This event was run by Year 3 Medical students from Manchester University.
In the morning we were all placed in groups of ten with people we had never met before. We were then given a mock PBL case on Cystic Fibrosis and expected to go through it with the guidance of a medical student who was playing the role of a tutor in this situation. I took the role of being the chair in the first half of the session and then became the scribe in order for me to experience what it is like to play different roles in a session like this. It was really interesting case (which I have attached at the back) as I had a small background knowledge of Cystic Fibrosis from GCSE and was keen to learn more.
We first read through the case as group and then discussed any words we didn’t know the meaning of with the help of the medical student. This made me really understand the importance of working in a team during a PBL session as we had to make sure that everything was understood by each member of the team before progressing. After fully understanding the case we all highlighted cues in the case study which the medical student told us was there to prompt us to investigate something further. I really enjoyed being part of the discussion and enjoyed listening to everybody’s ideas on what certain symptoms could represent. We were then asked to construct a learning agenda structured under the four headings of: Anatomy, Physiology, Pathology and Psychosocial Development. I learnt that Anatomy is in simple terms, where in the body the issue is; Physiology is what the normal function or state of this particular part is; Pathology is about how it’s different in this particular case and the Psychosocial development is about the effect this illness can have on social behaviour. It was a great insight to be able to see how medical students learn and experience the amount of self-study and individual learning that is required.
After the session was concluded, we were given the opportunity to go through some scenarios playing the role of either a patient or a medical student who has been asked to find out why the patient has come to the GP. I learnt about the importance of using open questions to allow the patient to express their feelings and elaborate on their problems. However, I have also learnt to recognise the relevance of using closed questions in certain circumstances, for example, when a doctor requires very specific information from a patient. I learnt to use the ICE (Ideas, Concerns, Expectations) model when speaking to a patient to enhance communication and I found it very useful during these scenarios. After practising with other college students I then had to speak to a medical student who acted as a stimulated patient. I found it extremely beneficial as it provided me with experience on have to consult a patient effectively as well as ask personal and sensitive questions to a patient.
During these stimulated patient scenarios I also learnt a lot about confidentiality. I found it very interesting to learn about the Gillick Competence. This is a law which allows a child who is under the age of sixteen to consent to their own medical treatment without the need for parental consent or permission if they are considered to be medically competent. I learnt that this also applies in the reverse situation, for example if an adult is not considered to be capable of making life changing decisions independently, they may require somebody else to consent their treatment; like the example we came across of a gentleman who had Schizophrenia causing him to have hallucinations and believe that food and water are toxic. Despite his age of 32 years, his mother had to make the decisions for him. Upon learning about this I remembered the ‘Inside The Ethics Committee’ radio programme which I once listened to where a 14 year old boy was able to refuse chemotherapy for a tumour which was very treatable. His parents and doctors wanted the chemotherapy to go ahead, but due to the Gillick Competence his decision was respected.
I was also given the opportunity to learn four practical skills which I thoroughly enjoyed. The first of these skills that I learnt was how to measure a person’s blood pressure accurately. I learnt that when the heart beats it causes a temporary rise in blood pressure. Therefore, when measuring blood pressure, the larger number represents the blood pressure as a result of a heartbeat and the smaller number represents the blood pressure when the heart is not beating. The next skill that I leant was how to test reflexes. I was very intrigued to learn the technique for testing reflexes as I have always known it was possible but never been able to gain a reflex response due to not tapping the right place. I learnt that you must gently hit the tendon below the knee cap in order for the reflex to travel to the spinal cord and then back to the muscle. I then practised tis practical skill on my peers. I found is very interesting to reflect on the idea that reflexes are often used to test if the spinal cord for a certain area of muscle is working and not receiving a reflex response can be a sign of motor neurone disease.
The next I learnt was how to listen to a patient’s heartbeat. I learnt how to position and wear the stethoscope and listen to the four different chambers of the heart. The sound of the heart beating is due to the valves opening and closing. I also learnt about heart murmur and how a whooshing noise can be heard when a patient is suffering from this. This condition is caused by damaged valves which can either restrict blood from flowing forwards or allow the blood to flow backwards. I found this really interesting and reflecting on this idea made me realise how fascinating it is that a patient can be diagnosed will an illness by simply listening to the rhythm of their heart. The final skill which I was given the opportunity to learn was taking a measurement of a patient’s pulse. I learnt that the three most common sites that the pulse can be taken is at the Radial Artery (on the wrist), Brachial Artery (on the arm) and Carotid Artery (on the neck). I also learnt that about a few of the less common places to measure pulse, including the back of the knee, the big toe and the side of the forehead. I was mesmerised to learn about the vast number of things that a simple pulse measurement is able to tell a doctor about a patient and the importance of taking the pulse for a whole minute as opposed to 15 seconds and then multiplying it by four. I also recognised the importance of reflecting on the fact that you shouldn’t feel both of the Carotid Arteries simultaneously as it could prevent blood flow to the brain.
Finally, we also discussed some situational judgement questions concerning issues such as confidentiality, professionalism and what the ethically correct action would be for a medical student. I found these to be really though-provoking and interesting.