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.

Glastonbury of Undergraduate Oncology

Friday Evening at 7pm. We're off to Cambridge for a Poster Presentation at the Cambridge University Oncology Society Conference. Short delay at Peterborough provided enough time to join in the Academic Medicine Society Committee Video Call - plans for the Conference are being mapped out. Great to give back on some of my experiences from the year before to students now planning their first Conference. Otherwise, just flicking through Reproductive Health notes from the day before. Sister messages me ask 'You coming to Cambo?!?!' Oh dear [she's a NatSci Graduate from Churchil College]. Navigating through this leads to a shared agreement that I will pop in to see here in Wagamama with her boyfriend.

Friday Evening at 7.30pm. Arriving at Cambridge Train Station. Lots of suitcases but I'm here with a rucksack and poster rolled up. Drop off the kit at Travelodge and head on down to Wagamama. Spot my sister and her boyfriend. Good catch-up. Otherwise, I'm out of here. Subway down the street does me just fine. Head back upstairs to finishing preparations for my Poster Presentation tomorrow.

Saturday. Conference Day. Lots of attendees (~60). Poster presentation at 12pm with a 3 minute poster speech. Went well. Hit the major points I wanted to cover over two months of hard work in Machine Learning Classifers ofa high-risk of tumour relapse subtype of ALL. I felt it was also important to comment on the limitations of the research - glaringly obvious to those actively involved in machine learning algorithms. On announcement of prizes, I was not one of them. This was honestly to be expected after recognising my limitations. After a Costa Coffee and WhatsApp message to the family, significant reasons to remain optimistic. Leeds Conference in Medical Education in March is the next one.

Building Societies

Its the end of the first term of my first clinical year at Newastle University. Been exciting to get on the wards for the first time. Experience a close to full length day with nurses, junior doctors, core trainees and consultants in a variety of wards and departments. Different places, different people, different ward-based cultures.

And now as the Christmas break begins, its also a time to catch-up on society events planning - Academic Medicine Society, Haematology-Oncology Society and Emergency Medicine Society.

Each of these three societies have three distinct cultures.

Academic Medicine - A highly commited society committee with growing experience. A flexible President keen to empower other committee members.

Haematology-Oncology - A new society with lots of clinical year members. An easy-going President happy to support the plans of other committee members.

Emergency Medicine - An empire of a society that put on patient-based simulations every fortnight. A passionate committee that previously included later clinical year students now features many highly committed pre-clinical and early clinical students.

As a consequence of being involved in some societies and cultures is the importance of understanding your role. Your role as a leader and as a team player. Being able to switch mindset between the two in orderto meet the challenges of each society. In an aging society, cultivating enthusiasm. In a society with lots of new members, encouraging interaction. In a large powerful society, navigating sub-cultures within the society. These are all fluid challenges that require continued commitment.

9 Days in the Life

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.

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!

Fear of Failure

We are officially two-thirds into this nine year projected voyage through university. That means just three years left to complete some goals. The next one - a first author publication.

Simply what a time to be doing some summer research. Navigating my through datasets, near identical in structure to when this journey began back in 2013-14. Since then, the methods to tackle the data are more developed and more methods are more available. Simply, more avenues of attack. More excitement. More expectation. More of a chance to finally convert this opportunity.

It all begins with an abstract and ends with a disclosure of conflicting interests. I have none.
Nine years at university with no first-author publication. That will not be me.

Year 2 Results

Two weeks late but with a good reason!

Passed.
Ranked 234/422
10 OSCE Stations passed.

Great sight to see! New record highs in OSCE, SBA and Coursework has definitely been pleasing. A drop in SAP is possibly a reflection of a greater commitment to the SBA (weighted more).

A tough year. That is another takeaway. A rise from mid-pack to the top ranked students requires a real plan at the start of the year. A plan that is an evolution from the previous year. Learning this has been tough to take but I'm glad I've taken it.

Throughout the second half, I felt that this year was really about commitment. How badly do you want it. Across all my years at university, you really have to get out of bed every morning feeling like there is nowhere else I would rather be.

And for the reason why this is two weeks late:

After those long January mornings, hunger is running high. Late June and its a very mild Summer Evening. Summer Research Project is two weeks in. Lots of plots, lots of preparation and lots more to learn. This level of hunger really is very similar to my first Summer Research Project in Plymouth '13. Back then, I was a passenger - developing my project under the direct guidance of a supervisor. This time, I'm the driver - developing my project independently with assistance of supervisors. More responsibility. More devotion. More care required.

Seeing how badly things have fallen to rescuing my ranking is pleasing but more can definitely come.

For now, bed for an early start to prepare my data presentations!

End of Y2

With sincere apologies for the delay, please find attached a letter outlining the outcome of your Research Scholarship application.

Brilliant. A pit of sheer despair in my stomach. I have to read a letter of rejection now. But....

The Panel was impressed with your application and consequently has decided to offer you a Research Scholarship for your project entitled: “Classification of Patients with Acute Lymphoblastic Leukaemia into Clinically Applicable Genetic Subgroups through Machine Learning Enabling Delivery of Precision Medicine”

The show goes on! For the first time since 2014, we have a Summer Research Scholarship!

