Its Reading Week! In seven years of university, never had anyhting life this. So why not return home - kick back and relax and run over some people on Grand Theft Auto V! And once we're happy with that, how about a time to reflect.
Monday 21st October 2019:
Its MOSLER day. Our first ever Modified Objective Structured Long Examination Review - just as daunting as it sounds. But to take-away my nerves before my 11am timeslot, I decided to head to the base ward - Elderly Care. Asked the doctor if he was a foundation doctor? He was a core medical doctor. Lesson #1: Don't assume the training level of a doctor. After that shaky introduction, felt comfortable looking at patient notes, X-rays and blood results. Just remember structured frameworks and we'll be more fluent in reporting results.
11am. The time has come. Sprint upstairs to meet my patient and examiner. History was going strongly - a couple of repeated questions but more to help lock-in my differential diagnoses. Examination was about to kick-off before a member of the nursing team pops in to say 'We're ready for your ultrasound.' And lights out - MOSLER over. Examiner explains the examination findings and we're off for our debrief.
How did I do? Well, I whiffed completely on the patient diagnosis - only one symptom was present - shortness of breath worsening over four weeks. Asthma? Right-sided HF? But a core condition that could present in this way could be a sub-massive PE. That was the patient. Hard luck for my first MOSLER. Great learning experience to focus on the core presenting symptom and branch out from there. Consider conditions that need to be ruled out before steam-rolling your way to a finite diagnosis.
Tuesday 22nd October 2019:
More patient circuits! Myasthenia gravis.Transient Ischaemic Attack. Stroke. Eye diseases. Multiple sclerosis. All presented in ways you might expect but pleasing to pick up on these diseases - even if examiner questioning did prompt a slight re-ranking of differential diagnoses.
In the afternoon, headed back to the Elderly Care ward to spend more time improving my diagnostic, examination and clinical reasoning skills. Visited a patient with neutropenic sepsis - confirmed to AML after a MDT meeting. Patient was yet to be told but will be soon once acute symptoms subside. Timing is crucial.
Wednesday 23rd October 2019:
GP visit! Met a patient with an extensive history of being systematically unwell - shortness of breath, cramping abdominal pain, burning on urination, back pain moving to the flanks. Possible pyelonephritis, persistent STI, renal colic. Routine Bloods, Ultrasound, Chest X-Ray - all ordered for her as an outpatient. A complete constellation of symptoms - further confirming the diversity of how patients present.
Thursday 24th October 2019:
Simulations Day! 'Please take a history from this patient in AMU.' There must be a catch here. There's no way we're taking a history from a patient for a full simulation. Instantly when we walk in, it's a tonic-clonic seizure. Oxygen, start the clock, manage the airway, find protocols / IV lorazepam / PR diazepam / phone a relevant senior. Handled the emergency well. Credit to the team here - airway was so well-managed. Made my job as the end of the bed inspector fluid. Other stations were headache, stroke, meningococcal septicaemia - not too challenging overall.
Friday 25th October 2019:
Last day of Essentials Block! Clinical teaching fellows are excited because we're playing articulate. Of course, its articulating various types of eplileptic seizure. Great end to a great start to the 3rd year.
Saturday 26th October 2019:
Edinburgh University Oncology Society Conference Day! Only around 15 in attendance but presenters were highly engaging and informative. Midday - presented my poster on machine learning classification on patients with a high-risk of tumour relapse subtype of ALL. Went smoothly - zero questions. In the afternoon, time to present my work as an oral presentation. A key question - that must be expected with bioinformatics-based projects is - 'what is the principal focus of the project moving forward.' Afterwards, I find out I'm the only oral presenter - the other two pulled out. Perhaps they were ill? Perhaps I was the only presenter to submit as an oral presenter? Perhaps they saw my project title and were put off? Either way, I'm walking home with the Oral Presentation Winner prize with a celebratory KFC in hand.
Sunday 27th October 2019:
Night shift back in A&E Epsom as an HCA. After my last shift over December on the wards, its great to be back and see some familiar faces. Also great to have a full team available, the difference it makes made the night run very smoothly. Not too many patients but the patients were handled smoothly and effectively. Pleased with how my first night shift went - great practise for life as a junior doctor in two and half years time.
Monday 28th October 2019:
Recovery day. A well-earned roast for dinner.
Tuesday 29th October 2019:
News comes rolling in.
I am writing to let you know that the judges have now assessed the entries for this year’s Paola Domizio Undergraduate Essay Prize.
Could it be? My midnight four hour piece to win the essay prize?
Unfortunately, your essay has not been selected as the winner for this year’s competition.
Not too disappointing really. I knew the essay was a last minute job but I was happy with the output in that timeframe. Previous failures - missing expectations in January exams, NSAMR ambassador role in 2018 have been overcome. This will be one to return to.
