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    (Original post by n1r4v)
    That's pretty fiendish. How long does it take to get used to it?
    Took me about 4 days to adjust to their (completely) different system, from the different units to the 'consult' system to the 'orders' system (which is excellent, essentially it is a blank form where you write whatever needs to be done and the nurses will coordinate it, e.g. "book CT abdo, make patient NPO, start drug x dose y etc) but the hours are just nutty. And I'm considered to be on a 'light' rotation atm.
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    (Original post by digitalis)
    Took me about 4 days to adjust to their (completely) different system, from the different units to the 'consult' system to the 'orders' system (which is excellent, essentially it is a blank form where you write whatever needs to be done and the nurses will coordinate it, e.g. "book CT abdo, make patient NPO, start drug x dose y etc) but the hours are just nutty. And I'm considered to be on a 'light' rotation atm.
    Was it insanely difficult to organise?
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    (Original post by spacepirate-James)
    Formative exam on Wednesday. It doesn't count for anything ... but I've just realised that I've not adapted, at all, to university study and am basically cramming four week's of stuff into a few days. Eurgh.

    :teeth:
    Sounds like you've adapted just fine to me :p:
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    Just gave my preferences for next semester's optional modules. Crossed fingers that I get immunology with an MFQ exam and coursework, not biochem; with its single exam comprised entirely of essay questions.
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    (Original post by Kinkerz)
    Was it insanely difficult to organise?
    Well, a lot of paperwork, but that was just notorious for the school I organised through. In general though, it wasn't bad at all. Definitely an interesting experience and a great learning opportunity.
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    (Original post by Captain Crash)
    Tbh, that's quite standard for Surgery in many hospitals in the UK. The person doing my surgery job I'm due to rotate onto starts an hour early to see all the patients before the ward round at 8 and afternoon ward round starts at 5:30 despite the F1 hours only meant to be working to 5.

    Despite all the moaning about the EWTD, in practice, most people regularly work over.
    Man, surgery is a whole different ball game here. I can only speak for Medicine, but the residents work ridiculous hours, one of the R2s here (who work to like senior SHO level in terms of knowledge, autonomy and supervisory roles) on my service clocked 100 hours over 6 days last week. 100 hours, that is nutty.

    On our call day, the R2 started prerounding (20 mins per patient, including a two page progress note in the chart-she had 7 patients) to be done by 8 and then admitted to midnight, and then back the next morning to round at 8.

    They have little cards on the back of their ID badges (like the penicillin allergy ones) that are 'Fatigue precautions' that gives handy tips like 'if you are falling asleep whilst writing your progress notes, this can be a sign that you are fatigued'

    I mean, this must be like what the 'back in the day' system was here when people were doing q2/q3/q4 call, the residents are extremely good but you literally have no life outside of hospital and are almost permanently knackered here.
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    (Original post by digitalis)
    Man, surgery is a whole different ball game here. I can only speak for Medicine, but the residents work ridiculous hours, one of the R2s here (who work to like senior SHO level in terms of knowledge, autonomy and supervisory roles) on my service clocked 100 hours over 6 days last week. 100 hours, that is nutty.

    On our call day, the R2 started prerounding (20 mins per patient, including a two page progress note in the chart-she had 7 patients) to be done by 8 and then admitted to midnight, and then back the next morning to round at 8.

    They have little cards on the back of their ID badges (like the penicillin allergy ones) that are 'Fatigue precautions' that gives handy tips like 'if you are falling asleep whilst writing your progress notes, this can be a sign that you are fatigued'

    I mean, this must be like what the 'back in the day' system was here when people were doing q2/q3/q4 call, the residents are extremely good but you literally have no life outside of hospital and are almost permanently knackered here.
    You have an opportunity to have a close look at the way they work, do you think their system benefits the trainees? The patients? The bosses? The hospital?
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    Currently filling out my 'reflective diary'. On reflection it is making me depressed.
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    (Original post by GodspeedGehenna)
    Currently filling out my 'reflective diary'.
    Welcome to medical school.
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    (Original post by GodspeedGehenna)
    Currently filling out my 'reflective diary'. On reflection it is making me depressed.
    'Doctors are like diamonds. The more you reflect, the more you shine'

    Quote from our very first reflective writing lecture hehe.

