Aftermath of OSCEs...

Hey guys,

Last Thurs we had our end of Year 4 Objective Structured Clinical Examinations (OSCEs). I thought I'd dedicate this post to a little bit on how you get assessed as you progress through clinical school. OSCEs are essentially practical exams, where you are assessed not only on your clinical knowledge, but also on how you interact with patients.

In the Oxford Year 4 OSCEs, the OSCEs are based on General Medicine and General Surgery. So you'll be expected to show how you'd exam various body 'systems' e.g. respiratory, cardiovascular, neurological, etc. You're also assessed on data interpretation (e.g. blood test results, X-rays, ECGs), communication skills (where you explain a procedure to an actor), practical skills (e.g. taking blood) and basic life support (i.e. first aid).

Whilst in preclinicals you have more 'traditional' written exams, the OSCEs are a completely different style of examining. It's quite different to 'revise' for OSCEs... it's all about practising your system examinations and how you 'present' patient histories and examination findings. Luckily for us in the 4th year exams none of the patients have any signs (they're all perfectly healthy actors!) so we don't have to worry too much about actually diagnosing anything!!

Our exams actually went OK, most of the year passed no problems (you get the results the next morning... :P) I for one am glad it's all over now, and have spent most of this weekend doing absolutely nothing... Next week we've got a written exam though (but it's 'formative' i.e. the marks don't count towards any rankings or grades, unlike 'summative' exams like our OSCEs which do count!), so I'm not toooo worried about it... having said that I probably should do something towards them!!

Hope you guys are enjoying the sun, will write again soon!
Kief

Back in Oxford...

Hey guys,

I'm now back in Oxford - got back on Wednesday and managed to secure a car permit so can now bring my car up without worrying incessantly about where I'm going to park it! (Oxford is an absolute nightmare for cars...)

For the next two weeks I'm doing 'thread courses' i.e. bits and bobs that the med school want to teach us, but can't be timetabled as part of other courses e.g. ethics, communication skills and practical skills.

Today was a pretty full day - had a 3 hour session this morning on 'patient safety', talking about how important it is you operate on the diseased organ/limb and not the normal one - was actually quite surprising how easily these errors can arise even in the hands of experienced consultants... guess it doesn't bode so well for the NHS!

In the afternoon we had a practical skills session on catheterisation. Somehow all the boys got into one group and all the girls into the other two... in the guys group we ended up practising PRs (rectal exams) blind-fold, with your partner putting in different prostates (some normal, some diseased) and you having to guess whether it's normal or not, and if not, why not!! Kept us amused for a while anyway, who says guys aren't mature?! Then we practised catheterisation (putting in urinary catheters) not on each other (!) but on male and female pelvis models. Apparently they're nothing like the real thing, but still gave a chance to play around with KY jelly and pretend to know what we're doing!!

That's all for today, I've just come back from a game of squash (which I lost cruelly by a few points), and am just getting ready to go out for dinner with some mates.

Will keep you up to date with more of our exploits in the clinical skills lab ;)

Kief

Back in Oxford...

Hey guys,

I'm now back in Oxford - got back on Wednesday and managed to secure a car permit so can now bring my car up without worrying incessantly about where I'm going to park it! (Oxford is an absolute nightmare for cars...)

For the next two weeks I'm doing 'thread courses' i.e. bits and bobs that the med school want to teach us, but can't be timetabled as part of other courses e.g. ethics, communication skills and practical skills.

Today was a pretty full day - had a 3 hour session this morning on 'patient safety', talking about how important it is you operate on the diseased organ/limb and not the normal one - was actually quite surprising how easily these errors can arise even in the hands of experienced consultants... guess it doesn't bode so well for the NHS!

In the afternoon we had a practical skills session on catheterisation. Somehow all the boys got into one group and all the girls into the other two... in the guys group we ended up practising PRs (rectal exams) blind-fold, with your partner putting in different prostates (some normal, some diseased) and you having to guess whether it's normal or not, and if not, why not!! Kept us amused for a while anyway, who says guys aren't mature?! Then we practised catheterisation (putting in urinary catheters) not on each other (!) but on male and female pelvis models. Apparently they're nothing like the real thing, but still gave a chance to play around with KY jelly and pretend to know what we're doing!!

That's all for today, I've just come back from a game of squash (which I lost cruelly by a few points), and am just getting ready to go out for dinner with some mates.

Will keep you up to date with more of our exploits in the clinical skills lab ;)

Kief

Special study modules

Seeing as I'm currently doing my 4th year Special Study Module (SSM) here in Oxford, I thought I'd tell you a little bit about what they entail...

