Year
- Summer Research Project in the Institute of Cancer Research at Newcastle University
- StaffBank Shifts at Epsom & St Helier.

Three exceptional opportunities that I've been able to carry on and build upon from previous university experiences. But what haven't I done?

- Reached Top 10%
- Published.

So there's the real question that matters. What matters to you most and what matters most to you now. We can spend time + look at patterns of how others have built their careers and sit in admiration and think about what we should do. But what matters to you is personal, might be original and in my mind. Everything else on leading societies / further summer research / healthcare assistant work have roles to play too: But let's be clear before we dig deeper - aka the need to further build upon what we've done.

Set some clear goals above your desk - just two sentences. What do you want to do with your time now? Just two years left at university. Make the most of it.

What Will It Take

Monday 24th March

Day 1 of Lockdown has arrived.

All non-essential shops have no closed. My laptop battery + FIFA 20 video game are in the post! Will they arrive?

The seriousness of

....
....the situation is becoming clear.
Summer Research
A week ago last Wednesday, I was rejected from my ICR Summer Research Project. The reason? Ultimately, this time we decided to go for another candidate that has already experience on the topic that we will be working on.

That ends my third ICR application in three years. This time to an interview. An improvement but experience is lacking. Perhaps a more clear demonstration of my experience? How does that translate to working on future projects? Definitely felt an awkward interview. Embracing that awkwardness has also been a challenge in recent days.

Healthcare Assistant

A week ago last Thursday, I was given a conditional offer to work as a Healthcare Assistant in A&E at St Peter's Hospital. There were no 'well dones,' or 'congratulations' from family members. The big challenge is Covid-19.

Since lockdown, deaths have risen. Certain people are at risk. None more so than a 56 year old father with Type 2 Diabetes of South Asian descent.

After a third family huddle, it has become clear that I cannot work from home. Precautions and checklists were great but media-provoked and insider-acknowledged fears are clear. Lack of testing. Lack of PPE. Lack of guidance. The decision is currently final. I cannot work from home. I felt prepared to handle this huddle. The prior huddle was sprung upon me whilst I was playing FIFA 20 -a dreadful game that I recommend no one to go through the pain of playing. It really does take clarity of mind to handle challenging conversations. You simply cannot rehearse a speech to handle this. This is not a press conference or a news bulletin. This is as real as it gets.

What will it take for me to work in clinical practice currently? Arriving home to spend time with family cannot seemingly blend well with being able to commit yourself clinically. This is a sticky reality.

In the meantime I've applied for an HLA Scholarship (last minute thanks to BST timezones with lots of supportive advice from the sister), begun to research epidemiological models and loosely done some background revision. There is more to do outside of clinical practice. Just not having the option to do so is very, very tough. For now, I've enquired about a reduction in rent to enable me to live outside from home. Speculative and hopeful. We will just have to wait.

Never Surrender

Sunday 15th March

It is freezing. I can hear students walking in the street. Birds are chirping. Yep, I woke up in my car this morning. Halfway Ball was not very memorable funnily enough. The mother's plan for lots of photos to be taken - may or may not be true.

I hurdle my way back home for a NEMSOC simulation day. All very exciting and daunting! Do I know my ABCs, prehospital escalation pathways. Do I know how to even intimate?! A lot of pressure but my station peers were very strong and held their nerve particularly during the station I led. Note to self. Learn paediatrics algorithms - BLS, airways and management for common cores. I know it's the rotation you haven't done but you'll definitely need to know it soon!

Monday 16th March

Back on the Mental Health Community Team. A very fascinating patient with a background of depression with periods of mania and anxiety, suicidial ideation, angry outbursts + overdosing, weight loss and obsessions with his appearance. An isolated incident of hallucination likely due to overdose. Obsessions with self-image related to hair transplant and dental gap closure. Worked as a teacher. Demonstrated good insight in his own health and condition. Appeared to be a patient to benefit from continued psychological support with crisis team safety netting.

Midway through an afternoon discussion with previous patients with the senior doctor, an email comes shuttling in.