    I remember when they were trying to deter people talking and messing around in the smaller lecture theatre (lecture given by video link there) and they said that they would put people on a report, make them sit in the first row... and lastly make them write a reflective essay.

    Which one do you think scared the students the most...
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    (Original post by Kinkerz)
    Welcome to medical school.
    We waste so much time on this stuff it's unbelievable. I take it that this is 'tomorrow's doctors' doing.
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    (Original post by Renal)
    You have an opportunity to have a close look at the way they work, do you think their system benefits the trainees? The patients? The bosses? The hospital?
    Hmm, I would say it is a mixed bag really.

    Medicine works around four medicine teams who are general medicine services, who take it in turns to admit. They then will call in speciality consults on their patients, who offer 'recommendations' and essentially are carried out. This can be very annoying because often they will just jump over your head and order tests themselves, carry out management etc so your actual involvment with the patient is limited to 'carry out renal recs' etc. From a continuity of care perspective, I think it is a better system. Everyone knows about all the patients very well and I think the q4 call system is excellent. Lots of times in the NHS I think patients can get dropped and sort of lost by the wayside.

    In terms of trainees, they operate at a lot higher level than their UK counterparts. I guess it is just more exposure really in terms of hours worked and experience gained. The team is very close knit and there is a constant flow of information between everyone all day long, we actually spend most of the day talking to each other and updating each other on patient status. Formal teaching is superior. We have a morning conference daily which is essentially discussing a single patient's diagnosis and management and a formal noon lecture on a variety of topics per day. In terms of supervision, the attending rounds every day on the patient and every resident progress note and recommendations must be checked and countersigned but apart from that, the residents are left to their own devices. I don't think supervision and availability of seniors is an issue really. Another thing I forgot to mention (but very hospital dependant) is the level of ancillary staff. It is amazing, you never have to do bloods, cannulas,ABGs, ECGs etc here, all considered 'scut work' nor do you ever have to book any investigations etc yourself. All done by very well trained staff.

    In terms of patients, I think they generally receive a level of care that is about the same or a little higher than the UK. There is a very low threshold to order complex investigations (MRI/CT/nuclear imaging ordered and done same day) and more broader batteries of tests (urine electrolytes and osmolality/FeNa calculated on basically every patient). I think a lot of money is wasted on unnecessary in depth evaluation of patients however. The insurance system rears its ugly head often, you have lots of underinsured patients who are in such poor health physically it is shocking. Hospitals regularly have to discharge patients because their insurance doesn't cover them and they literally have to get a cab over town to a hospital that does. Medication is always an issue for the same reason, some plans cover things whereas some don't.

    Attendings are very knowledgeable and are much younger in terms of training years. GIM attendings are there only after three years of training and they are excellent really. A lot of career decision choices are based on projected income, largely driven by issues of student debt. As I said, all round daily by law.

    All in all, mixed bag really, but I think the system favours trainees here by far. In terms of knowledge, formal training and autonomy, why do 10 years of postgrad training when you can be done in 3?
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    (Original post by digitalis)

    All in all, mixed bag really, but I think the system favours trainees here by far. In terms of knowledge, formal training and autonomy, why do 10 years of postgrad training when you can be done in 3?
    Does that mean that after 3 years they get to stop working 100 hour weeks and have a life? And surely even the increase in hours cannot get 10 years of experience packed into 3?

    Not sure it's a lifestyle I'd want, but does sound very interesting.
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    (Original post by Becca-Sarah)
    Does that mean that after 3 years they get to stop working 100 hour weeks and have a life? And surely even the increase in hours cannot get 10 years of experience packed into 3?

    Not sure it's a lifestyle I'd want, but does sound very interesting.
    That's the beauty of SSMs/electives really, it opens your eyes to how medicine is done differently across the world. For good or for bad, it definitely is interesting.

    Well after three years, that's it really. Your a consultant in GIM effectively. You can work as you like: set up a clinic, as an internist...work in a hospital as a hospitalist...work part time, do as much or as little as you want, do a fellowship to subspecialise etc.

