lorna

Year 6 MBBS Medicine

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lorna

Year 6 MBBS Medicine

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What to Expect: Clinical Years

So you are about to start studying Medicine at Imperial, but what will it involve? When will you meet patients?

What firm are you on? How’s placement? Where are you at? The medics I know keep asking all these questions and leaving the house really early dressed smartly, but what actually are clinical attachments?

Year 3 is clinical, with attachments (‘firms’) in hospitals across West London. They are called ‘firms’ from back in the old days when you would be with the same medical team for a while and became like a little family. Firm means the group you are with, and the name seems to have stuck (we like using technical terms to confuse non-medics).

Hospital placements at Imperial covered a lot wider area than I expected- from Paddington (St. Marys Hospital), Chelsea (Chelsea and Westminster Hospital), Hammersmith (Charing Cross Hospital), White City (Hammersmith Hospital) across to Twickenham (West Middlesex Hospital), Harrow (Northwick Park Hospital), Southall (Ealing hospital), Harlesden (Central Middlesex Hospital), right out to Uxbridge (Hillingdon Hospital) and Chertsey in Surrey (St. Peter’s Hospital). In third year each 10 week attachment covered a different speciality at a different hospital, and within a 10 week surgical block we rotated through anaesthetics and different types of surgery- which kept things varied and interesting! Most students who visit Hillingdon or St. Peters end up living out in the hospital accommodation (if they are lucky enough to get a room!) which provides a unique experience (we organised pizza deliveries and film nights) but can be quite isolating from the rest of the medical school, never mind the rest of Imperial! Exams are both written and practical (you see 12 different patients and examine them or perform a practical procedure e.g. take bloods/suture a wound, or talk to them to find out what is wrong (‘take their history’ in medical speak!)).

St Peters- way off the map

St Peters- way off the map

Looking cool on the wards with the stethoscopes around the neck!

Year 5 is a very long year (for me I worked out it was something ridiculous like a 54 week year!). This starts with a pathology lecture course, after a 1 month summer holiday, before moving onto continual clinical placements across a range of hospital sites. Rotations include Orthopaedics, Dermatology, GP (in London), Rheumatology, HIV/sexual health (I got to visit a very interesting clinic in Soho!), Psychiatry (most placements mix community services and psychiatric hospital inpatient care), Obstetrics and Gynaecology (yes I delivered some babies by myself!) and Paediatrics. Exams again are both written and practical (this year you have a viva after each patient and have to manage them, not just find out what’s wrong!).

Yes, I actually bought a baby into the world!

Everyone seems to get broody after paediatrics (“ahh, that child is sooo cute! Look what it just did! Coochy, coochy cooo!”), but that often changes during obs and gynae (“What is going on? All of those complications are from childbirth? Count me out!”)

Year 6 starts after a 2 week holiday from 5th year exams, so is a bit of a shock to the system! This year is basically preparing for the first year of work, so rotations include medicine and surgery, GP (outside of London), A&E, Neurology, Cardiology and a special choice module. Again, it’s a tiring year, running in continual clinical placements from mid-July to Christmas without a break! However, this does free up time for later in the year, when, after exams in March, we depart on a medical elective of our choice- anywhere in the world, any medical work, for at least 7 weeks- so I cannot complain!

Very nearly a doctor now….

What to Expect: Medicine Course

So you are about to start Medicine at Imperial... What will the six years involve?

 

So, final year, what even is that? And how did I get there?

At Imperial Medicine (MBBS/BSc) is a 6 year course:

Years 1&2 are pre-clinical years, learning how the body works and all the science behind diseases. Lectures run 9-5pm pretty much every day, with practicals, PBL, Communication sessions and anatomy mixed in. Practicals varied from looking down a microscope at your own blood, to drinking 2 cans of energy drink and measuring your observations whilst doing 10 minutes on an exercise bike! PBL (problem based learning) sessions were group sessions tackling clinical presentations (e.g. a man with shortness of breath just returned from LA on a long-haul flight) and teaching each other relevant information. Communication sessions involved visiting a patient with a chronic medical condition at home (for me out past Heathrow!) and discussing the impact of disease, as well as role-playing consultations with colleagues and medical actors! Anatomy sessions were the most interesting, dissecting cadavers in small groups (the sound of ribs cracking still goes through me!) to learn how the body fits together, and examining and drawing (in face-paint) the anatomical landmarks on each other and skeletons in living anatomy.

A suprisingly accurate picture from Imperial's website- all crowded round the skeleton desperately trying to name a bone other than 'the skull'!

A surprisingly accurate picture from Imperial’s website- all crowded round the skeleton desperately trying to name a bone other than ‘the skull’!

Pre-clinical is often seen as an ‘easy-ride’ for medics, as there are few bits of coursework to hand in compared to other subjects, however when you hit study leave you start to realise that is not the case!

