patients

The final rotation of third year…

/ Emily Hedley

My final rotation of third year was ‘Neurology and Elderly’. I was really pleased I got placed on this rotation last as I heard from senior years that it involved a lot of pharmacology topics as well as revision of 2nd year topics – perfect just before exams! For this rotation I was also pleased to be placed back at Lancaster Royal Infirmary – so it was an emotional farewell to the barrow bus…not!!

A lot of this rotation involved revision of 2nd year topics such as heart failure, osteoporosis, dementia and arthritis. I soon found that had forgotten so much so it was good to have the chance to revisit these topics just before exams, as we are still expected to know about them and be able to answer questions in relation to them. In terms of clinical placement I spent a lot of this rotation on the general medicine wards and the elderly wards taking histories – a lot like 2nd year! The main difference was that during this rotation we were also expected to attend ward rounds and other ‘Key Clinical Experiences’ such as observing the signing of a death certificate, attending a physiotherapy session and observing an occupational therapy session. We also had to visit the Speech and Language Therapist (SALT) to get an idea of their role. The idea of this rotation was to become familiar with the Multiple Disciplinary Team (MDT) involved in elderly care because as doctors we will work along side professionals such as these and often refer our patients to them too.

Along with elderly medicine, this rotation also covered neurology. Although we had covered some neurology as part of general medicine in 2nd year, as a specialty on its own it was again completely new to me. The neurology rotation involved lots of bedside teaching, which means the doctors come on to the wards with the students and have patients waiting for you to take a history from, examine and then the doctor asks you questions and has discussions with you about the patient’s condition, all whilst the patient is present. This kind of teaching is SO useful as there is a real life patient in front of you to apply your knowledge to, rather than a textbook. It’s also handy to gain the patient’s perspective of their condition, for example how they cope at home with their Parkinson’s disease. The bedside teaching was also great for practicing examination skills ready for the upcoming OSCE, as the doctor we were with made sure my skills were perfect before signing me off!

The neurology aspect of this rotation also saw us travel down to Blackpool for some teaching about EEGs. An EEG is one of the investigations carried out within neurology and is a way of assessing brain waves and brain activity. During my neurology rotation I learnt a lot about anatomy of the nervous system, epilepsy, headaches and weakness. Overall I found neurology very challenging, and although I look forward to returning to the specialty next year, I think I can safely say that it hasn’t made it to my specialty short list.

Following this final rotation, its revision week and then Summative exam time! This year I have three written exams; 2 medical sciences and 1 ethics/sociology/psychology/law/statistics, followed by one practical OSCE. I feel like there has been a big jump in expectations of us since 2nd year, especially in terms of the management of conditions and the pharmacology of drugs.. so with that said, I’d better get revising!

Huz Khojani

/ Lauren Kennedy

Starting 4th year

You would imagine that starting fourth year of medical school would be a daunting experience, knowing that your final university exams would be at the end of it. But as it turns out, that isn’t the case. There is a tremendous amount of confidence that comes from passing exams at the end of a medical school year, and so by the time that you’ve done it three times, you feel unstoppable. “Bring it on!” you declare to the challenge that lies ahead.

The first day of fourth year starts very similarly to how every other clinical year does; an entire day dedicated to talks that reinforce the principles of that we have been taught from the beginning, such as how to keep patients safe as well as ourselves. Then, during the final segment of the planned day, we are given the information that is most important to us; how fourth year is organised and which groups we are placed in.

In a nutshell, fourth year consists of a whistle-stop tour of the entire hospital (excluding the Accident and Emergency department). Four weeks are spent on each specialty except Medicine and Surgery, which get double the time. This makes sense, as these can be argued to be the “meaty subjects”. Because there are so many specialties to see, the year group is divided into groups that would rotate between the specialties. The concept of having “rotations” has been persistent since second year, however this year the groups are as small as five students. This means that a majority of the academic year will be spent with the same four people.

The first big change of the year that is quickly noticeable is the higher level of respect given on wards by doctors and more junior students. Along with the respect comes an expectation that we are able to perform more and better clinical skills on the wards. This means that we are given more responsibility in clinical practice, which I very much welcome. So far, the year has had me and my clinical partner running our very own GP clinic, as well as clerking patients in on a paediatric ward. Clerking a patient means that you are the first person that a patient talks to once they are admitted to the hospital. This can seem incredibly challenging as there are no patient notes and you are left with nothing but a stethoscope and your own clinical knowledge to determine what might be wrong with a patient. However, having a hands-on experience to this degree does make you more emotionally invested into the patient’s condition, resulting in remembering the features of the patient’s diagnosis for a long time in the future.

Not all clinical experiences have been rewarding however. The most frustrating time that I have had this year was when trying to examine a child who refused to let me go anywhere near them, but managed to pull at my ID badge and undo the lanyard that is attached to it from around my neck. Being particularly fond of my picture, the patient decides to put my badge into their mouth and starts chewing on it. The next half-hour is spent trying to get it back, which was a lot harder than expected.

As eventful as fourth year has been so far, I look forward to the challenges that it will definitely bring in the future. By this point in medical school, instead of seeing these challenges as problems you see them as opportunities to continue growing