Clinical Skills Sessions – Generation Medics

Generation Medics is a social enterprise aimed at inspiring and aiding students in their pursuit of a career in Medicine. For the past two days, they ran a 2-day conference at the Chelmsford campus of Anglia-Ruskin University, where Year 9-11 students have had the chance to attend a range of workshops alongside clinical skills sessions.

As a mentor for the second day of the conference, I was fortunately able to facilitate my own clinical skills sessions, teaching students how to do a respiratory examination and take a patient’s history. It was a fantastic experience that really tested my ability to recall information and communicate it in a way which can accommodate my target audience and their style of learning. As well as that, it was truly an opportunity that tested my public-speaking skills and my ability to organise/plan a 45-50 minute session which, according to the student feedback, were concise yet very formative.

The respiratory exam session was my particular favourite to teach. Initially, me and my FY2 colleague, began by teaching the students the basic anatomy and function of the heart and lungs, proceeding to measuring pulse and respiratory rate and then going on to simulate the examination via every medics favourite acronyms WIPER and IPPA. It was great to see them engaging, auscultation being the bit they enjoyed the most. Watching their faces light up with pure elation when listening to the sound of their own breathing and heart was hilarious but similarly epitomised how I reacted upon my first encounter with a stethoscope, that being only last year.

For the history-taking session, my role involved simulating a patient who had just had a heart attack. Admittedly, still being a second year preclinical medical student, I learnt a lot from this session myself, making SOCRATES and THREADS the extra two additions onto my already endless list of medical acronyms. Moreover, the students did a phenomenal job of asking the right questions, recalling the information and diagnosing me correctly, to which I was genuinely pleased. Although a content-heavy session, it was gratifying to know that they had really tried to absorb as much information as possible.

I have genuinely enjoyed today and hence I am really glad that I took the opportunity to mentor. Not only was I able to pass on valuable knowledge but I also learnt a lot about myself. Upon reflecting on the day, I realise how much more confident I have become since I first started medical school. This has only been possible through the variety of volunteering roles I have undertaken in the last year and a half. Whether for widening participation or for the medical school, in most cases it has required communicating and sharing ideas with others, which once upon a time would have completely pushed me out of my comfort zone yet now has become an effortless task, and I am glad.

It is genuinely amazing that there are organisations such as Generation Medics, which are there and ready to help students get into medical school. As someone who has benefitted greatly from widening participation schemes myself, I have always been grateful for the work that these organisations put in to ensure every student applying for Medicine, regardless of background, has the knowledge and skills they need to be successful. It is for this reason I choose to volunteer for as many of these organisations as possible, as my way of saying thank you but also in hope that I can also help to inspire the next generation of aspiring medical students.

 

 

#TalkNHS – the past, present and future of the NHS

A few years back, I attended a very similar structured talk at the Battle of Ideas in the Barbican. The issues raised then were similar to the ones raised now, just in a different environment and upon a different climate. Hosted by a range of educated and passionate professionals, the programme today was well worth attending and truly topped off with a keynote finale held by Professor Stephen Hawking himself.

As the title suggests, the talks were all based around our National Health Service, what its current state is, how we got here and what the next steps are; a very neat way of structuring a debate concerning the past, present and future of the NHS. With a variety of speakers from multiple backgrounds alongside a very passionate audience, naturally it quickly became a very heated yet informative day.

The first group of panellists held the discussions in response to the question ‘What is the state of the NHS?’. They raised a few very interesting points. The first being the division of health care and social care. Ms Liz McAnulty, chair of Patient’s Association, stated ‘care is care’ as regardless of what type they both address an individual’s needs. The fact that they have been classed as two different brands of care, which is understandable since they both address two entirely different perspectives, in the era we currently live in whereby the two are so intertwined, maybe it is time we see both as one in order to reduce this belief that one is more important than the other when we are increasingly starting to see the need for both to work together. Secondly, there has been a reduction in patient and public engagement. As Professor Richard Murphy goes onto say later, it is the people that pay for the NHS and are also the users of the NHS, hence covering both ends, but nowhere do they get a say or some form of engagement from their local commissioning groups which is supposed to be tailoring care for them. As a result, decisions are made that do not accommodate the public. Thirdly, as Ms Liz McAnulty stated ‘the same problems are happening time and time again’ due to the failure of the system to listen and learn from complaints. The same mistakes being made are costly and ineffective. Finally, there is the issue of a constant service transformation. The speakers clearly highlight that due to the above factors and many more, the NHS has reached a point whereby it is not able to deliver the care it aspires too, and as Dr Rachel Clarke put it, it is the ‘human cost of those statistics that are horrifying’.