Most clinical schools now have SSMs / Student Selected Components (SSCs) / Special Education Modules (SEMs) which are all essentially the same thing... you get 4-6 weeks off from the main clinical course to pursue an area of medical or non-medical interest. This is all part of the GMC's grand plan to broaden the medical curriculum, so doctors have the opportunity to develop skills outside the medical profession.

In Oxford, we do SSMs in 4th and 6th years. In 4th year, you're not allowed to go abroad, but you are allowed to do it anywhere in the country. Some choose to go deeper on a medical speciality e.g. paediatrics, intensive care, etc. Others maintain a medical context but do something less mainstream e.g. ancient history of medicine, whilst others go the whole way shebang and do something completely random, like Arabic!

I'm not quite sure where my SSM fits under that classification - I'm spending 4 weeks in London working for the Dept of Health, to gain a little insight into the type of work they do. It's interesting that medical students are never taught about the organisational/policy-making side of the NHS, and if you want to better understand the NHS, it's important you observe all areas of it, both clinical and managerial.

The DH is a very interesting place, constituted largely by analysts of various kinds, and guided by clinical directors (who have some medical background). They are involved in several healthcare projects, many of which include developing guidance policies on management of specific conditions endemic in the UK. These policies are known as National Service Frameworks, and are then passed on to PCTs across the country to use as a reference tool for treating patients.

I've just given a very brief summary of an area that is incredibly complicated... at the moment I do a mixture of writing reports (to help with their work here on developing new NSFs), and also sit in on some interesting meetings e.g. to do with pandemic flu, etc etc. It's all quite cool, and a nice change to Oxford!

Will be updating you with how my SSM unfolds soon :)

Surgery...

Hey guys,

I've now completed 6 weeks of medicine, and am 4 weeks into my 6-week surgical rotation, so thought it'd be the ideal time to indulge in a bit of surgery chat...

In the Oxford 4th year we do three 2-week surgical specialities; I was allocated to do vascular surgery, breast/endocrine surgery with surgical emergency unit shifts and finally a 2-week placement in Banbury, where they have a mix of several specialities.

Vascular surgery's pretty cool - it's all about whether or not to chop off gangrenous cheesy-smelling legs... well kinda. Most of the patients seen under vascular surgeons have one of 5 main diseases: aneurysmal disease (usually an abdominal aortic aneurysm or AAA), venous disease (e.g. varicose veins), carotid disease, acute limb ischaemia or chronic limb ischaemia. You learn a completely new schema for how to examine the patient from a vascular point of view, and also get to play around with cool Doppler ultrasound probes to try and measure blood pressures and blood flow in both arteries and veins.

Being in theatre is generally the high-life of surgery, provided you're not standing right at the back and being completely ignored whilst watching an 8-hour procedure... There are definitely some cool operations to see - in vascular, one of the ways of dealing with carotid artery disease (where patients have cholesterol plaques in their neck arteries, that may increase risk of stroke), is to do something called a carotid end arterectomy, where the carotid is cut and the scummy atherosclerotic plaque is literally scraped out. To top it off, all this is done under local anaesthesia, whilst the patient is still awake!!

After vascular I was on the Surgical Emergency Unit (SEU) for a week. This was probably the most fun I had on surgery, as you actually get to play doctors and follow the surgical house officers around, taking bloods, putting in cannulas and catheters, clerking emergency referral patients and generally getting to grips with what F1 doctors do! Over the week we were assigned SEU shift rotas, either 8am-4pm, 4pm-midnight or (the killer) midnight-8am! The best shifts were probably the evening ones, when all sorts of weird and wonderful patients come sailing through the doors.

Last week I did breast/endocrine surgery. This week was split into going into breast clinics (and getting to practise breast exams), endocrine clinics (mostly people with thyroid or adrenal disease) and watching some pretty interesting operations in theatre. One patient had a phaeochromocytoma (a type of adrenal gland tumour) that was a particularly intersting operation to watch!

This week I'm at the Horton hospital in Banbury, and it's a bit more relaxing (though hospital accommodation does take some getting used to)! I've also got a nasty 3000-word surgical case report to write up by the end of next week, so I'm sure that'll keep me preoccupied for a while!

Will keep y'all updated soon with more surgical banter!

K

Life on the wards...

It's the new year, and a new start for the Oxford 4th years... having finished our Pathology course, we now move on to a series of rotations, including 6 weeks medicine, 6 weeks surgery, 4 weeks of special study modules (SSMs) and 6 weeks of medicine/surgery in a district general hospital (DGH). Although I'm doing my rotations in that order, others are doing it in different orders, so unlike the pathology course we're all now split up and doing different things (which in a way isn't quite as much fun)...