Year 3 is the first clinical year and involves a variety of placements and some lectures on a range of medical presentations and conditions, as well as ethics and law.

Finally know something useful in medicine… until my Dad asks me to look at his dodgy knee, and I have to explain that I haven’t learnt about knees yet…

Year 4 is the intercalated degree year; each student picks a subject to study for a year (I picked Global Health, others include things like Endocrinology, Cardiology, Surgery, Respiratory, Pharmacology and Haematology) in more detail and has the opportunity to undertake a research project in that area (keeping some cells alive, analysing lots of numbers or interviewing patients), or a short-course module in medical ethics and law, medical humanities or the history of medicine. A great year to be back in lectures, be more involved in clubs and societies and to have a minimal commute!

Looking after cells can be hard work- they are difficult pets- needing watering, feeding, love and cuddles- no holidays for those on lab projects

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Year 5 and 6 are both clinical and involve a wider variety of placements in a range of different areas of medicine (or specialities). The further through the years of placement you move the more responsibility and interaction you have.

The slow evolution into a doctor continues!

What to Expect: Top tips for life at Imperial

In which I give my freshers top tips...

It’s not long until term starts again, so I thought I would write a couple of posts for the new freshers to prepare you about what to expect during your first few weeks and months. It is a daunting and exciting time, so relax and enjoy it and remember if we all made it then you can too!

My top tips:

  • Where to work: Find somewhere you can work well- try a public library or college computer room. If you do like the library get there early- it gets very busy and warm
  • Make friends with hall seniors: they can be a great source of support and advice as they understand life at Imperial and have been around longer than you!
  • Join lots of clubs: you can slim down your commitments after Christmas, but to start with throw yourself in and find out what you enjoy
  • You don’t need to drink or drink lots to have fun: Know your limits and stick to them
  • Get to know older years: they can give you revision notes, hold mock exams and they usually have a great student house to invite you round to!
  • Buy a hot drink flask: bringing your own coffee takes very little time, but will save you a fortune
  • Learn how you relax best: there are lots of options- gym classes, swimming, walks in Hyde Park, sport teams, art clubs, music, TV- the list goes on and on- if you figure this out early it makes everything a lot less stressful!
  • Know where to get help and support: there are so many people at Imperial to help, from tutors to the chaplaincy to the counselling service. The people are paid to help you so if you are stuck do use them!
  • People change: don’t be put off by people during freshers- people will change as term goes on. Friends will change too so stay open to meeting new people!
  • Fresher’s Flu: this will hit you at some point, so stock up on paracetamol drinks and medications in advance.

University is a huge change. Most people love it, but if you do hate it- you are not alone and it does get better. Now I’m starting to sound like my mum so I shall stop writing…

What to Expect: living in halls

In which I share my top tips for freshers on moving into halls...

It’s not long until term starts again, so I thought I would write a couple of posts for the new freshers to prepare you about what to expect during your first few weeks and months. It is a daunting and exciting time, so relax and enjoy it and remember if we all made it then you can too!

What to expect:

  • Culinary delights and disasters– organising food shopping and cooking defeats even the best culinary students- expect mushroom clouds of cheese sauce, setting fire to various meats and very unusual food combinations. Best advice: try cooking as a group, keep things simple and make use of the freezer (to avoid forgetting about things and them going off in the fridge). If all else fails ask your mum for some emergency meals…
  • To lose lots of crockery and cutlery– however hard you try this always happens. Some people try keeping everything in their room, but my best advice is don’t bring your favourite items and remember you have them!
  • To never have enough milk– people will ‘borrow’ milk, but you may well find yourself doing the same so don’t be quick to judge! Learn to accept it or try marking the level of your milk with a marker pen after use.
  • To make some great friends
  • Mayhem and madness– goes without saying…
  • To have to do your own washing– sounds simple, but more complex when you are trying to work the machine. Top tips: save up coins in advance (you generally need pound coins and 20p pieces), keep on top of your washing, write down how to use the machine and the washing detergent. Try to avoid taking it home- it’s very heavy to carry and your parents will probably not be that impressed…
  • To have some rough nights sleep– things settle down after freshers so don’t panic. Until then expect some noisy nights and fire drills- just remember your room key and a jumper when you leave to assemble outside.
  • Parents (aka ‘Hall seniors’)– a great source of support and help if you are stuck, but will also discipline you if you cause trouble…
  • To have some great trips out– get involved in as many trips as possible: theatre, concerts, experiphoto-1430760814266-9c81759e5e55ences out etc- it’s usually subsidised by the halls so lots cheaper, plus you get to go with all your friends!
  • Common room TV marathons– Second to the kitchen this is the most social place- head down for team Apprentice viewing, movie marathons and much more…