Unfortunately, as the system is being drained of funding and resources, we know that this has also meant morale amongst staff is low. As a result, it has led to ‘burnout’ and a huge portion of valuable NHS staff leaving the profession hence causing further damage to the service. The government and many believe the solution to this issue is to just recruit more individuals but as Dr Sarah Wollaston, MP for Totnes and Chair, mentioned, ‘it is not just about recruitment but also retention’. The pressures and the challenges in the NHS have created a very unattractive environment for current and future healthcare employees to want to work in. The individual drive due to the core principle of compassion and the staff wanting to be there for their patients, is the reason why the NHS still stands today. But as Dr Clarke wrote in her book, which I recalled in my last blog post, there is only so much one can give without becoming exhausted. Personally, as a medical student, I am scared for the future. I know the reasons as to why I came into Medicine and I hope these reasons stay with me for the years to come. However, considering what is going on, I fear that this constant battle between healthcare professionals and politicians, with one party trying to explain the situation and the other not wanting to listen, may create an environment that will inevitably mass produce a future workforce that may not retain the same compassion the NHS staff now hold. Why would the future workforce try to give it 110% when inevitably their efforts will not have an impact? Would it not be easier for them to come in, do their job and then just leave? That is what low morale will lead to, a drain in determination and passion to genuinely want what is best for the patient, because it is this cohort which will be tired of fighting against an unresponsive system.

One member in the audience posed the question “Should we dissuade individuals from the NHS?”. A great question which encompasses what many would think considering the state the NHS is currently in. Dr Clarke made a valuable point: we cannot proceed to stigmatise individuals especially when they need the care. I completely agree with her. In a system which is being let down due to the government’s decision to poorly fund a complex service and hence not provide patients with community alternatives, we cannot place the fault of the government upon the patients. The public have a right to healthcare and hence the government have a duty to provide this healthcare. Through trying to dissuade people to balance the numbers, we risk pushing away those that may need vital and immediate intervention.

Time and time again, as is the case with any complex situation, when it comes to finding solutions to the problems the NHS faces, they are never clear-cut. When organisations, politicians or even individuals have their eureka moment and think they have sorted the issue out, they find they have just scratched the surface. It is like cutting garden weed off the surface but not pulling it out of its root, it will always grow and hence will always continue to be a problem. The NHS is facing a similar scenario. It is difficult to pinpoint where in the timeline things have gone awry and what needs to be done to undo the actions of previous individuals, hence in each attempt to fix the problem we can sometimes be doing the complete opposite. Naturally, this is expected of a service which is very complex and caters for the needs of millions. Over the years, like an old house, there has been renovations and decorations, but the foundations upon which it was built in 1948 were not accommodated for the society and the demands we have today. What would be great is to break the whole thing down and start again, however this is not possible. Therefore, our only course of action is to continue doing what we have done, which is to make gradual changes. Hopefully this is a with a much more evidence based approach and not like Ms Lara Carmona, Associate Director at the Royal College of Nursing put it, an ‘evidence informed’ approach which is usually adopted, i.e. the evidence is there but it is chosen not to be looked at.

Considering the fragmented service that exists today, where one service provides mental health support, another provides the physical support and so on, in an era whereby people are living with multi-morbidities, Anita Charlesworth, Chief Economist for Nuffield Trust, mentions the fact that inevitably this means individuals are being treated as body parts rather than holistically. As a result, in response to the question ‘what next?’, she suggested four things: funding needs to be increased on a sustainable level, the social care system must be secured, the workforce matters should be put first and inequalities must be addressed. Very broad but clear goals to achieve, which would hopefully begin to dig at the bigger issue.

‘Your voice is important’ – whether Stephen Hawking meant it in the literal sense as prior to this he was explaining how the weakening of his larynx led to a tracheostomy which meant he lost his voice hence realising the value of oral communication. Or if he meant it in the metaphorical sense, that our voices need to be heard in order to bring about change. Regardless, this short statement really stuck with me. He then went onto mention that there are multiple forces of different interests looming above the NHS and ultimately the future will be dictated by which force is the strongest. Hawking believes the balance of power currently lies with the profit making private companies but the power of the public and democracy exists too, therefore we need to take advantage of this. Which brings me back to why the four words Professor Stephen Hawking spoke, stuck with me. I did not realise how strong and how much of an impact simply speaking your mind and open communication can have, but after sitting in a room full of passionate professionals and campaigners and hearing how they have all made their mark through standing their ground and vocalising the values and belief they strongly hold onto, I think this is a great step forward in ensuring we protect the service we treasure the most. As Professor Richard Murphy responded to one of the audience members’ question ‘What can we do for the future of our NHS?’ – “Talk.”.