Ever since those January results, it's been a really tough five months. A lot of pensive moments of:

- Is this as good as it gets for me? Am I just set out for clinical work? Can I be an academic oncologist? Am I good enough to be a research student again?

But you turn up to lectures each day, get your notes done. Take a quiet study room over a group study room. Practice your OSCEs nearly every day in Easter. Condense and synthesise your notes. Address your society commitments - Emergency Medicine and Academic Medicine (Conference went well!). Maybe, just maybe, your Summer Research Project application gets accepted. And lo and behold, we are back!

Its a bright sunny day in Newcastle - summer is truly here!

OSCEs have also just rounded-up and here are my uber-quick thoughts:

Day 1:
1/10 - Hand Exams
Felt fluid. Covered the major bases before failing to do a Phalen Test! Examiner said 'Well-done' at the end. What a jokester.

2/10 - Information-Giving to a Mother with a Child with Viral Ear Infection requesting Antibiotics
Quite straight-forward to explain that antibiotics aren't recommended at all for viral infections. Six minutes is a long time so easy to waffle (guilty!) but overall managed to address concerns of the patient's mother.

3/10 - Cranial Nerves (except Eyes + Ears) Exam
This is a tip. Assume the volunteer is a patient not healthy. Covered all the major nerve components and concluded the station. Job done? No, just before the end I asked the patient if her loss of smell was real. Turns out she was a patient. Oh dear.

4/10 - Lower Leg Swelling History
Covered this well as I could have (given my very open questions leading to lengthy verbose replies). A slightly too focused family history may cost me.

5/10 - Blood Pressure
The sound of Korotkoff sounds was simply music to my ears. Remember to write the date of the BP.

Day 2:
6/10 - Sexual History of Vaginal History
Empathy sensitivity and delivery critical with this one. Felt I covered those domains well (despite some slight day two first station nerves!).

7/10 - Breast Exam
Another highly sensitive station. I felt I covered this well.

8/10 - GI Exam
Time was tight for this one! Inspection was lengthy but comprehensive. It was a race to finish on time and I did not quite manage to squeeze in our post-examination recommendations. Good otherwise.

9/10 - Headache History
A lot of systemic symptoms to get through beyond the headache and general symptoms. Felt I managed the best I could. Oh yeah and listen to the patient. They'll tell you a lot more that may tick further boxes.

10/10 - CPR
With work on my oxygen delivery technique, I think we'll be okay with this one in the future.

And that wraps up second year! Results in just under a month. Clinical placements start next week in North Durham (lots of new people to meet!).

Even better days are still ahead!

Two Weeks Later

The sun is out. Springtime in Newcastle has never seemingly looked so good in early February.

A relaxing weekend back home also included a trip back to Cambridge to visit the old stomping grounds - Wolfson Court. Sadly, it is in a early stage of disrepair after losing down just after we all left. Three of the Girton Boys are motoring on with PhDs, two are in employment and one is at Medical School (me). PhD students have the unique responsibility of supervising young undergraduate students. From this, it was insightful to appreciate that students can come up with perspectives that are different to the supervisor. These perspectives come from a deeper understanding of the topic area - not simply regurgitating slide material. Over the last five and a half years of university, I have been guilty of this. Taking material, revising material and synthesising material into a mental model or carefully crafted essay has been my staple. Taking a step back and thinking about the deeper reasons for why situations are occuring in the way in which they are is an area I have not particularly thought about - providing time for yourself.

Something to think about in the future.

Highs and New Lows

New Year. New decisions.

Assignment 1: 89%
Short Answer Paper: 59% - 389th out of 421 students.
Single Best Answer Paper: 59% - 320th out of 419 students.

We're making real progress in coursework from first year. A huge improvement in coursework mark from thinking through feedback from last year's essay. This was a fulfilling mark as the key area I needed to improve in was clear:

- Critical analysis of papers by reflecting on limitations > broad over-arching review giving yourself an opportunity to give your own opinion.

Reflecting on Limitations.

My exam results have set new lows for my ranking within the cohort. Reflecting on limitations is crucial and after employing notes per learning outcome and flashcards with the aim of boosting my long-term retention of pre-clinical material, I have seen large drops in my Single Best Answer Paper mark. This is reflective of a huge shift (after my January exams last year) in my learning style from repetitive memorisation of models by writing and condensing during Biomedical Science to revising a series of key facts.

During both exams, I felt unable to draw upon experience of thinking through a problem I've not seen explicitly seen before because I had not learnt the material as a model but rather a fact. Learning material as model first rather than fact first is reflective of my learning style as an Abstract Learner. As someone who learns through experience and generating a visual model during my Biomedical Science days rather than someone who remembers concrete facts and builds knowledge through a series of defined principles, I have appreciated this much more now.

Knowing what it took to get here and understanding various learning methods and how they apply to my strengths has been vital. Focusing on my core learning skills will help me right the path I'm on.

For now: A Charity Pub Quiz to prepare for! [Very Abstract!]

