East Lancashire Hospitals Trust Work Placement – Day 1
Teaching Sessions with Year 5 Medical Students
For my first session I attended a lecture presented by a Foundation Year 1 doctor with year 5 medical students on data interpretation. The students had to practise making diagnoses based on the values of different substances in the blood and a short past history of the patients. I sat with a student who explained the diagnoses to me and got me involved in considering the options of what possible diagnoses of the scenarios could be. I was mesmerised by the logical and critical approach that was taken by the students in order to arrive at a final decision. This taught me the importance of problem solving skills and having confidence in your decision making abilities as a doctor. I also learnt that pursuing a career in Medicine requires an incredible amount of dedication and commitment as you have to make sure you know all the warning signs of a particular illness and keep up to date with any new symptoms which are discovered through scientific research.
I also learnt about actions which could have an effect on the blood results, for example, taking blood from an arm which also has a drip attached can cause dilutions in all the substances in the blood and give inaccurate results. In this case, the blood test should be repeated, but by taking blood from the opposite arm. The students had to also state which further tests they would send the patient for in order to prove their diagnosis. It’s imperative that this is done quickly in order to prevent bad consequences of a patient, for example, high levels of potassium in the blood can cause the heart to stop. After this session I was also able to appreciate the importance of personal details of a patient, especially age when making diagnoses as certain illnesses are more common in certain age groups. In the session there was also an emphasis of speaking in an articulate and professional manner, e.g. by saying “there’s mild hyperkalaemia” as opposed to “the potassium’s a bit up.”
The second session was case based learning with the Year 5 students. Two students presented a case of a patient which they came across on their placement. Each person in the group has to then suggest a possible diagnosis which is discussed in terms of arguments supporting and opposing their idea. I think this is an effective way of learning as it allows the students to constructively criticise and recognise mistakes in their own work. I learnt that the important factors to consider when making a diagnosis are: medical history, drug history, social history and family history.
The final morning session was the Mini Grand Round in which I got the opportunity to watch medical students present a five minute speech on any medical related topic of their choice. The first speech was about DVLA restrictions and the medical aspect of fitness to drive. I learnt that health conditions such as Epilepsy, Diabetes, Dementia and Cardiovascular illness can provide a doctor with the right to withdraw a patient’s fitness to drive. I found this really interesting as I had never considered a doctor to be responsible for matters like this. I now understand that as a doctor you have a duty of care to everyone, including those your patient may harm as a result of not being safe to drive. I learnt that doctors require a very strong and assertive character as by not allowing somebody to drive you could become involved in direct conflict with them for limiting their independence. I was able to recognise the issue of not being able to inform the DVLA of a patient’s inability to drive safely due to confidentiality reasons and only the patient can do this themselves.
The second mini speech was on Temporal Arteries. I was very shocked to learn that even if the biopsy shows a negative result, a patient will still be treated for Temporal Arteries. The final talk was on Traumatic Head Injury. The student presented different types of head injuries, their shapes and the part of the brain they affect. These two medical talks in particular were difficult to understand due to a lot of medical terminology which I was unfamiliar with being used, but they still provided an invaluable insight into the expectations of a medical student.
In the afternoon I spent my time in the Histopathology, Haematology and Microbiology Labs. They were all quite similar and allowed me to explore an alternative perspective of the role of a doctor as a researcher in a laboratory. I think this experience provided me with an invaluable insight into the medical career as I was not aware that the biomedical and biochemical testing actually takes place in the hospital itself. I was shown the process in which various tumours and cells are tested and the automatic machinery which is now available to carry out blood tests. I was particularly amazed by seeing the blood donation fridge with all the different blood types in the hospital. I learnt that blood has different expiry dates depending on its type and the person it has come from, but it’s typically 2-3 weeks.
Something else which I found to be really fascinating was watching the histopathologists working on a tumour which was extracted from a patient’s neck. They were cutting the tissue up in order to extract the lymph nodes and check to see if the tumour had affected each of these lymph nodes. I found this to be a really interesting procedure in the way that it allows the doctors to detect the areas of the tissue which the cancer has affected. If there isn’t clear tissue all the way around, they would be able to determine which part of the neck, in this case, may still have cancerous cells left in. The patient may then be taken for further surgery or given a dose of radiotherapy. I was given the opportunity to feel the cells and I could recognise the cancerous cells to be harder than the unaffected ones and typically white.
In the haematology unit I was shown various microscope slides of patients’ bloods with different red/white blood cell counts. It was fascinating to be able to compare the difference between a high red blood cell count to a low one. I learnt that the red blood cells and white blood cells can be seen directly under a microscope and placed in specialised machines which can detect their count. However, other substances such as potassium and sodium in the blood can only be tested for chemically. I thought this was really interesting as in the morning the medical students were diagnosing illnesses based on these results which were presented to them, and now I was able to see the process in which the results are maintained.
Finally, the Microbiology lab I watched the preparation of petri dishes in order to see the effect of certain antibiotics on certain bacteria. The petri dishes were made from various substances, an example which I was very surprised by was horse blood. The idea that petri dishes were once composed of human blood surprised me even further. One of the microbiologists mentioned a case from a few years ago in which a patient had an infection in their foot. After various testing and experimentation, the department were still unsuccessful in finding an antibiotic which the bacteria wasn’t resistant to. Unfortunately, the patient was left untreated and eventually left the hospital and then the country. This highlighted and allowed me to appreciate the importance of doctors not over-prescribing antibiotics as patients like the one in this example will now be able to pass these resistant strains on to other people.
Another interesting case was the example of a patient who was suspected to have contracted Ebola and had been admitted to the hospital. Everybody was required to take extra precautions and wear specialised garments in order to prevent contamination when carrying out the tests. This allowed me to understand the importance of these procedures daily in the small laboratory at the hospital which deals with contagious diseases on a regular basis. Overall I was able to compare the difference between laboratory work as opposed to clinical work of a doctor. From previous experience, I know that I really enjoy the patient based role in which a doctor can directly interact with the patient, but this was a very unique and great insight.