University is a huge change. Most people love it, but if you do hate it- you are not alone and it does get better. Now I’m starting to sound like my mum so I shall stop writing…

What to Expect: Starting Medical School

... in which I offer my top tips for new freshers

It’s not long until term starts again, so I thought I would write a couple of posts for the new freshers to prepare you about what to expect during your first few weeks and months. It is a daunting and exciting time, so relax and enjoy it and remember if we all made it then you can too!DeathtoStock_Wired7

What to expect:

  • To be behind on work– no matter how hard you try, how organised you are or how much stationary you buy from the Union shop you will never be on top of lectures. Learn to ‘park’ things (but not too much, you do need to do some work too!).
  • To have ups and downs– it’s a huge transition and gets the better of the best of students- learn how to relax and where to turn for some help. The student counseling service can be brilliant.
  • To feel out of your depth– everyone feels like this, but few people are honest about it
  • To be persuaded to buy lots of books that you will never read– this is hard to avoid. It’s worth chatting to older years to work out which are essential, borrowing from the library, buying second hand (although check the edition!) or using the library ebooks (these are invaluable).
  • To be a small fish in a big pond– everyone goes on about this and no-one believes them… until it happens.
  • To make lots of friends and not remember anyone’s name– it’s worth asking early, it gets a bit awkward after Christmas!
  • To get lost– don’t be afraid to use the maps around campus (they are there for a reason!)
  • To have LOTS of social events– it’s tiring to go to them all, but my advice would be don’t miss any boat parties- they are very special!
  • To dress up lots– nearly every med school event involves dressing up: Bops, boat party, freshers ball, RAG invasion…. So bring your fancy dress box and a tux/smart dress

University is a huge change. Most people love it, but if you do hate it- you are not alone and it does get better. Now I’m starting to sound like my mum so I shall stop writing…

Challenge of the week: Stereotypes

In which I am challenged by stereotypes...

In Medicine, like many other jobs, we tend to subconsciously stereotype. We rely heavily on pattern recognition for diagnosis, and being a certain age/ sex/ gender is part of that pattern. For example abdominal (tummy) swelling in a 20-30 year old woman has different likely diagnoses that the same swelling in a 70 year old man.

However I was recently challenged about my subconscious stereotypes. I was visiting a HIV clinic in the heart of Soho. When the first patient arrived I found myself surprised- they weren’t the patient I had expected. In fact none of them were.

I saw high flying city workers, happily married couples, internationally renowned performers, hard working shopkeepers and smiling children from all over the world, including many different parts of the U.K.

I’m not quite sure what patient I expected to walk through the door, but meeting this range of patients really challenged my stereotypes. I hadn’t realised exactly how much the media and stigma of society had coloured my way of thinking.

It’s the small things…

I am reminded of the small things in Medicine and why they matter...

I was upset recently to realise that in the midst of studying I had lost sight of why I went into Medicine.

It’s easy to do. Placements are hectic, stress builds around exams, studying in the library disorientates you and finding opportunities for sign-offs and achieving competencies become your first priority. Recently I found myself stressed in theatre on a Friday afternoon frantically trying to sort out achieving my last competencies on that placement and make sure I had all the paperwork for them sorted.

I was stunned to see the attitude of the student nurse and staff nurse, and how different this was from my own. Instead of worrying or stressing they were attending to the patients. Whereas I was concentrating on their surgery, they were concentrating on the small things that would make a massive difference to their hospital care.

The staff nurse was making sure that every patient who was waiting was warm enough and had enough blankets. Later, the student nurse held a patient’s hand through the whole operation to help her feel better. I discovered that she’d spent the whole afternoon chatting to the patient and alleviating their fears.

It made me realise that it’s so easy for me sometimes to get bogged down in the big things- studying, sign offs, exams- that I miss doing the little things that really make a difference to the patient. I went into Medicine to care for my patients and make a difference. After seeing this attitude of care I am more resolute to forget my own priorities and serve my patients as well as I can.

Medical Student Syndrome

Medical friends always diagnosing themselves with rare diseases? Here's why...

As term draws on and first years begin to prepare for exams, I thought I would share a few thoughts on Medical Student Syndrome.

Medical Student Syndrome… what is that?

Defined by wikipedia as a condition where medical students students “perceive themselves to be experiencing the symptoms of a disease that they are studying”, this is a very common issue faced by medical students all over the world!

Put simply, when you study a disease for a long time, you begin to persuade yourself that you probably have it and need to go to your GP. However by the time you get to your GP you have forgotten about that disease, and now think you have something else that you are studying.

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How does it present?

This condition typically begins in first term when students start learning about the thyroid (an endocrine gland in the neck). Their first lecture on the thyroid one week is about an over-active thyroid. After being taught about the presenting symptoms (feeling hot, palpitations, hyperactivity, anxiety, insomnia, fatigue, weight loss…) students begin to diagnose themselves with an over-active thyroid.

