As a first-year medical student, you can often feel like you are at the bottom of a very large and overwhelming mountain. I can remember that feeling very well, but it was also paired with a huge excitement that I was actually, finally doing medicine! 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 actually, finally do it too. This article is paired with another one I’ve written “A Week in the Life of a Final Year Medical Student”, which will be coming out next week, so that you guys can see how much development occurs and how different weeks are as you progress through medical school.
Hello and welcome to the week, we are a few months into the course, and we’ve just started the respiratory module. Monday is taken up with a lot of academic work, starting with lectures which cover several topics. Something I didn’t realise before starting medicine is that it has its own language (mostly Greek and Latin) and that subjects are split into a completely different system than I’d learned at school. For the respiratory system, our lectures are arranged throughout the week to cover things like this…
- Anatomy – what are the structures of the respiratory system (nose, mouth, trachea, lungs, alveoli), how are they supplied by arteries and veins, what nerves give them sensation and motion
- Physiology – how do the components of the respiratory system perform their jobs (how does oxygen enter the nose, how is it warmed, humidified and filtered, how is it transported to the lungs and then to the alveoli, how is the gas actually exchanged, how is carbon dioxide removed)
- Pathology – now we know how the respiratory system works, how does it go wrong (asthma, flu, pneumonia, COPD, cancer, tuberculosis etc), how do we tell it has gone wrong and how do we fix it
- Pharmacology – what drugs can we give someone to fix the above problems, how do they work, and what can happen if we give too much or too little of these drugs
A lot of the early years of medical school involves learning a metric ton of information, and it can be fun but also quite overwhelming. It’s really useful to try to organise your notes into bundles that follow the layout above and make shorter and more accessible notes for yourself instead of relying on large 70 slide PowerPoints from lecturers!
Tuesday starts with Problem Based Learning (PBL), where a team of 8 students are given a patient case to work through to apply some of the things we learned in Monday’s lectures. This week our patient has something called a pulmonary embolus (PE) which is an emergency, last week we had a patient with asthma, and next week it will be something different. It’s really useful to be given a patient case to work through, we can think about the questions we might ask the patient (history), what we might want to look for (examination), any tests we’d want to run (investigations), and what we might do to fix their problem (treatment). Because it’s the first PBL session of the week we focus on trying to figure out what is wrong with our patient (diagnosis). We also agree as a team what learning objectives we will look at for our next session on Friday, to finish this case off.
To go along with our ‘emergency case’ in PBL, we are taught how to do basic life support as a year group. This involves the standard training that anyone who works in a clinical environment gets – we are told how to check for signs of life, how to do chest compressions and rescue breaths, how to get the resuscitation team in the hospital to come and help us. I’ll admit I found this a bit scary in my first year and it felt like a lot of responsibility, but it also really felt like learning medicine.
Wednesday morning from 0800 to 1200 is spent in my placement GP. I arrive early and have a coffee with my GP who talks me through her patient list for today. Because we’re doing the respiratory module in university, she says I can take a history from and examine the asthmatic patient she has coming in a bit later. During the early morning I watch her speak to loads of patients with different problems, and she asks me questions as well as showing me how to examine things like a painful abdomen or a clicky knee. When my asthmatic patient arrives, the GP lets me take the lead and take a history from the patient, listen to their chest with my stethoscope and look up their medications on the system. I feel a bit awkward asking the patient lots of questions, but she gives me some great feedback and some pointers for improvement in the future.
Wednesday afternoon is free, so I scurry home to try and do some additional reading and sort out my notes so far for the week. I found arterial blood gas (ABG) analysis difficult earlier on in the week, so I focus on that to try and improve.
Thursday morning is an anatomy workshop back in university, we are lucky enough to have pro-sections which means we have cadavers that have been pre-dissected and preserved so we can study the lungs in detail. We have excellent teaching from anatomy tutors who show us the structure of the lungs, the arteries and veins, and quiz us on different pathologies. There are also some interesting practical bits they show us like how you put in a chest drain so that it enters the chest wall but doesn’t puncture the lung.
The final part of Thursday is taken up with a lecture and then some group tutorials which look at ‘psychosocial’ elements. These are some of my favourite lectures because they look at why patients behave the way they do, what factors can influence how patients react or respond to treatment and other psychological elements of their care. This is far removed from the ‘hard science’ of medicine but it’s important for understanding patients and facilitating the best care for them.
Friday morning is clinical skills, this is where we learn how to examine patients and focus on what we would actually be doing as a doctor with a poorly patient. This week we learn the respiratory examination, which is looking at a patient’s face, hands and chest to see if there are any ‘signs’ of respiratory disease as well as checking their chest expansion, if their trachea is deviated, if they have pus or fluid in their chest by tapping on it, and then listening to their lungs with the stethoscope. I find all this hard to fit into my head in order, but I really appreciate working with other students to practice it and I feel like if I keep at it, I can learn it really well.
The week is finished off with PBL again, and now that we’ve all been saturated in respiratory knowledge for the full week the group feels much more confident in deciding what we’re going to do for our patient in the case we were given at the start of the week. I still feel like there’s loads I need to learn, but I’ve covered so much that I’m looking forward to seeing what’s new next week!
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Written by Charlie Bailie