The End of An Era

After 9 years in the city where I studied for my BSc, went to medical school and then did my foundation training, I will be moving on next week. Just a weekend of night shifts and 350 miles stand between me and the next chapter in the Learnaholic Chronicles.

In particular, I'd like to take this opportunity to reflect on the crazy, stressful, interesting, exciting years that are foundation training. A year ago, I wrote this post as a sort of FY1 survival guide for all the new doctors starting their training. This year, #tipsfornewdocs (started by people much wiser than me, I must point out) seems to have gone viral and everyone from the highly entertaining Medical Registrar on facebook to the British Medical Journal keen to impart their words of wisdom onto the fresh faced new graduates about to be let loose on the wards. With that in mind, this isn't going to be a list of tips - there are loads of them out there. It's just my thoughts on what the last 2 years have meant and what I've learnt.

Setting foot on the wards 2 years ago was the start of a huge learning curve. As I've mentioned before, I had a bit of a difficult time outside of work in the first month of the job, so in particular the first few weeks were pretty tough. Slowly, though, I think I've managed to find my feet.


There are some things that I think I will always remember. There are a lot of firsts for junior doctors, and those tend to be pretty memorable. From the first death I confirmed or the first time I told a relative their loved one had passed away to the first time I did a lumbar puncture or correctly interpreted a CT scan, those "first" encounters tend to be pretty memorable. Some of the memories make me cringe, others I think I dealt with pretty well.

Then there are the people you just won't forget. I'm not sure why certain stories stick with me more, certain patients are more memorable than others. Often it's about timing; a particularly memorable patient is often one who I've spent more time with and got to know properly. Other times, it's been a particularly intense encounter, or a patient who has reminded me of someone I've known personally. From the lady who hugged me and thanked me after I told her her brother was dying to the patient with terrible venous access who I'd have a daily giggle with whilst attempting to get his morning bloods, some people are just etched on my brain.

I've attempted before to try to express how I feel about the encounters we have in medicine. I still haven't worked out exactly the way to say it. I suppose the key thing I've learnt over these past two years is just how much of medicine is about people. I love the detective work involved in working out a new diagnosis. I love the science which helps me to understand why condition x produces symptom y and is treated by drug z. But a doctor who gets every diagnosis right and knows the molecular mechanism behind everything he does will only get so far. I'll admit to having rolled my eyes at the "fluffy" bits at medical school, but if these couple of years have taught me anything, it's that without the fluffy stuff, we're not much use at all.

Working Girl

Apologies for the unintentional hiatus in posting recently. Things have been rather busy recently. I have moved into a new flat, graduated, been away for a week and started work since I last posted (there's also a boy on the scene but I shan't bore you with the details).

My graduation was absolutely lovely. I was lucky enough to graduate on the one day where it wasn't absolutely tipping it down with rain. Lots of close friends were there and it was a very happy occasion with plenty of wine and Pimm's too. The icing on the cake was my friend's boyfriend proposing to her just after the ceremony - very exciting and I'm delighted for them :-)

I've also had another week away with Over The Wall. Anyone who has read my posts from last summer will be aware that I'm something of an OTW evangelist. Once again I had an amazing week and met some really inspiring kids. I hope I can arrange my leave/days off so that I'm able to go next year - I'd be absolutely gutted if I couldn't. After a wonderful but tiring and emotionally draining week, it's sometimes easy to forget the real reason we do this, but the comments from some of the kids and their parents after they'd got back just sum it up so well. These are two of the quotes which really made this year worthwhile for me.

"I have just recently came back from the 2012 Tulliallan "over the wall" camp, i would just like to say thank you now because i did not have time to do it before i left.

Thank you for.....

Helping me push myself beyond myself beyond my limits
Making me enjoy at first seemingly immature songs :).
Letting me feel Normal for once"

"Thank you so much for letting me join you again this summer, for another amazing camp. This past week has been the best week of my life. I will never forget the laughs, songs, the dances, the tears (emotional/happy ones!), and the memories that have come out of it. I have met some fantastic people that will inspire me everyday for the rest of my life. It is truly impossible to put an Over The Wall camp into words. From the staff and volunteers, to the campers: every single person at Over The Wall is just incredible. Your camps are the highlight of my year and heaven on earth for me. I look forward to seeing the photos that were taken this past week, which I will treasure forever. Leaving camp this morning was so difficult and emotional for me - but that shows what a great time I've had there.
What you do is wonderful.
Thank you."