As I sit here, reflecting upon the fantastic day I have had, learning all about the NHS and its people, I am left wondering what I, as a medical student, can do for the future of our NHS. And I think I will simply start by talking. Talking about issues the NHS faces. Talking about the politics surrounding it. Talking about what the possible next steps are. The more knowledge I can gain on the topic, the more I can raise awareness amongst my peers too, and hopefully this will mean a greater interest is taken, across the board, to try and help save our NHS.

Surgical Skills for Students – Royal College of Surgeons

Lately, I have developed a keen interest in wanting to explore different medical specialties. Throughout the year I have spent some of my free time attending talks and conferences to gain a little insight into a handful of them, these include: general practice, oncology orthopaedics, cardiology and very recently surgery.

On Monday, I attended the Royal College of Surgeons for a one-day course on surgical skills. The course touched on a range of skills, from gowning/gloving, to suturing techniques and even learning how to apply local anaesthetic. Upon completion of the course, I acquired a set of quite specific yet useful practical skills.

Initially, we began with the basics of getting geared for the ‘procedures’. This involved gowning and gloving following very strict protocol/steps in order to minimize contamination as much as possible. After this, in order to get us started we practised tying knots using a piece of string. This involved multiple knot ties: one handed reef knots, surgical knots and instrument tied knots. Then, once we had grasped these basic principles, we moved onto tying these knots using the suturing equipment/material.

It took quite some time to perfect the techniques, I found that with each suturing attempt I was either putting too much tension on the wound, the sutures were not the right width or they were not straight. This was really frustrating to begin with but as one of the faculty members said “practice, practice, practice”. Eventually, the practice truly did pay off as I found that by the end of the session my fingers were running on their own as I was able to tie the knots without having to think about each step.

After reflecting on each exercise, I realized that for all of the techniques that I tried, ambidexterity, good hand eye co-ordination and even resilience were required in order to conduct the procedures in good time with satisfactory results. Although all these skills can be innate for some individuals, they are skills I found you can learn and practice, this was especially the case with ambidexterity. As a right handed individual, at the beginning of the session my left hand was pretty useless in doing anything but through the progression of the course I found I gradually made use of my left hand equally as well as my right, which is definitely an achievement!

The day ended with a quick exercise on excising a skin lesion and the removal of an artificial cyst with the aid of local anaesthetic. In order to be able to conduct these simple yet vital procedures, I had to be very meticulous. It was so easy to let the scalpel cut deeper than you wanted it too, therefore I found it was crucial to grasp the scalpel correctly, whether this was through the pencil or fingertip grip, each orientation enables its own type of cut. The fingertip grip best enables a cut through the skin however the pencil grip allows for finer and more controlled cuts. To be able to make a judgement between the two types of cuts, depending on what you are going to incise next, is a skill a surgeon is required to have in order to maintain the integrity of surrounding tissues and to ensure no damage is done.

I thoroughly enjoyed the course. It did not only offer me a valuable set of practical skills but it has also sparked an ongoing interest into the surgical specialty. It is a field I definitely want to keep exploring, maybe through further courses or even work experience placements. As for now, I shall keep practicing and refining the suturing skills that I have learnt.

Although the programme does come at a cost, I think it was worth it. It offers multiple benefits: suturing skills, small group work, the presence of a faculty member at all times to observe your craft and even feedback/scoring of your progress. If you are interested, here is the link https://www.rcseng.ac.uk/education-and-exams/courses/search/surgical-skills-for-students/.  It is definitely worth having a go at!

 

 

 

 

It is easy to forget…

It is 9am. The first patient comes through the theatre doors. A little 2-month old baby appears cradled in her mother’s arms, comfortable and at peace. After a quick confirmation of the procedure and the consent form, WHO regulations, the mother anxiously places her baby on the bed. With tears falling down her face she presses a kiss on her baby’s forehead and slowly begins to leave. As she leaves the anaesthetists begin their work.

The surgery was going well. The scrub nurses were ensuring the surgeons had their equipment at hand. The anaesthetists were carefully observing the patients’ stats. The surgeons were making their fine cuts and sutures hence swiftly conducting the procedure. Just as much as the team, I became so engrossed by the operation. I was thinking back to my lectures, trying to apply the medical knowledge I had gathered over the year to make sense of the procedure in front of me. I was listening out for key terms the team were throwing around and noted them to myself. And ultimately, I wanted to fulfil the point of the shadowing which was to try and figure out whether this was the medical specialty for me.