    I think a lot of the reduced training time is based on the structured postgraduate training. It really is excellent in that regard. If you look at foundation years, they are pretty crappy in terms of training. They are essentially service jobs. Yes, we may have useless assessments like CBDs and mini-CEX but they just seem assessments for the sake of doing assessments.
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    (Original post by digitalis)
    That's the beauty of SSMs/electives really, it opens your eyes to how medicine is done differently across the world. For good or for bad, it definitely is interesting.

    Well after three years, that's it really. Your a consultant in GIM effectively. You can work as you like: set up a clinic, as an internist...work in a hospital as a hospitalist...work part time, do as much or as little as you want, do a fellowship to subspecialise etc.

    I think a lot of the reduced training time is based on the structured postgraduate training. It really is excellent in that regard. If you look at foundation years, they are pretty crappy in terms of training. They are essentially service jobs. Yes, we may have useless assessments like CBDs and mini-CEX but they just seem assessments for the sake of doing assessments.
    So presumably they're working with a far higher number of doctors per patient if they can offer more training and less pure service provision?

    How hard was it to organise? I need to start thinking about elective in the next few months and I'm limiting myself to developed world and English speaking, so it's fairly high on my options list.
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    Thinking about elective now - I'm tossing between Australia where it'll be like here but different caseload/patients (i.e. can still do things like cannulating/assisting in surgery etc) or being in the US where it's an observership.

    Thanks for your post digitalis - really very interesting and one of the better posts in a while . *reps*
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    I don't think I could afford to go out of the UK for my elective unless I manage to snag some all-encompassing grant of some sort.
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    (Original post by Philosoraptor)
    Thinking about elective now - I'm tossing between Australia where it'll be like here but different caseload/patients (i.e. can still do things like cannulating/assisting in surgery etc) or being in the US where it's an observership.

    Thanks for your post digitalis - really very interesting and one of the better posts in a while . *reps*
    What about Canada? Or is that pretty much just like the US? I think Aus is probably top of my list at the moment. Any idea what kind of thing you want to do?
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    (Original post by Becca-Sarah)
    So presumably they're working with a far higher number of doctors per patient if they can offer more training and less pure service provision?

    How hard was it to organise? I need to start thinking about elective in the next few months and I'm limiting myself to developed world and English speaking, so it's fairly high on my options list.
    Hmm, well yes and no, I just think that by having more hours in the day it allows you to do both really. That is the main problem with EWTD, by limiting yourself say to a 9-5 you can't do both and of course patient care trumps teaching. That was the whole deal with the surgeons a few years back.

    Our team consists of the sub-i (note, importantly, that the sub-i is actually considered part of the team here, whereas in the UK finalists still have that observer thing going on), two interns, a resident and the attending. The average team census between Red, Blue, Green and Gold is 20ish atm. Each intern has a hard cap at ten patients (which is considerable, taking into account the 20 minutes per patient preround before the 8AM round), sub-Is cap around 4/5.

    It was a lot of paperwork to organise, but I am told it is just the particular school I went through. Had to fill in a form, get a list of all the rotations I had done to date, get a transcript, get MDU/Health insurance (free from uni) a letter of recommendation and a bunch of other stuff iirc.


    (Original post by Philosoraptor)
    Thinking about elective now - I'm tossing between Australia where it'll be like here but different caseload/patients (i.e. can still do things like cannulating/assisting in surgery etc) or being in the US where it's an observership.

    Thanks for your post digitalis - really very interesting and one of the better posts in a while . *reps*
    Thanks man. Why would you be doing an observership?? On the contrary, the opportunity to do *more* as a med student exists in the US, through a sub-internship or consult rotation.
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    (Original post by Becca-Sarah)
    What about Canada? Or is that pretty much just like the US? I think Aus is probably top of my list at the moment. Any idea what kind of thing you want to do?
    V similar, but lot less unis who are in high demand. U of Toronto has a two week application window per half year per year. Need to apply like 6/12 in advance and pay a like 250 pound private medical to go (put me off going to do mine there)
 
 
 
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