I'm feeling quite emotional reading those back. I know both the kids who wrote them and they are really wonderful young people who have overcome some really tough challenges but are none-the-less bright, talented, enthusiastic and kind.

I could talk about camp all day (in fact, I pretty much do) but I should move on to what I imagine is more exciting for most people who read this: starting work!

I was one of the slightly unfortunate people who drew the short straw and my first ever shift was a night shift. Although it was pretty nerve-wracking and hard going, I feel like in only two shifts I learnt an awful lot and am already much more confident than I was before starting. I've also now done 5 day shifts on the ward where I'm based. I'm quite lucky in that the other doctors are very supportive and helpful and our consultants are happy to be contacted if we have any queries or concerns. The nurses, therapists etc are also all lovely, which makes the whole process of settling into the job a lot easier.

Without giving away anything confidential, I have seen and done a real mixture of stuff. I was really worried about practical procedures as my last student placements didn't offer much opportunity for practising, however, I have successfully managed venepuncture, cannulation, arterial blood gas sampling and catheterisation in the past week. Hopefully this means that my colleagues won't think I'm incompetent should I struggle with a few difficult patients in future. I have also confirmed death and filled in death certificates - rather morbid but something every junior doctor needs to get used to doing.

Whilst it's true that being an FY1/JHO/lowest of the low is largely about organisation and paperwork rather than medicine, I have found I've had plenty of opportunities to assess sick patients, prescribe, examine and generally use my brain - something I was worried wouldn't be the case. In true Learnaholic fashion, I have also found myself some research to be getting on with, and my MSc starts in October.

Right, I must head to bed as tomorrow is day 1 of 12 and I need to get enough sleep!

Goodnight xxx

Dr Learnaholic, at your service

That's right, I have passed finals and am thus Doctor Learnaholic! Extremely happy and relieved to have got to this point after seven years of pretty hard slog at university. I will be starting work as a very, very junior doctor on July 31st, with a week of shadowing beforehand. This also means that I've got on to my MSc (in paediatrics and child health), which I'll be doing part time over the next couple of years. Well, I need to justify calling myself the learnaholic, don't I?!!!

End of the year...

So, 2011 is finally drawing to a close. It's been a rather interesting year for me and so I feel compelled to join in with the corny reflective blog entries, and then I'll probably continue with the corniness and make some resolutions of some kind.

2011 didn't start off in any particularly exciting way - my then-bf's uncle died on New Year's Eve and so the first event of any significance in the New Year was a funeral. I suppose that did mean that things really could only improve!

My first placement after the holidays was in general practice. I hadn't really expected to enjoy it much but I had a fantastic time. The staff were all lovely and I've kept in touch with one of the nurses and one of the receptionists. I was also able to do an audit whilst I was there, which was probably pretty good for the CV/job applications. Plus, it was on one of my "favourite" (read "favourite thing to rant about") topics - MMR vaccine uptake.

The rest of the academic year went fairly well, if uneventfully. Fourth year was rather stressful in the sense that, GP aside, we were only on most blocks for a week at a time so by the time we'd worked out who and where everyone/thing on the ward was, it was time to move on. On top of that, as anyone silly enough to have read my blog will know, in June we had our final written exams. From about March time I spent most evenings and weekends studying. Rather sad, but it paid off when I passed. A little scary to know that the next written exams I take will probably be my membership exams - eek!

Over the summer I had two wonderful weeks away volunteering. I won't go into details as I've already blogged about them, but they were lovely experiences and even now, months later, I still smile when thinking about them. I very much hope that I can squeeze in at least one this year.

This academic year has been rather up and down. After something of a dull start (professional practise block - yawn!( I had a wonderful experience on my elective in New Zealand. As well as enjoying the travel and change of scenery, my placement was fantastic and only reinforced my absolute love of paediatrics. After getting back to the UK, my gastroenterology placement was slightly less to my liking. However, I do feel like I came on a lot in terms of my knowledge and clinical skills, so overall I'd say it was successful.

