TSR Med Students' Society Part III

Yeah, I'm starting to feel pretty crap at the moment as well. Don't get me wrong I had lack of motivation last year but this year I struggle to find a reason to get out of bed unless my girlfriend is coming over. Not even video games keep me entertained for very long which is ****ed up.

SSC week with Med Ed next though, hopefully it'll perk up a bit. I'm 99% sure we haven't covered hypothermia, I don't even see where that would fit into the wierd blocks of Metabolism, CR, Met, Loco and B&B. Maybe CR? It definetly wasn't in CR though, nor met.

You made me LOL! I saw a great cartoon about PRs the other day:

x

x

I think partly the problem is the huge variation between consultants. Take last term for me. I was fortunate to be under 3 consultants and got an hour and a half teaching from at least 2 of them a week.
It was then a busy firm and this being painfully obvious I offered to help as I could so wrote in notes in rounds, did bloods when phlebs didn't turn up, rewrote drug charts (obviously checked and signed after), orders tests etc. They appreciated it so then spent more time teaching me (of the cuff stuff like a crash course in the difference between t1/2 scans because the SHO had done a masters in it) and then was given a patient to look after by a reg for a while and went and clerked new people we got in handover. I really enjoyed the firm and as a result stayed late a few times because that is when things seemed to be happening although spent the entire time thinking I didn't know enough!
However this time I am doing much less, seems to be the way of the team (plus a less busy firm and huge number of juniors) but I have (I think) persuaded the reg to let me see patients in outpatients first and then present to him. This is provided clinic isn't overrunning etc.

There are still all the problems you talk about though. I also think we should be made to do more on calls (our hospital last time made it easy to do and one on call mandatory to be signed off...the new one makes it a hassle to go on call which is a major deterrent)

I think less students on wards would be good too.
I might have done more because I have not been in big teaching hospitals too. Ah well we will see how they go in final term...

Sorry to butt in but this is a really interesting point and related to a question I have for your student medics! (notice how I said student medics, not medical students....)

Anyway where I work we're very fortunate in that I have my own doctor per bay and as there is one nurse per bay- it means instead of me wandering the ward finding a doctor covering the whole ward, i get my very own doctor!

Now the 5th year medical students have to spend a week on medical admissions and a week on surgical. They spend the week with the HO/SHO in my bay and either observe, shadow or take histories, practice clerking etc which is done a lot!

However One of the students shadowing my doctor last week was lingering around my desk looking bored, think he was waiting for the doc to come back from lucnh. So I offered if he fancied taking some bloods from a patient, and putting a venflon in and if he wanted to do a catheterisation with my supervision whilst he was waiting as I had (rarely) a bit of time on my hands and he seemed very bored but nice!

Anyway he looked REALLY surprised and like I was ordering I said he didn't have too but if he wanted it would be good practice for when he's an fy1! Anyway, he told me he'd never put in a venflon before without someone watching him?! How normal is that and whats expected of medical students in terms of clinical skills such as this towards the end of their course?

So I offered to supervise him doing that, despite probably having less experience than him in cannulation as I'd only started my package and not had the teaching session yet!

He did the bloods fine no problem, and the catheterisation he was ok-ish at it was a female one and just needed prompts/reminders which (if I'm right) in my trust most medics don't get my practice doing as the nurses tend to do them. However he told me after he'd never done one on a patient and wasn't even sure if he was allowed to do it with not a doctor supervising but just a nurse? (Although I think he needed a doctor supervising to get it done in the log book?)

So I was chatting to fy1 after and he said something similar to you that the medical students need to get in more with their training and become PART of the team not the observers- but he said it could work with them being 'assigned' a mentor similar to how student nurses work we have someone who we do the same shift pattern as and work aside and they supervise us. However doesn't this already exist?

Just think it's interesting, you've raised a really good point. At the end of the day on a ward it's all staffs responsibility to make sure ANY student has a positive learning experience, and fair enough maybe some of it does from medical students who maybe aren't assertive enough to ask? Or the culture they're in by the senior medical team not to get involved?

My ward very rarely has student nurses so i'm always happy if there is a medical student around as there are always loads to give them a hand or get them involved or help with something. Mainly as I hate to see them lingering and not doing anything because it must be so boring!