Dealing with Off the Field

We are now onto Case 18 in pre-clinical programme at Newcastle University. This week we're learning about Malaria and Global Health. Learning about diseases that we may never see clinically in the UK but are likely to in other areas of the world. Its new and different so learning in second year feels fresh and exciting.

Society commitments with the Emergency Medicine and Academic Medicine committees are ongoing with various levels of success. Disappointments of having the Charity Pub Quiz and passing on the Glasgow Trip have lingered. Feeling that you've let down committee and society members is very tough.

Having a clear boundary between social and professional friends has been an area I've always had at my time at university but since many of my close friends are society or committee members, this boundary is not so clear-cut. As a result, how I handle myself has to change and this comes down to sculpting yourself around the person that you want to be. An oncologist? A dermatologist? A plastic surgeon? An AFP trainee.

Only once you become more true to yourself in both your goals and mannerisms will you end up becoming that person.

Being Useful

Second year of medicine at Newcastle is now just under two weeks away! A long summer to reflect and think about the future - those professional, social and academic goals. It feels strange to think about being on the 'back nine' of your university experience (sixth year of a projected nine) but having now had the journey of being a first year medical student, it really is still all to play for.

When I think back to the best year I had academically, it also was the year I was most useful socially. In November of 2014, I was elected to be the Academic Secretary of the Plymouth Biomedical Society. A very proud moment but also was finding out out my second year degree average to be 73.5% and nonchalantly handing over that transcript to my mother in the Summer of 2015.

And now fast forward to September of 2018, as I begin my post as President of the Newcastle Academic Medicine Society, this is also a time where I'm realising how useful I can be socially. Inspiring a committee, providing advice and engaging with presenters. Through planning for this opportunity over the summer, my academic goal - an AFP interview, has only been heightened. Having clarity on what that goal was, has certainly helped me realise what I'm playing for. All the previous rejections, people counting me out and still a greater opportunity lies ahead.

And now back to fixing a server connection to my SQL database!

Year 1 Results

Passed.
Ranked 267/456
6 OSCE stations passed with 1 fail (CPR).

Relief to have passed but a tinge of disappointment with my overall ranking. OSCE and SBA marks overall were below average and SAP just above average.

Exam Papers:

Surprised to score highly in the more social medicine-based paper (SAP - 65%) than in the more scientific paper (SBA - 61%). Poor performances were noticeable on Skin, Respiratory, Nervous System and Genetics questions in the SBA while investigations and histopathology of bowel diseases proved costly in the SAP.

Spaced repetition proved useful in memorising key definitions and concepts but a lack of knowledge of finer more biomedical details was evident. Clearly a need to structure learning throughout the year and effectively use mindmaps to draw out areas that are not as well understood, flashcards to test learning and write out answers to questions on definitions, symptoms and common pathologies.

OSCEs:

A lack of continued OSCE preparation throughout the year proved to be costly. If you fail to prepare, prepare to fail and BLS was no surprise. Remembering to wash hands, ask for consent and systematically work through. Being fluent and taking time to think especially in examinations and patient histories will be elements to improve upon for next year.

Summary:

A similar story to the first year of Biomedical science degree. Back to being average with a lot more to prove. Margins are a lot closer in this degree but the rewards are significantly greater.

A Week in the Life

Monday
6:20am. Land at London Heathrow after an 8 hour flight from Heathrow. Feeling surprisingly refreshed.
12.30pm. Arrive at Newcastle University. Scoff down some scampi and sprint off to lectures.
7pm. Emergency Medicine event on Gynaceology and Obstetrics emergencies. Feeling tired after munching two Mayo Chickens on the way home.

Tuesday
9am. Peer Mentoring training session in preparation of being a Peer Mentor for second year. Engaging and exciting session. Not feeling tired.

Wednesday
12pm. Lecture on Pharmacological Intervention of Gastric and Oesophageal Disease. Rarity this year where I actually felt prepared after pre-reading but also linking aspects of previous lectures together. Still on feeling balanced.

Thursday
10am. Meeting with a Writing Tutor to assess my writing style but more simplifying my writing approach. Writing as a student that is being challenged by ensuring I demonstrate an understanding of the subject before applying, analysing, evaluating and synthesising. Realising that the World is built around models and taxonomies.

Friday
1pm. Team-based Learning. Team fared very well and ended up ranking as the highest achieving team. Frustrated at my performance individually. Had a broad skim over case lecture notes but failed to pick out individual details. Also failed to schematically prepare for the types of questions i.e. differential diagnoses and questions that are likely SBA questions.
7pm. London 2012 on PS3 with flatmates. Helped to put my mind at ease after earlier's disappointment.

Saturday
9am. Newcastle Academic Medicine Society Conference. Enjoyable day. Setting up, helping run stands and attending the odd lecture. Great to meet the full committee and looking forward to committing myself more.

Sunday
11pm. Feeling refreshed after an easy day of Case-embedded and End of Case questions with some simple GI blood anatomy. Not feeling overworked but inspired to return to work.

And that's a week. How quickly fortunes and events change throughout the week. Important to move onto the next day with a mindset of always looking to improve.