Wednesday, 30 October 2019
Sunday, 6 October 2019
Week in the Life
Monday
Its Monday quiz time! Fared better than the GI quiz two weeks ago. Pleased with my performance. Skin condition management is still blurry. Will improve this soon!
Clinical skills in the afternoon features subcutaneous and intramuscular injections as well as a good old return to catheter preparation. Both were rather solid. Feeling better about my aseptic technique. Still one to practice on dummies rather than patients at this stage!
Midnight tonight is the deadline for the Pathology Society essay. With a bare-bones plan and grand total of 0 words, its time to sprint off to the Walton Library for any book inspiration (sadly none) before a downtown trip to the University Study Rooms with a bottle of Summer Fruits Oasis. The 1,000 word essay was complete 40 minutes before the deadline. This essay was really good practise for a change in my writing style - becoming more descriptive, fluent and easy to read. Avoiding hefty jargon and sticking to the expectations of what's being asked of you. This was a fulfilling essay to write. With more dedicated time, very assured I will be able to be really competitive in academic writing.
Tuesday
Patient circuit is lively. Knees, spines, hands, shoulders. My patient was extremely reticent but that provided me a really good challenge. Patient presented apparently asymptomatically with no real concerns. If you don't have rapport with someone, how do you respond? Looking back thinking about a clear opening question - please do tell me about your diagnosis / recent medical problem would help set the tone. If cancer, a question on any recent concerns about a diagnosis / medical condition that you may have?
This patient had metastatic cancer. Thinking openly, focusing the conversation precisely if off-target and assuming nothing. This was a great consultation in being fundamentally sound - not looking for a diagnosis but a picture.
Knee exam needs work. Simply explanation for this is just to practise patient movements.
Wednesday
Dermatology pictures in the GP! I thoroughly loved this - flicking through slideshow pictures of skin conditions - describing it and coming up with spot diagnoses. Very enjoyable.
Met a patient with eczema leading to persistent pain, itching and discomfort. Previous lines of treatment provided short-term respite but impacting his life, adding to stress. Certainly skin conditions have the capacity to make people feel extremely vulnerable and insecure but in this patient, just feel frustrated. Assessing the difference, managing expectations from a GP consultation is something I enjoyed from this. Perhaps providing a more optimistic tone through the dermatologist referral would help.
Sat in a multidisciplinary team meeting on end of life care of patients with cancer. The GP lead with a roundtable of caring nurses all were very succinct in their delivery, had clear expectations and clear direction provided by the GP made this meeting extremely slick. Is this an insight into MDTs? Highly enjoyable.
Thursday
Dermatology clinics and quizzes! This was also an occasion where going off-script on the pre-reading and looking at diseases through my own resources thoroughly helped me prepare for the slideshows and quizzes. I felt really prepared and comfortable to nail the quizzes. First round, I was explaining the condition far too slowly - did not anticipate the speed required. By the second round, I was flying through describing the conditions. With greater confidence, comes greater execution, comes greater speed.
Edinburgh Oncology Society accept my abstract (Summer Research Project in Machine Learning and AI) for an oral and poster presentation in October! My first time presenting and looking forward to it!
On Reddit, I spot an opportunity to apply for an FIA Sid Watkins Scholarship. With each of his two biographies on both bedside tables, this is a very exciting opportunity to throw my name at. What is extremely motivating is to see previous scholars perform so strongly and to see them making a real impact in their fields. Translating Machine Learning into biometric data / baseline quantitative concussion analysis possibly?
Canteen food of sausages, beans and bacon was a delightful mid-clinic reward!
Friday
SBA and WRISKE questions. Felt nervous for these SBA questions once again but performed well. Even in the tougher questions, I did feel fulfilling to know that I had previous notes on these areas. Everything is in the ballpark now.
WRISKE still requires more practice. Making sensible and logical adjustments to pain management, detecting and explaining X-ray key terms e.g. subchondral cysts and making sure details e.g. contact details and reports are correctly filled in.
KFC with the boys was a great reward
Saturday
Very relaxing Saturday back home. A trip to the Golf Range, Kingston, Lamb Schwarma, watching the footie (Milner with a last-minute penalty!) and a 15 minute run with a great home-made Lasagna. Little bit of casual GTA 5 and Strictly Come Dancing as well. A real transition phase in the life of me!
Sunday
More big news! I've been accepted as the NSAMR Ambassador for Newcastle for this academic year! Very, very fulfilling after being unsuccessful the year prior! What a difference a year makes - a few tweaks on the application and we're in business!
Only downside? NSAMR AGM date is the 26th October. When is the Edinburgh Oncology Conference. Yep, it's the same date. Will need some advice on this one.
Train back North. Spent an hour in King's Cross flicking through musculoskeletal arthritis notes. After grabbing the classic Smoked Ham and Emmental Cheese Boots Sandwich, its train time.
Back in Durham. Completed going through my Cardiovascular, Respiratory and GI core conditions for Monday's OSCE circuit! Little bit of examination preparation too. All set for tomorrow!