Sorry to butt in!

That's great, I'm sure that student really appreciated it! Nurses are allowed to supervise med students, I learnt how to set up infusions and draw drugs from them. Especially practical stuff like that and catheters etc. Sometimes it won't be relevant to medicine, but I think they will just say if they are already OK at it or don't need to do that particular topic.

The skill set is massively variable in the final year of medicine, the episode of junior doctors and the cannula disaster also showed that. I know plenty of people who have not cannulated successfully yet or done an ABG; I have never inserted a urinary catheter or done a PR.

The mentor system is a great idea. I just think in general, the ward based setup is very very solid in nursing education. They have all these mentors, ward contacts, supervisors...get given shifts, "student nurse: jane and julie" written on the whiteboard etc.

Medicine is a bit more loose, which can be a good thing as it gives you freedom and independence, but also allows for people to slip through the cracks quite easily. For example, I pitched up to my current firm and there was no timetable made for us, so the head of education literally made one up on the spot. We were then told to pitch up at 9. The teams therefore weren't expecting us, didn't know what we were supposed to be getting out of this module, where are competency level is etc...coupled with the very brief firms that we seem to be doing (one week in theatres, two weeks on the ward, one week in ITU, one week back on the ward) it doesn't give much time for the team to ascertain the above. I take it your mentoring things are for longer periods than that?

Medicine is a bit more loose, which can be a good thing as it gives you freedom and independence, but also allows for people to slip through the cracks quite easily. For example, I pitched up to my current firm and there was no timetable made for us, so the head of education literally made one up on the spot. We were then told to pitch up at 9. The teams therefore weren't expecting us, didn't know what we were supposed to be getting out of this module, where are competency level is etc...coupled with the very brief firms that we seem to be doing (one week in theatres, two weeks on the ward, one week in ITU, one week back on the ward) it doesn't give much time for the team to ascertain the above. I take it your mentoring things are for longer periods than that?

Just saw your edit, hmm as the above, I can only speak for my own experiences. The handful of emergencies I have been to, I have mostly been an observer (most were in A&E). Done compressions once. Put in a cannula in a peri-arrest situation. To be honest, I don't think there is much more medical students could do in arrests really, we would generally turn up with the crash team if ever and there are enough bodies in that anyway. Might be a bit different if it happened on the ward like students nurses are based on one (having said that, it happened to me once, woman started getting acutely SOB: just sat her up, put on some O2, got venous access and bloods, did an ABG and got the nurses to fast bleep the HO on call and get an ECG done: isn't much else I could have done as a student really)

It doesn't make sense that clinical skills are so variable I get that there can be just circumstantial in terms of what you can do/see but I'd feel better knowing I'd just bleeped a doctor to do a catheterisation knowing he had just as much experience as myself in them, not less! I never understand why only doctors can do male catheterisations...when student nurses are trained to do them (and we can do them in community, but not acute!) so we get loads of experience doing them whilst in community. Yet when we're qualified we have to request a junior to do them who'd potentially done them a lot less than myself!

Yeah, I totally agree, an uncomplicated male catheterisation should definitely be able to be done by the ward staff. Maybe not in some complex urological patients or pelvic trauma, but otherwise it is fine. Hell, even if it was on a complex urological patient, I don't see a dr digitalis the house officer who's never done one on an uncomplicated patient will do any better!!

But you have to, because you're the doctor.

(And the nurses won't take 'responsibility')

(Although If i was a nurse In scotland I'd be able to do all forms of catheterisation and trained from day one to take bloods and cannulation!. I know where I'm moving too...)

Got a 2 week placement all the way in Doncaster next month

Umad?

Is doncaster a bad hospital? Or is it just the distance?

Seems like you got the better deal!

OSCE was actually quite fun in the end No more exams of any kind until June!


By the way... is there a special technique to percussing.. or do you basically just need to practise? We had a chest examination as one of the stations and I couldn't get ANY sound when I was percussing the "patient"'s back!

OSCE was actually quite fun in the end No more exams of any kind until June!


By the way... is there a special technique to percussing.. or do you basically just need to practise? We had a chest examination as one of the stations and I couldn't get ANY sound when I was percussing the "patient"'s back!