Final year feels like the end of a marathon, you’re tired and you’ve done so many miles your feet are about to fall off, but the finish line is in sight, and you’re so psyched to graduate! Applying to medicine, sitting A-levels, finishing personal statements, chasing up work experience and smashing aptitude tests can all be a bit of a drag so in this article I will outline what you can look forward to when you are successful, and you get to finally do it too. This article is paired with another one I’ve written “A Week in the Life of a First Year Medical Student” so that you guys can see how much development occurs and how different weeks are as you progress through medical school.
Monday morning is an early start, an 0800 induction at a local hospital that we’ve been placed at for our Critical Illness block. The later years of medical school are mostly placement based. You’re no longer taught loads of science in university by academics but instead you go onto wards and into clinics and theatres to see patients and you’re taught in hospitals by other doctors and healthcare professionals. This is quite a big change, and it’s a practical style of learning and teaching which I really enjoy. The year is usually divided into different placements such as medicine, surgery, critical illness etc. and they can be in different hospitals, so you get a real variety of placements and experiences.
Today we are shown round the teaching centre and the main hospital, we’re given cards to access different areas and logins for hospital systems so we can look up patients. We’re also introduced the module by the clinical teaching fellow. Later years module teaching is a lot more portfolio based, you’re expected to go onto wards and perform procedures, have case-based discussions and record it all in your portfolio, which you’ll discuss with your assessor at the end of the module to ‘pass’ the placement. All of this would’ve seemed really overwhelming for me a few years ago but the organisational skills I’ve developed on the course really help to keep everything on track.
This morning I’m in a 1:1 simulation training session with the teaching fellow. We’re in a hospital room with one of the simulation dummies and a resuscitation trolley. The teaching fellow gives me patient cases one by one and times me to assess the patient using the A to E method, make a diagnosis, interpret investigations and come up with a treatment plan in 10 minutes. At first, I feel out of my depth but as I start working on the first scenario, I can remember the things I’m supposed to do, and I start to assess the patient. I respond to numbers (she says blood pressure is 80/40, I cannulate the patients and give IV fluids), and order some quick tests to try and figure out what’s going wrong. When she asks me for a preliminary diagnosis, I tell her and then advise on what I think we should do next to try and treat what’s wrong.
I manage to complete all the scenarios in the time, with the right diagnoses. There were loads of problems including acute asthma attack, small bowel obstruction and pulmonary embolus (PE). Thinking back to first year it seems funny that it took a group of us about a week to figure out that our case patient had a PE and decide how we wanted to treat them!
Today we are having a group session to go through Intermediate Life Support, this is the next step up from Basic Life Support and we’re all quite nervous. The teaching is done by a member of the hospital’s resuscitation team, and he runs dozens of scenarios with us and teaches us how to try and resuscitate someone as a junior doctor. We are now able to check for signs of life, put out the appropriate bleep call for the resus team, start compressions and rescue breaths, put in a non-invasive airway, use the defibrillator and give drugs like adrenaline during a cardiac arrest. I actually say the words “stand clear for shock”, press the button on the defibrillator, and then tell my colleague to give the patient another dose of adrenaline. Aside from feeling like an extra on Grey’s Anatomy, I’m very conscious of the fact that as a junior doctor I will be expected to try to resuscitate someone like this in just a few months.
Today I’m down for A&E so I attend early in the morning to be assigned a section of the department and attend the handover of patient information from the night team. We are short staffed, so I’m asked to help out in the resuscitation bays in case there are emergencies. The nurse shows me how to put up an IV infusion and asks me to monitor one of the patients while she finds a senior. Later, the red phone rings and an elderly lady is brought in via ambulance with a very low heart rate and chest pain, I am part of the team that assesses her, and I assist with bloods, cannulation and investigation. I look at her ECG, write down all her medication from our online system and take a history from the patient as well as I can. I then summarise all this for my registrar and make suggestions about what we should do next. This lady isn’t in cardiac arrest, so I don’t get to use the paddles (oh well), but my registrar is happy that I’ve assessed her well and he agrees with what I’ve suggested. I can’t believe I’ve been able to do all this by myself!
Friday morning, I go back to A&E and this time I’m in minors, so I assess and take histories from walk-in patients with aches, pains, cuts and bruises. Not quite as dramatic as resus but I can still do a lot of practical things to help these patients and I have to think about a really wide range of medical topics that I revised a long time ago.
Friday afternoon I head back to the teaching block for a clinical skills drop in and ask the teaching fellow to show me how to perform an arterial blood gas (ABG). This is a scary procedure because it involves you placing a needle into the artery of the wrist to withdraw arterial blood for the ABG machine to interpret. Normal bloods are taken from veins, so it’s a bit more serious to stick an artery and you also can’t see it the same way you can see a vein. She demonstrates how to do it on a model, and I copy and practice a few times, getting a bit more confident each time. After we’ve got the technique down, she hands me some practice results from the ABG machine and asks me to talk her through them and explain them. I remember in my first year being totally bamboozled by ABG results and I’m really surprised and also a little proud of myself when I can talk her through each of the results. It also feels like a big step that I am now allowed to go and perform this procedure on patients during my next day in A&E next week. It feels like I’ve come a really long way from my first year in medicine.
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Written by Charlie Bailie