As the surgery came to a successful end and the final stitch had been tied, the team began to remove the blue sheets. At this point the reality of it all dawned on me. I realised something was wrong. During the procedure my perspective of the scenes that had unfolded before my eyes had altered. The amalgamation of the anatomy, the work and the medical terms had clouded my mind and as a result of gravitating towards the science, in the midst of it all, I had gradually lost touch with the patient. This tiny being in front of me, that had been draped in a sea of blue sheets had just become another surgical case to apply my knowledge too and to carefully observe the skills the surgeons were using in order to conduct such a procedure.  Yet this was the same baby that I had seen anaesthetised only a few hours ago. Guilt washed over me as the images of the crying mother flooded my mind as I realised there was so much more to this case than just the procedure. There was life.

In the moment of it all, I had become medically selfish, I had forgotten the baby’s worried mother and the family patiently waiting in hope that everything will be OK. There was not just a patient in front of me but in fact a human being.

I have always read and heard that in the process of trying to extract problems and focussing on finding solutions in the form of treatments, clinicians forget the patient. However, even though I was aware of all of that, I had fallen into a similar trap. But we must keep reminding ourselves: medicine is about the individual just as much as the conditions we aim to battle.

This epiphany put things into perspective for me and made me realise it is easy to forget.

The experience I have recalled and the lessons learnt, are things we all know and hence nothing new. But as a medical student, I want to take this memory with me for years to come. As I train, I want to try and not forget the person in front of me, as the famous Hippocrates once said “wherever the art of medicine is loved, there is also a love of humanity“, and I think it is a love we should hold onto.

AstraZeneca – ‘together we make a molecule a medicine’

AstraZeneca is a UK based pharmaceutical company aimed at using scientific research to offer patients life changing treatments. Yesterday, thanks to the SMF programme, I was able to attend an AstraZeneca masterclass at their HQ in Luton. The day involved a series of talks given by a range of AstraZeneca employees, explaining what their role involves and hence their contribution to AstraZeneca.

In the medical profession, although we make use of multiple drugs in order to treat patients, we rarely get a chance to understand the process of how drug gets ‘from bench to bedside’. However fortunately in attending this event I was able to get an idea of the bigger picture.

One of the activities yesterday involved working in teams to draw up the journey the drug takes to become a medicine. The process begins with the discovery of the molecule then it is followed by preclinical trials, early phase trials followed by phase 3 trials and then the need for regulation and funding by NICE. The activity taught me that at every aspect of the journey an obstacle presents itself which undoubtedly impedes the process of getting the drug to the patients. It explains the following statistics: only 1/100 drugs developed are taken to market and on average it takes 14 years with a cost of around £700 million to ensure that it does so successfully. However, whilst doing this activity I realised that when looking at the journey on a broad spectrum, it is so easy to forget the professionals at each stage of the pathway who make the whole process possible in the first place. From the researchers, to the manufacturers, the sale representatives all the way to the directors/leads, their input ensures the drug is able to make it to the next stage even if it is not guaranteed. As the AstraZeneca team very nicely put it ‘together we make a molecule a medicine’ – a great ethos to stand by, clearly emphasizing the need for teamwork and communication.

Today the NHS faces many challenges: an ageing population, high birth rates, increasing effect of lifestyle factors on diseases, change in public expectation and even a change in the healthcare structure, which has meant pharmaceutical companies have had to adapt their approach to marketing their drug in order to accommodate the current system. Previously, healthcare professionals would have more time to meet up with pharmaceutical sale representatives for face-to-face meetings about the new drugs on the market and hence then would proceed to decide whether they would want to invest or not. However due to the increasing challenges the NHS faces, today doctors do not have time and therefore companies have become heavily reliant on online media in order to to sell their product. This involves the use of email subscriptions, phone calls or webinars to ensure the clinicians are kept up to date with new treatment. As these pharmaceutical companies are continuously working on adapting their approach to accommodate a form of communication that is best for the medical field, it ensures that the NHS is always able to provide a range of treatments for their patients.

Regardless of the fact that the masterclass was solely based on the way a pharmaceutical company works and the different roles within it, it was still very useful to attend. From a medical perspective, it has made me appreciate how this strong network of committed and hard working individuals, who also have the patients’ best interest at heart, ensure there are new forms of life changing treatment available. Without the input of the pharmaceutical industry, my role as a future doctor would not be possible.