With effect from Tuesday, 17^th March 2020:

-Clinical Placements in year 3 will be cancelled.  This includes ICCP and SSC3 placements.

-The Year 3 OSCE will be cancelled.

-Year 3 written exams will be cancelled.

That is it. The end of 3rd Year. Hours after Halfway Ball. Coronavirus has struck. A week later, looking through computation-based modelling evidence provided by a team at Imperial College London has helped dramatically shift government policy. Universities are to close.

Could I work on hobbies? Further qualifications? Publication preparation? Textbook collection? Financial learning? Planning to move out starts tomorrow.

Tuesday 17th March - Interview for HCA?
Bags are packed. All ready to shift back home. Whilst planning to make a pit-stop to the library to drop-off books, I notice the possibility to collecting an online copy by scratching off the inside code. Well, its now or never to learn Obs+Gynae, Mental Health and Paediatrics using these valuable resources. At the library, whilst considering the likelihood of loans being extended regardless because of the virus, I consider the possibility of collecting more textbooks - this time question finals books.

At the library, I meet a colleague. She's already planning to return to work as a HCA. It seems an incredibly valuable use of your time between now and September. Maintain clinical skills and exposure to teaching environments. That evening, I submit an application to St Peter's Hospital to work in their A&E Department full-time.

Wednesday 18th March
The Yaris is packed. I'm off home. Goodbye Durham. Rumours of a lock-down affecting London are filtering through.

On returning home, I receive an email explaining they would like to meet but:

You may have already been invited to attend a recruitment event on the 28^th March however due to the large numbers that were due to attend and the current guidelines on large gatherings, the Trust has decided that this event should be cancelled.

Hospitals seemingly can't even run recruitment events. The impact of coronavirus is becoming more and more real.

Thursday 19th March - Interviews Scheduled
Thank you for your application (AR-190-035-891) in respect of the above position. We are pleased to invite you to attend an interview.
A&E Full-time is looking real again. This time under unprecendented conditions. Will require self-isolation from the family. A great deal of resilience and clinical understanding to cope. Will prepare for this as best as possible.

Thank you so much for your application. Please apologize us for the unexpected longer time taken for reviewing the applications. It has been a highly competitive call for only one position in our lab. We are happy to inform you that you have been pre-selected for the next stage of the process. First, we have attached the detailed project proposal that you will be working on during the summer and would like to know if you are motivated and keen to work on this project. 

Well, my third annual Institute of Cancer Research Summer Application has a bit more traction this time. We will see how this ends up tomorrow. Meanwhile, to start learning all about the proposal.

Friday 20th March - Interview for Summer Research
2.30pm arrives. Load up Skype. Audio isn't available. Restart Skype at 2.32pm. Audio is available. After that technical blunder, 'tell me about yourself.' I explain past experiences relevant to the application and my suitability towards genomics. He asks any questions for me, 'I ask about monitoring during the project.' He dutifully explains the balance will depend on being in-person or online. In either case, he will be the principal supervisor. 2.42pm Skype meeting over. Not much more to add. Felt I had prepared strongly academically. Felt robust in my plan of attack of the project. Certainly, could have been more elaborate about myself, rather than what I've done before. Strengths and weaknesses whilst directly relating it to the proposal. It was a challenge to prepare in <24h. We shall see come next week.

Saturday 21st March
Horror stories start filtering through. Consultants on ventilators. Front-line healthcare staff left without PPE. ICU staff feeling overburdened, overstretched with not ease in-sight. If there ever was a time to avoid being in hospital literally, it is now. But perhaps this is is my time. Just when everyone is trying to get away, get towards the source and use your experience and knowledge to the best of your ability.

For now, probably time to work on my lung fitness. Playing hockey in the street - by myself of course.

Sunday 22nd March
I begin to map out plans to self-isolate in case of work acceptance and illness. The bedroom, car and bathroom are my limits. Food delivery in plastic / disposable containers. Clothing washing to be minimised + only by me. Avoiding infection risks to my family is my responsibility should I have the opportunity to go into work. This cannot be understated.

