My Monday started off a little differently this week. Normally, on Mondays in this academic year, I’d have online lectures (which used to be face-to-face on campus, but COVID-19 said otherwise!), followed by writing up my study notes for the week. This time however, I was in London for the weekend, so after attending my online morning lectures on Genitourinary Emergencies and Urinary Incontinence, I then made my way back to my University home which is approximately a 2 hour journey. I guess one of the benefits of live online lectures this year is the freedom to access it anywhere – especially when you wake up 30 seconds before a 9am lecture and you’re quickly scrambling to log in before it starts! Once I had arrived, unpacked and overcome some procrastination, I continued making my notes on the medical conditions and learning objectives that we were expected to study for the week. I normally do this in advance of the GP placements that we have every Tuesday; not only for my knowledge in discussions, specific patient history-taking and clinical examinations, but also so I can withstand being grilled by questions from my GP tutor!
I am currently in my last week of studying Urology in the module of Endocrinology, Urology and Renal Medicine which is an 8 week module. Following this, we have many weeks of secondary care (hospital) placement and an OSCE which tests our clinical skills for that module. Immediately after this, I then have the ENT, Ophthalmology and Neurology module followed by the Gastroenterology and Surgery module. In my medical school, we start GP placements and hospital placements from literally the first week of first year, meaning very early patient contact; alongside PBL sessions, lectures/seminars, and other countless compulsory components we have to complete (such as medical research and audits). With the sheer amount of specialities and content that we need to study, this third year in my medical school is notoriously known for being the hardest out of the entire Medicine degree, so you can already imagine the energy levels and work-rate I’m running on!
Tuesdays in third year are GP placement days. Each PBL group (10 people that you are grouped with for the year) attend an allocated GP, with a GP tutor. Apart from the extremely early wake ups and getting home half-asleep and drained, these are actually one of my favourite days in medical school! For me, it’s the freedom to speak to and get to know patients, take their histories, clinically examine them, perform procedures and practice with medical equipment, which I love doing. Sometimes we do ‘hot clinics’ alone, whereby each person undertakes the role of the GP doctor for the afternoon, manage patients who have booked urgent appointments, and report back to our GP tutors. Since we have learned to do all this from very early on, it’s not seen as daunting anymore, and it’s almost like learning how to drive. I’d say it takes lots of practice and confidence.
Today, we started off the morning by reviewing some Urology topics, before meeting and speaking to patients face-to-face. The patients I saw had prostate cancer and benign prostatic hyperplasia. After introducing myself and gaining consent to speak to the patients (vital to do every time before talking to patients!), I took their history, but I didn’t examine the prostate as we were told by our GP tutor not to carry out prostate examinations today – otherwise each patient would have about five people all examining their prostate (not very comfortable!). Then, I had a telephone appointment (a recurring theme in GPs due to COVID-19) with a young female patient suffering from recurrent urinary tract infections. After speaking to these patients, I summarised the patient histories to my GP tutor and the rest of the group, as well as discussing their management plan, and any relevant points from the patient cases.
The evening was much more hectic. Since our OSCE is fast approaching and this was our last GP placement for the module, there was no better way than to finish off with a mock OSCE. Whether an OSCE is the real thing or a mock version, your heart will still race because it’s so brutal! In different ‘stations’ under time pressure, we were all examined on emergency situations relevant to the module, performing the thyroid status exam, the renal examination and prostate examination. After a long day, it was finally home-time.
Our anatomy sessions used to be on Wednesdays. In anatomy, we study and dissect cadavers (dead human bodies). This has moved online and is now on certain dates for the time-being. So, this academic year on Wednesdays, we have online PBL on Zoom. Each PBL group has their own PBL session running from 9am-12pm. During PBL sessions within your PBL group, each person presents and discusses their learning objective which they were assigned to research for the week - this could be via PowerPoints, Kahoots, Q&As etc., and this may be a medical condition. PBL sessions each week are related to the specific week of the module that we would be studying at the time.
This week, I presented a PowerPoint with a Q&A on the topic of testicular cancers. Next, we discuss the following week’s patient case-scenarios and learning objectives. Since it’s our final PBL session for this module, we ended the session with constructive feedback of how PBL has gone so far, and improvements to make for the next module of PBL sessions. At 1pm, it was time for clinical relevance (online again!). This involves a lecture from a consultant who summarises and consolidates everything that we should know for the week we have just studied, relating it all to real-life patients, and how we should be managing them as doctors in the hospital and in GP. Wednesdays are half days in my university, so pre-COVID times, this would be the day to do sports in the afternoon or just have the day to yourself. Personally, I would use the rest of the day to catch up on sleep! Especially if we had 8am anatomy sessions, or currently, the 9am PBL sessions. On other days, I may use it to run errands or have a self-care day. Today, I opted for a much-needed self-care day, but in the evening, I attended an online module revision session on Renal medicine and Urology.
This week, we were returning to secondary care (hospital) placement for 4 weeks. This is for 5 days a week, from 9am-5pm. So, from today, these 4 weeks are going to focus on the specialities we have just studied - Endocrinology, Renal Medicine and Urology. The days consist of attending clinics, ward rounds, operating theatres, clinical skills practice, multidisciplinary team meetings and performing clinical procedures. The days are quite intense, but I generally enjoy them as we undertake and practice the duties of a doctor. My day started at 6.30am, with just about enough time to ‘eat’ before I went to campus. On mornings of placement, I actually just survive on hot chocolate to be very honest! Everyone in the year-group is assigned to different teaching hospitals organised by our medical school, so we all meet at campus every morning, ready for the coaches to take us to the different hospitals. Once I arrived, I met with my allocated group for placement. We were then greeted by the Urology consultants, who later took us to see patients in the Urology outpatient clinic for the morning. Apart from getting grilled by questions from the Urology consultant (you actually just get used to this – or not!), I had to interpret abdominal X-rays, as well as CT and MRI scans of the kidneys, ureters and bladder. I also observed and took notes of patient consultations, which included kidneys stones, bladder cancer and genital abnormalities.
Throughout my time at the clinic, the consultant was trying to convince me to specialise in Urology when I become a doctor. Urology is incredibly interesting…but I can’t say I’m dying to specialise in it! In the afternoon, we learnt how to catheterise males and females (inserting a tube all the way into the bladder). My first attempt – I ended up splashing fake urine all over my tutor and leaving a puddle on the floor. But after a few more practices, it’s safe to say that I can now successfully catheterise!
Today I had a scheduled day off from hospital placement, so it was definitely my day to try and rest. But that didn’t last too long, because all the work I had to do was calling me to complete it…who else can relate to that feeling of guilt?! In terms of my week, it has been one of the more eventful weeks this academic term, since a lot in the medical school timetable has changed due to COVID-19 and lockdowns. But, now that the intense days of hospital placements have started again, I’m bracing myself for the short winter days!
Written by Third Year Medical Student (Anonymous), Norwich Medical School (University of East Anglia)
Cover Image Reference: https://www.ebony.com/life/nccu-grant-minority-health-disparities-2017/