The penultimate block of 3rd year I have to tell you all about!
Respiratory was another 4 week block and it kind of surprised me seeing this side of Medicine. I would have thought different general medical specialities would have been quite similar, but this Respiratory block was completely different to the Cardiology one I had earlier on. Respiratory had a lot of the patients had chronic conditions, so for the time that we were on there the patients didn’t change that much. I was also quite surprised by how severe respiratory conditions can be and can affect some patients in particular.
On the Respiratory ward there was 3 teams focussing on different aspects of Respiratory Medicine: Interstitial lung disease, cancer, ventilation. I learnt a lot about oxygen, ventilation and chest x-rays of course! We had a high care respiratory unit as an extension of our ward so there was the opportunity to learn about and see different examples of ventilation quite a bit.
Overall respiratory was quite a relaxed block. There wasn’t as much teaching as Surgery and the ward rounds weren’t what I’d describe as hectic so our weeks were quite free; something which I welcomed after the exhaustion of Surgery.
Throughout the year we had 4 of these “sim sessions” and that’s what started with on that particular morning. They were held in the simulation suite where there was a life-like mannequin acting as a patient and it was set up like A&E. Each session we were divided into groups, promoted to “doctors” and had to go in a deal with the situation. The point of these sessions were to emphasise the effect errors in our decision making and team working capabilities. So each session something would happen and you’d have to deal with it as a group and then you’d reflect on your performance. I want to give you some examples, but I don’t want to ruin the experience for next year’s 3rd year medics that might be reading, so I won’t.
In the afternoon I had that long IPE (Interprofessional Eduction) session that we have to do once a block. This is essentially a shift we do with the nurses, helping them out with tasks. On this shift there wasn’t many skills or little jobs the nurses had left to do so I spent that time chatting to different patients on the ward.
Each block we have to get a list of activities completed in our own time (4 presentations, 4 clinical examinations, 12 patient histories etc.) Respiratory was a bit of a difficult ward to get these logbook tasks done, so there was extra sessions we could go to if we needed to present a history or do an examination; so that’s what I was doing at 8 am on Tuesday morning.
After that I had the Cough Clinic. Before I went to this clinic I thought it would be people with different lung conditions that are experiencing cough as a symptom, but instead it was all focussed on Idiopathic Chronic Cough. This is was interesting and hearing each patient’s symptoms was too – I had never really considered “cough” to be a bit of a specialism in its own right.
I spent my free afternoon working on the week’s case.
Clinical debrief in the morning, which if you’ve read my other posts about 3rd year you’ll know is a weekly session we have to practise our clinical reasoning skills and discuss the events of the week. This week I presented a case of multiple bilateral pulmonary embolism. In the afternoon I had a bedside teaching session where we practised some examinations and I was able to get one signed off as part of my logbook.
The ward round this morning was based in the team looking at interstitial look disease. Each patient we saw the consultant shared the background of and talked us through their test results which was helpful. I was also able to go away and talk to some patients and later come and present to get another logbook task done!
In the afternoon I went on the ward with a friend and we practised some examinations on patients OSCE-style. So she watched like an examiner whilst I examined and I did the same for her and then we gave each other feedback. We were doing this because our mock OSCEs were coming up in 2 weeks from then and we can get real patients in our exams so the more practise we can get, the better.
We had some Pharmacy teaching which was really useful – I’m always in awe by how the pharmacists remember every single medication and literally know the BNF like the back of their hands! In this session we were given an overview of how pharmacy work son the wards and what types of things you’d ask of a pharmacist as a junior doctor. We then went over and practised pharmacy tasks that we can be practising now as 3rd year students.
And to end the week we had our weekly Themed Case Discussion where we review and apply the knowledge we’ve gathered from the week’s case.