Managing Losses

Friday 28th February

Back in Lanchester Road Hospital Education Centre. It is time for a day of teaching on Bipolar, Personality Disorders and Eating Disorders. Snacks and coffees are plentiful. Mental Health rotation has been very welcoming so far.

As has been the case so far, we've been taught some human psychology and sociology. Depression as a battle between stressors and resilience. Bipolar with percentage swings between high and low mood. Personality disorder, a consequence from defence mechanisms that protect you from your inner self. Been very insightful.

Evening comes so I dart for a train back home. En route, I map out the 10 Year Plan - a presentation for myself, first, and parents, second, on what I expect to do over the next 10 years. More on this on Sunday!

On a side-note, Coronavirus is spreading! Stocks have crashed today by 2-3%. Raising a more ideal time to consider investment in mutual fund trackers - another interesting decision to make!

Saturday 29th February

Got to love waking up at home. Clean bed. A true 8 hours sleep. Today braces come off! Expecting a tension headache but only felt a slightly mild one later that afternoon. Brushing my teeth has never felt better! Gotta take care of them now.

Sunday 1st March

Another relaxing day at home followed by a greasy burger and milkshake at GBK with the parents. Just a real staple of a home trip is a burger with the parents. Afterwards, I raise the attention of my parents to the 10 Year Plan presentation. Parents happy with this forethought. Thinking of career pathways - could it be Adult Oncology, could it be Paediatric Oncology? Paediatric Oncology? Certainly have lots of inspirational people to look up to. But my focus right now is just being a good clinical year medical student.

Just before midnight, launch my first £500 into my mutual investment fund!

Monday 2nd March

Arrive at King's Cross at 8.30am. Train breaks down. Board next train at 9am. Delayed at a stop for 3h. Arrive at 3pm. 6.30h train? Feels more similar to a Plymouth to London journey. Rail expenses have been claimed for. But the damage is done. I've missed an afternoon of patient simulations.

Whilst I'm at home for the afternoon, I complete my budget spreadsheet. Its emailed off to head office - the father for review.

Tuesday 3rd March

News in back from Head Office. They approve of the budget. They have one recommendation - do not get too granular. Essentially the safeguards are good. Just don't worry about it.

Wednesday 3rd March

Day off from Uni. Always loved - especially with examinations just over two months away. Managed to continue some Flashcard graft. My Flashcard plan should be completed by end of March. Providing April as ample time for consolidation drawing + past exam questions. That is the plan!

Thursday 4th March

Mental health continues on. Today is a CDF - simply a formative asssessment of your history + examination skills. Feel comfortable with my plan. After 30-35 minutes of chat, it is concluded. Felt I covered major bases that the patient and I felt comfortable with the plan. Feedback praised the communication skills and open questions. However, execution of the agenda was poor. What was the main diagnosis? Low mood? Sure could be it. But what subtleties did he have in expression and what exactly was he saying. Listening out for verbal cues is critical. Can't get by through simply hoping for keywords.

So a terrific lesson, take your cues and build a conversation through them. Over time, try and develop a stem of questioning followed by a systematic list of screening questions. Move between lists through having a filtered list of differentials. This will come with time.

This CDF felt different to the ones before. Sure, I did not get the diagnosis but I felt that this was all within my realms of development. I felt I could dramatically improve this. I felt more assured of myself before and during the consultation. I had a plan that was too rigid and firm. Was not quite flexible and tailored to the patient. This showed but this showed me a good plan to improve. Being Mr Nice may get you a good friendship but you have to take more advantage of the limited time you have to get more out of it.

After a challenging afternoon, it really was time for a haircut!

Friday 5th March

Stocks were falling once more. Another time to invest. This time a heftier amount has been placed. More will need to be put in to get more out of it. It fits my budget so I pull the trigger.

The financial plan has moved to one of 'set and forget.' This is one for the long-run not monitoring day to day volatile gains. Because at the moment, we're managing losses! Stick with the plan and it will all work itself out.