“I must see my GP,” they remark, “that lecturer perfectly described how I feel all the time… I do feel tired, sometimes I get anxious and I do sometimes feel hot and find it hard to sleep”.

However, being early in the year, the GP is busy, so they get an appointment for a couple of weeks time.

The full symptoms of medical student syndrome begin to show the following week however, when the thyroid lectures begin to cover an under-active thyroid gland. Once again sufferers get that sinking feeling when the lecturer begins to explain the features of the condition (fatigue, weight gain, cold intolerance, constipation, dry hair, dry skin, muscle aches…) and they start once again to diagnose.

“Gosh, I am glad I booked that GP appointment,” they remark, “an under-active thyroid explains all of my problems… I do get tired sometimes, and I occasionally need an extra jumper because of the cold, and I have gained a little weight.”

Musing on the way home, they begin to consider that they might have symptoms of both an over and under-active thyroid. Perhaps they are the first person to have this they explore, perhaps they could write an article in a journal about it.

The next day whilst studying the biochemistry of thyroid disease they begin to realise that perhaps their thyroid is normal (as it’s not possible to have both an over and under active gland at the same time). They sensibly cancel the GP appointment, only to regret it during the next lecture, when they self-diagnose diabetes.

I live with some medics/ sometimes enter SAFB, is it contagious?

This can be contagious, particularly when discussing conditions in a group. Prophylaxis can involve singing loudly whilst medics talk, or simply not letting them diagnose you- if you are worried and have some symptoms go and see a doctor instead!

That sounds serious… is it fatal?

Most of the medical school suffers from this at some point or another, including myself, and we’re still all here!

If you are worried about symptoms you’ve experienced go and see a doctor, don’t try and diagnose yourself!

 

Elective: They think it’s all over…

... it is now!

Hello! Sorry it has been a while since we last posted- Internet has been very limited in Rushere as the shops had run out of data for our network, and we had spent too much of our data spending money on cups of tea and accidently ringing up the talking clock!

We are now in Entebbe- the town by the airport relaxing before we fly tomorrow afternoon. It is a luxury to be here after the last few weeks – we even have a fan, a TV and fast wifi!

The last couple of weeks at Rushere have been busy. We have enjoyed helping with more theatre cases- one week we had nearly one caesarean and one gynaecological operation a day, which is a lot here- it got to the point where we had nearly run out of clean instruments!Picture18

I particularly enjoyed more outreach trips out into remote villages in the bush. My husband Sam was relieved to see me return safely after one of the midwives suggested leaving me out there to see how he would react!! Another highlight was helping a lady deliver on the grass area in the middle of the hospital as she couldn’t make it to maternity in time- fortunately she had brought a midwife with her!

We have also enjoyed getting to know the staff better particularly the doctor on call. His family recently came to visit and we enjoyed spending time with them. It was sad to leave our friends of the staff at the hospital, but we are most looking forward to seeing our family and friends in the UK!

Seven weeks down…

...One week to go

Sorry for the lack of blog posts. We have been having Internet issues. We bought some more data for our modem only to find less than 5 minutes later it had run out (it was to last us a fortnight!)- turns out our Imperial ipad had used all the data to update it’s apps. As a result it is banished to the suitcase!
The last couple of weeks here have been interesting.

Medicine-wise we have spent a lot of time in theatre seeing lots of caesarean sections (done to prevent serious problems, not cosmetic!) and a finger amputation!

On the wards we have helped manage lots of challenging cases of malnutrition which at times has been heartbreaking, as well as lots of paediatric and neonatal cases which has been great revision.Picture16

I have really enjoyed going out on an outreach day-trip to a nearby village this week. I joined a team going to the next village along the road to weigh babies, vaccinate children and do antenatal checks on expectant mothers. It was an experience, with a squeeze to get there in the hospital vehicle, equipment strapped to the roof, nearly getting stuck in potholes on the way and stopping to pick blueberries on the way back! It was however a huge privilege to visit rural villages and provide healthcare free of charge.Picture17

We have had many trauma cases recently which, as well as convincing us to never go on a boda boda here at night, have also shown us the radiology department. The hospital is fortunate to have a x-ray machine, which was an old one brought over from the UK many years ago. Once they have been taken they are developed in a dark room (which is very dark as the light doesn’t work) and then rinsed and hung on a barbed wire line outside to dry. To interpret them you can use the official light box in radiology or just hold them up to the sun!

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In other news last weekend we visited a local cultural museum. We learned about the history of the tribes in this area, as well as seeing houses they would have lived in and items they would have used. We realised these are still very similar today.

Fortunately the museum also has a great restaurant so we got our fill of coffee and pizza!