Uni aside, I have of course got my job for once I've graduated. Rather exciting and terrifying at the same time. I'm still waiting to find out the exact details of my contract but it's nice to know that, providing I pass my OSCEs in June, I will have a job to start. After 7 (!!!) years of studying I'm rather looking forward to joining the real world.

Ignoring a lot of trivial and banal things which really don't matter, I'd say overall 2011 has been a pretty successful year for me - I hope 2012 continues in a similar way!

Now, resolution time! These are largely unrelated to work so don't really belong in this blog, but I thought it would be good for me to write them down somewhere so that I felt accountable!

- Get fit again. This is a major one for me because I know when I'm fitter and exercising more regularly my mood, energy and sleep are all much better. I was going to the gym at least 3 times a week until exams started taking up too much time. Then with elective and a placement out of town I haven't really had the chance.
- Start eating properly again. This is another "again" as it's a good habit I'd managed to get into which has lapsed recently. Ideally I'd like to lose weight but my primary goal is to eat properly and stop using food as an emotional crutch.
- Sort out my finances. Rather dull but as I'm now in my 7th year of student life, I am rather skint. This isn't an immediate thing but I'm hoping that if I'm sensible now and start working (hopefully!) in August that by the end of the year I will at least have cleared my credit card and overdraft...
- Attempt to be more positive. This is something I say every year and I'm not very good at it (look what I did there, self deprecation in action!) so I'll have to keep on trying.

Right, those are my little aims for the next year. And to graduate and become a doctor of course!

Happy New Year everyone! xxx

I'm A Terrible Blogger!

v note with some shock that it's been 3 months since my last update. Time has flown by pretty quickly and I'm now over 25% of the way through my final year in student-ville. I've been pretty busy so here's a brief update:

- I got back from my elective 2 weeks ago. A couple of months in New Zealand flew by ridiculously quickly. I had a fantastic time there, the people are super friendly, the country is beautiful and I learned loads on my hospital placement. I was based in paediatrics and got loads of hands on experience, including sticking venflons in neonates - something decidedly easier than I'd expected it to be. I'm seriously considering moving out there for specialist training. There were quite a lot of British registrars at the hospital and it's apparently pretty easy to get jobs.

- I have a job!! On 15th September I unfortunately didn't get offered a job in the first offers round, but was placed on the waiting list by two deaneries. However a couple of days later I got an offer for an acamic medical job. After briefly considering what to do, I decided to accept. I've already spoken to one of the consultants I've worked a lot with and he said he's happy for me to do the academic part of my job in paeds, so I'm super happy.

- At the moment I'm on placement in gastroenterology ward. I'm actually really enjoying it and it's been really good for showing me what I know and what I still need to learn. I've also got to do a few practical procedures; last week I got to put in a paracentesis drain which was pretty cool. However, what scares me about this placement is that the first two weeks have already flown by and there are only 6 before the Chr!stm@s holidays, when I'll technically be half was through the year. Terrifying.

Anyway, those are the major updates. I shall attempt to blog more regularly from now on, although no doubt my posts will be more medicine and less job related now the AFP is secured.

xxx

Somewhat Overdue...

Greetings from Kuala Lumpur! I'm currently here for a couple of days en route to my elective placement in New Zealand. Staying in a rather basic (but clean!) hostel, exploring a new city and chilling out so that hopefully by the time I arrive in Hawke's Bay on Friday morning I'll be nicely rested and relaxed :)

The lack of updating recently has been due, in no small part, to me deperately trying to get organised for my elective. However, I also had my last week of work at my job (summarising medical records in a GP surgery - just can't commit a reasonable amount of time to it this year), 2 weeks of uni and an interview for the Scottish AFP. I'm hoping that justifies my silence in the blogosphere!

