rotation

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!

New experiences

/ Emily Hedley

Towards the end of my third year, I had two rotations left to complete. The first was psychiatry. Similarly to Obs and Gynae, psychiatry was a completely new speciality for me. I had of course come across some aspects of psychiatry during my GP rotation  for example anxiety and post-natal depression, however overall it was very new. Unfortunately we still live in a society where there is some stigma attached to psychiatry and mental health. Although this situation is improving, I think it is fair to say that some stigma and prejudice does still exist. This rotation enabled me to see psychiatry from the other side (i.e. from inside the wards, rather than from the outside looking in) and I was really looking forward to seeing what it was all about. My first day on this rotation involved observing a review of a patient who had schizophrenia. The patient we saw had several symptoms that I could not recognise at the time, however after attending lectures I realise now that the patient we saw actually exhibited symptoms such as auditory and visual hallucinations and ideas of reference. ‘Ideas of reference’ basically means that the patient believes that an event or coincidence that they experience or notice actually has a specific reference to them and has a special meaning. I found a lot of the new concepts in psychiatry, such as ideas of reference, difficult to get my head around at first, as they seem quite abstract and hard to imagine. This is one of the reasons why I enjoy studying at Lancaster so much as it allows me to apply my theoretical learning to real-life patients, making the learning a lot more memorable.

The rest of psychiatry rotation involved spending time on the wards taking histories from patients and attending clinics, such as the Substance Abuse clinic and the Memory clinic. I found the Memory clinic particularly  enjoyable as I found the tests and screening tool used in elderly psychiatry, for example to aid making a diagnosis of dementia, really interesting. The psychiatrists use tools that test the patients’ short term memory recall, knowledge of current news, ability to name objects and ability to draw to help make diagnoses. I even got the opportunity to take one of these tests myself and the outcome wasn’t as I expected! (Should I be worried?!). Overall I thoroughly enjoyed my psychiatry placement, especially the weekly teaching we received from Nick (Mullin) – he is fantastic and made every topic so interesting and engaging. I enjoyed psychiatry so much that I would now consider it to be on my short list of potential specialties I may want to seriously look into in the future!