Its Monday quiz time! Fared better than the GI quiz two weeks ago. Pleased with my performance. Skin condition management is still blurry. Will improve this soon!
Clinical skills in the afternoon features subcutaneous and intramuscular injections as well as a good old return to catheter preparation. Both were rather solid. Feeling better about my aseptic technique. Still one to practice on dummies rather than patients at this stage!
Midnight tonight is the deadline for the Pathology Society essay. With a bare-bones plan and grand total of 0 words, its time to sprint off to the Walton Library for any book inspiration (sadly none) before a downtown trip to the University Study Rooms with a bottle of Summer Fruits Oasis. The 1,000 word essay was complete 40 minutes before the deadline. This essay was really good practise for a change in my writing style - becoming more descriptive, fluent and easy to read. Avoiding hefty jargon and sticking to the expectations of what's being asked of you. This was a fulfilling essay to write. With more dedicated time, very assured I will be able to be really competitive in academic writing.
Tuesday
Patient circuit is lively. Knees, spines, hands, shoulders. My patient was extremely reticent but that provided me a really good challenge. Patient presented apparently asymptomatically with no real concerns. If you don't have rapport with someone, how do you respond? Looking back thinking about a clear opening question - please do tell me about your diagnosis / recent medical problem would help set the tone. If cancer, a question on any recent concerns about a diagnosis / medical condition that you may have?
This patient had metastatic cancer. Thinking openly, focusing the conversation precisely if off-target and assuming nothing. This was a great consultation in being fundamentally sound - not looking for a diagnosis but a picture.
Knee exam needs work. Simply explanation for this is just to practise patient movements.
Wednesday
Dermatology pictures in the GP! I thoroughly loved this - flicking through slideshow pictures of skin conditions - describing it and coming up with spot diagnoses. Very enjoyable.
Met a patient with eczema leading to persistent pain, itching and discomfort. Previous lines of treatment provided short-term respite but impacting his life, adding to stress. Certainly skin conditions have the capacity to make people feel extremely vulnerable and insecure but in this patient, just feel frustrated. Assessing the difference, managing expectations from a GP consultation is something I enjoyed from this. Perhaps providing a more optimistic tone through the dermatologist referral would help.
Sat in a multidisciplinary team meeting on end of life care of patients with cancer. The GP lead with a roundtable of caring nurses all were very succinct in their delivery, had clear expectations and clear direction provided by the GP made this meeting extremely slick. Is this an insight into MDTs? Highly enjoyable.
Thursday
Dermatology clinics and quizzes! This was also an occasion where going off-script on the pre-reading and looking at diseases through my own resources thoroughly helped me prepare for the slideshows and quizzes. I felt really prepared and comfortable to nail the quizzes. First round, I was explaining the condition far too slowly - did not anticipate the speed required. By the second round, I was flying through describing the conditions. With greater confidence, comes greater execution, comes greater speed.
Edinburgh Oncology Society accept my abstract (Summer Research Project in Machine Learning and AI) for an oral and poster presentation in October! My first time presenting and looking forward to it!
On Reddit, I spot an opportunity to apply for an FIA Sid Watkins Scholarship. With each of his two biographies on both bedside tables, this is a very exciting opportunity to throw my name at. What is extremely motivating is to see previous scholars perform so strongly and to see them making a real impact in their fields. Translating Machine Learning into biometric data / baseline quantitative concussion analysis possibly?
Canteen food of sausages, beans and bacon was a delightful mid-clinic reward!
Friday
SBA and WRISKE questions. Felt nervous for these SBA questions once again but performed well. Even in the tougher questions, I did feel fulfilling to know that I had previous notes on these areas. Everything is in the ballpark now.
WRISKE still requires more practice. Making sensible and logical adjustments to pain management, detecting and explaining X-ray key terms e.g. subchondral cysts and making sure details e.g. contact details and reports are correctly filled in.
KFC with the boys was a great reward
Saturday
Very relaxing Saturday back home. A trip to the Golf Range, Kingston, Lamb Schwarma, watching the footie (Milner with a last-minute penalty!) and a 15 minute run with a great home-made Lasagna. Little bit of casual GTA 5 and Strictly Come Dancing as well. A real transition phase in the life of me!
Sunday
More big news! I've been accepted as the NSAMR Ambassador for Newcastle for this academic year! Very, very fulfilling after being unsuccessful the year prior! What a difference a year makes - a few tweaks on the application and we're in business!
Only downside? NSAMR AGM date is the 26th October. When is the Edinburgh Oncology Conference. Yep, it's the same date. Will need some advice on this one.
Train back North. Spent an hour in King's Cross flicking through musculoskeletal arthritis notes. After grabbing the classic Smoked Ham and Emmental Cheese Boots Sandwich, its train time.
Back in Durham. Completed going through my Cardiovascular, Respiratory and GI core conditions for Monday's OSCE circuit! Little bit of examination preparation too. All set for tomorrow!
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