Having got back from my Sense holiday, I had 2 days at my parents' house before returning back to my uni flat and working for the final week of my summer break. It was quite odd finishing as I've been there over 18 months and actually really enjoyed it. I would happily keep it up, particularly as the money would be handy, but with elective, placements, finding an FY post etc I just don't think it's realistic to pretend I can hold do a job. Once I was done with work, I had 2 weeks of (pretty dull) classes on professionalism, communication skills, careers and all the other dull stuff you have to do at medical school aside from the actual medicine. It does feel quite strange knowing that, after all this time, I'm actually in my final year of medical school and if all goes well I'll be a doctor in less than a year...

As I mentioned before, I had an interview for the Scottish academic foundation programme on Thursday. It was a really difficult interview to prepare for as I genuinely had absolutely no idea what to expect. The interview was in 2 parts, a 10 minute interview with 2 clinicians (in my case a GP and a liaison psychiatrist) on clinical issues and a further 10 minutes with 4 academics on the more academic side of things. The clinical stuff was ok, largely about communication, professionalism, good qualities for a dr to have etc - really quite similar to the kind of things they were asking when I applied to med school, but looking for more specifics as I actually know some medicine now! I did screw up a bit when they asked how I'd treat an insulin overdose because we've never been formally taught that so I didn't have an answer to hand the way I would if they'd asked about, say, DKA or acute asthma or paracetamol overdose, but I'm hoping that I managed to come to the right conclusions eventually, and if not, the fact that I said "call for senior help" will give me some credit! The academic part was really difficult as it's a bit strange trying to talk to 4 people at once, but the questions themselves were easy enough to answer and the panel all seemed really nice. I hear either way on September 15th so just got to keep my fingers crossed until then - although it's not the end of the world if I don't get it, it would be nice.

Right, it's 11.30pm here and I'm hoping to fit in a decent amount of sightseeing tomorrow as it's my last day here, so I'm going to sign off and head to bed.

Hope everyone's keeping well and I'll update about New Zealand once I get there :) xxx

Makes Sense!

Yesterday I got back from a week's volunteering with Sense (http://www.sense.org.uk/), who are the UK's national deafblind charity. A group of volunteers took 5 young boys with multisensory impairment (as well as other needs/difficulties) away to the Cotswalds for a week, where we swam, ice skated, go-karted, ate, drank, laughed and generally had a fantastic time. This was my third holiday with Sense (those of you who also read my OTW-related posts may have gathered that I'm a bit of a volunteering addict), although my first with children as I'd previously worked with adults. I cannot describe adequately what a special experience this kind of work is. It is, however, rather tiring, thus I have spent most of the time since I got home sleeping. This got me thinking - I am exhausted after just a week. How on earth do parents/carers who look after these kids full time manage? I have the utmost respect for anyone who looks after someone with these kind of complex needs.

After such a good week, I'm feeling pretty positive. This is in no small part due to the fact that on Monday, I received an email inviting me to interview for an AFP at the end of the month. There are two short interviews, one regarding clinical issues and the other on academic/portfolio issues. I am absolutely terrified as I have no idea what to expect. I'm going to make sure I've read over my application and know everything there is to know about anything I've mentioned. The last time I had any kind of serious interview was when I applied to medical school so I feel a bit out of practise... Any tips greatfully received!

Hope all the students reading have had exam success and are enjoying the summer and all junior docs are settling into their new jobs :) x

The Waiting Game

Today is, according to their website, the day when the one of the AFPs I applied to are due to finish shortlisting of applications - which means that by the end of today, someone, somewhere, knows whether or not my application form was good enough to convince someone to interview me. I'm not entirely convinced it will be; of the three forms I filled in, I felt I made the best job of the other one, and I didn't get an interview there. That said, I don't know how much emphasis each deanery put on different components of the application. Unlike a lot of applicants, I don't have a single publication yet. I have got something which has been approved and is currently with the editors, but that doesn't count for much. I am hoping that my BSc, having some lab experience and the audit I did during my GP placement will go some way to compensating for that, but we'll just have to see. I hope I hear soon one way or another - I can cope with disappointment but the not knowing is frustrating!