So medicine. What's it like?... Having spent the better part of a week doing it, I guess I can point out the immediates pluses and minuses of being on the wards. In the hospital, doctors are assigned into 'firms', which each firm typically consisting of a consultant in charge, a registrar, an senior house officer (F2) and generally 1 or 2 junior house officers (F1s).

In medicine these firms rotate and take it in turns to be 'on take' i.e. in charge of admitting new patients. Being on take is the best time for us medical students as we're given the chance to 'clerk' patients first-hand i.e. take a full history, do any relevant examinations, and then present what we find to a senior doctor. It's really interesting and varied simply because you don't know who's going to be referred and what's wrong with them - there's a pretty wide range in the type of patients you can see on a typical medical take.

After 'take' comes the post-take ward round, where the entire firm will go through each patient one-by-one, lead by the consultant. The doctor/med student who clerked the patient will then present the patient's case, and the consultant will then authorise the management plan to be carried out. It's quite interesting from the student's point-of-view, especially as we're treated as part of the team and given the opportunity to present what we found out.

When you're not 'on take', there are still things you can do, like taking blood, putting in catheters, etc etc, but one thing you'll hear every med student complaining about is that there's a lot of standing around going on, and for every hour of actual history-taking or teaching you get, there's probably 5 hours of standing around you need to do before you get there!! It's something I think you get used to with time... unlike preclinicals, you really have to be proactive on the wards, and make best use of your time there, and it's down to you to decide when to leave and go and do something else (in my case go for a coffee break!) and when to stick around in case something happens!

Since it's only been a week on the wards (after 3 years of medical school!) I haven't got much else to talk about, but will definitely keep you guys up to date with what's going down in the Radcliffe as my attachment unfolds ;)

Kief

A week before path finals...

Now that our Oxford panto is over, it's now back to cramming pre-clinical style before our path exams next week...

In the Oxford clinical course they do pathology first in 4th year (contrary to most unis that do path exams at the end of 6th year)... the thinking behind this is that you gain all the understanding you need to make better use of your ward time (which in principle sounds fine). However, one major criticism is that we're probably going to forget all the different types of brain tumours by the time I get round to doing my Neuro attachment, and a lot of the fine details we're learning now. Some other med schools have a different approach where they learn the relevant pathology just before starting each attachment (which in my mind at least seems to make a bit more sense). Also cramming the whole of medical pathology into an 8 week course is not ideal by any means...

But enough about boring path.

What else have I been upto? Well since injuring an ankle ligament at the start of the season, I've been out of all sport and been really out of touch (esp with our Balliol MCR footy team), which has been rather depressing! One of the beauties about Ox/Cam (which I've probably said a million times now) is that you do get the opportunity to meet people and make friends who aren't medics, especially doing College/Uni-based activities like sport...

One thing about clinics though is that because you spend so much time in the hosp and in with the medics, you'll inevitably get sucked into medic life (which isn't necessarily a bad thing), but is definitely a big difference I've noticed between pre-clinicals and clinicals.

At the moment (apart from cramming) I've also signed up to produce next year's pantomime, and along with the Director and Treasurer, we've picked the rest of our panto committee (including musical directors, vocal coaches, techies, choreographers, costumists, publicity, etc etc).

In 5th year in Oxf the whole year group gets split up into 6 groups, and you stick with that group of (usually 27 or 28 people) for the entire year whilst you do your specialist attachments, e.g. A&E, orthopaedics, neuro, psychiatry, obs & gynae, paediatrics, etc. The 27 of us running the panto next year are in a firm of our own, so we can pick what attachments we want to be doing in the lead-up to the panto. One of the good spin-offs of this is that you do end up with a bunch of really cool, outgoing guys to spend clinics with for the whole year, which I'm really looking forward to!

Right I think I've blagged on for long enough for now - will hopefully be writing back in a week telling you how my exams went...!

K

Busy as ever!

Hey guys,

It's been a long time since I wrote a post, and there's a very good reason... I've been totally preoccupied with a combination of our pathology course (which incidentally is a lot more interesting than preclinicals, but the lectures still make perfect nap times occasionally) and the clinical school pantomime. This year's pantomime will be held next week (29 nov - 2 dec) so the rehearsals are becoming more and more frequent (and my lines aren't still 100% learnt...)

I'll hopefully be back on track with the blogs once all this acting melarky is out of the way!

K