No Going Back

After a lot of stress and panic over my application forms yesterday, I asked my consultant friend to have a look over them for me. I always feel slightly guilty asking for help with this sort of thing, but I suspect most people will have someone look over their forms, so surely it's not giving me an unfair advantage... After constructively ripping my answers to shreds (in a nice way, but still...), he did help me make them sound considerably more confident and professional. So, slept on it last night, had one final read this morning and sent them in! Eek! I'm convinced I've left some glaring errors on there somewhere so I'm not looking at them again unless I get an interview and need to remind myself what I wrote!

Cold Feet

Well, I've filled in all 3 of my regional AFP application forms. I've read, them, re-read them, had my Mum (!!) check them... I really don't know that there's anything else I can do - and yet I don't dare to send them in - my first deadline is 20th so I have a week or so to calm my nerves, but I don't know why I can't just hit send... I'm currently debating asking some doctory friends to have a look over them, but I think I'm just trying to delay the inevitable! I need to get a grip!!!

It's Started!

So today I registered with the foundation programme website and submitted my general application form - that was just a basic one where I listed my personal details, qualifications, referees and where I wanted to apply. I found it a bit odd only being allowed to apply for 3 schools, but then some of the foundation schools cover fairly big areas (Scotland is one school, despite there being 4 and a half medical schools and 4 postgraduate deaneries there). The first of my school-specific applications could be sent in on the 6th, which is rather a scary thought and it only gives me a couple of days to perfect my responses to deliberately difficult and vague questions with stupidly short word limits. That said, the forms for 2 of the 3 schools I'm applying for have been available for a while, so I have been working on them. The third is and online only form which isn't yet available, although they have published the questions which will be asked so I can prep them too. It's all starting to feel a bit too real now that I've officially enrolled in this round of applications though - eek!

Busy Bee!

Why is it that weekends seem to go by so quickly?! I had so many things I wanted to get done, but am nowhere near through them. My list looks a little bit like this:

1) Finish neurology revision and start on gp stuff
2) Work on application forms for academic foundation programme
3) Complete pre-elective reading, write up findings and send to host supervisor
4) Work on systematic review for home supervisor
5) Clean kitchen and bathroom
6) Do food shop

So basically this weekend I've successfully cleaned my flat, and bought some food. Useful, but not exactly the top priorities, were they?! I have done some neurology (and covered a bit more in clinic this morning), but I really ought to have finished it by now. I've added nothing recently to my AFP forms - I'm struggling to answer questions such as "explain how your SSM or elective demonstrates your suitability to an academic post" - argh! I did do a little bit of my pre-elective work, but ideally I would have finished it. My host supervisor is very relaxed so there's no pressure, but it'd be nice to have out of the way. The systematic review has been largely ignored, but I'm less concerned about that as there's not a lot I can do until I receive other people's information.

I probably spent too much time catching up on Grey's Anatomy - what a tear-jerking season finale! I actually cried more than I did at the end of season 6, which I didn't think possible! Anyway, it's now finished, so I suppose that's one less thing to distract me this week.

Better get back to the books...

Not Another Medic's Blog...

I've been thinking for quite a while about starting a blog. I had one as a teenager, where I whined about how unfair my life was and how nobody could possibly understand me, but I like to pretend that I'm slightly more interesting now.

To put the rest of my gibbering in context, here's the compulsory "about me" entry.

I always wanted to be a doctor, but I messed up my A levels* so ended up studying Biomedical Sciences. I really enjoyed it, particularly the last 18 months. I did contemplate applying for a PhD and going into academia, but for some (not entirely clear) reason, I decided to apply to medical school once again. Luckily for me, my initial BSc covered lots of anatomy, physiology etc and I was able to go straight into second year at the same uni where I'd done my degree. This does mean that by the time I graduate next summer, I'll have been in this city for 7 years, so I'm rather hoping to get my foundation jobs somewhere else.

Despite having spent a silly percentage of my life in formal education (rough guestimate ~80%), I feel like I want to spend more time doing research and learning things, which is why I've decided to apply for an academic foundation programme. The application window opens shortly, and nicely coincides with my exams, so no doubt my next few entries will be somewhat stressy - apologies in advance!

Bye for now xxx

*Didn't strictly mess up, just didn't do as well as I needed to get into medical school