Author: graduatemedicuk

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gamsat

March GAMSAT Reflections

The March sitting of GAMSAT has been and gone and whilst results are not due to be released until the middle of next month, it’s given me some time to reflect on how it went.

Things you need to know:
March was my first sitting of GAMSAT.
I have read many horror stories about this exam, full blown excruciating pain-worthy stories.
I spent a lot of time procrastinating and felt rather underprepared.
Despite having some science background, I felt awfully underprepared for section 3.

The Decision to Take GAMSAT:
I booked my GAMSAT registration on New Years Day, 1st January 2019. A little New Years resolution to myself and the kick I needed. If I didn’t book it now, when would I?
I plan on applying for Graduate Entry Medicine in September for 2020 entry. After hearing all about GAMSAT and how grueling it could/ would be, I was determined to have a ‘trial’ run with the exam for the experience and general know-how. I’m currently in the North of England and so I booked for Liverpool as my test center.

The Preparation:
I wish I could say that I spent weeks of hard work and determination spent on the run up to GAMSAT. In reality, I did what any other person does, procrastinate, put off and prioritized topics that I liked or got the hang of. I kept countdowns and a calendar view of the days running up to the exam date. I found the biggest flaw for materials and prep are the overly expensive courses and books. I unfortunately do not have the money to join numerous prep courses or online seminars, nor do I have the time to spare when working a full-time job, Mon-Fri, along with all the other necessary volunteering and general social life that I have (or lack of).. My local library was a huge help for getting books and materials that I could never have afforded.
Materials:
A-Level text books – Biology, Chemistry and Physics.
Books – for reading, wide varieties and topics.
Gold Standard – I bought this a while ago and so use it every now and again.
AC Grayling – The Meaning of Things – Good prep for section 2.
Hebe’s Notes – A webpage designed by Hebe who sat the GAMSAT herself and she now shares her notes openly (if you find them useful then please donate.)
Des O’Neil, Acer – Past papers.

The Day Before:
I worked my day as usual. I hadn’t felt stressed until I suddenly realized that this was it. There was no more time for cramming, or anything that would be useful that is. By the time I left work and made my train it was just gone 18:00. In 24 hours this would all be over.

I made it into Liverpool by 21:00. I had already looked into what was near that I could grab food from before heading to the hotel (I stayed in the new Premiere Inn at Liverpool Lime Street). There was a handy McDonald’s down the road (healthy, I know) so I picked up some food before checking in for the night. Ideally, I would have gone for a wander to have scoped out the venue and where it was before tomorrow morning but by this time I was tired and just wanted to shower and get an early night.

I watched some TV and tried to do some light revision but I guarantee it did not go in.

GAMSAT Day:
I woke up just before 05:00. I had dreamt that I was due to take GAMSAT and was running late and was going to miss it. I remember it being such a vivid dream and waking up panicked! I tried to doze off again but with no luck.

By the time I got everything sorted for the day and packed up, checked out, It was just before 08:00. I used Google Maps to track where I was going and managed the quick dash to the venue. It was easily spotted by everyone lurking outside and looking equally as nervous. I tried to distance myself away from everyone as I didn’t want to fall into the trap of overhearing conversations and getting anymore put off. There was a girl there with her parents and her dad was anything but supportive, my idea of the nightmare pre-exam scenario to have a parent telling you how badly you’ll do if you don’t know X and Y by now.

We were let into the building and started to queue down to the registration desks. They were organizing candidates by last name groupings. ID and tickets were checked and you were ‘ticked off’ as attending the first session. We were given seat numbers and told to report into the hall. After dumping bags in a separate room, I found my seat. It was gone 09:00 before everyone was registered and seated to begin. There was easily 300 candidates sitting in Liverpool and I had heard that candidates wanting to sit in London couldn’t due to the London venue being fully booked.

Then the exam invigilator said those dreaded words “Welcome to GAMSAT“.

Section 1:
I didn’t really know how I was going to get on with section 1 but the passages didn’t seem too bad, no long winded passages, over and over. Some even had medical themes so were genuinely interesting. There were texts that were more ‘wordy’ and required more reading time. Overall, I actually found it not too bad and definitely a good ease in to GAMSAT.

Section 2:
Section 2 followed section 1, there were no breaks in between and you could not leave to go to the toilet. The two topics were actually quite good, I was able to find one topic that I felt would be manageable and that I could write about for each. Reading time was really useful here for picking my choices and deciding my arguments for and against. I found that I could have built a better structure and made it sound a bit more articulated but overall again, it was relatively painless.

Lunch:
There was then an hour lunch break and luckily there was a Tesco round the corner to grab some food. I hadn’t eaten breakfast but hardly do and now I felt more at ease, was starting to feel a little hungry. I knew section 3 would be a large push to the end so I needed all the help I could get in the nutrition side of things.

Section 3:
After coming back from lunch, we all queued again and were registered in for the afternoon session. I couldn’t help feeling nervous. Out of all the sections, I knew that section 3 would be my downfall. Reading time came and went and all I saw was a blur of graphs.
If you have read anything about the March sitting, you’ll probably have already noticed that it was far from your usual and predictive GAMSAT syllabus. Whilst I won’t go into specific questions, I will say that there was a large amount of graphs, Maths, Physics and interpretation. The general feeling was that Acer were trying a new approach with section 3 and that it was very much a curve ball. I don’t think any amount of my preparation made me ready for section 3. Everyone was thrown in the deep end and we were all hazarding guesses.

After it Was Over:
When we had finished up, everyone darted off on their separate paths. No-one was coming away bragging that it was easy, no-one was trying to put people down, everyone really did feel in the same boat. The same boat without a paddle, heading for waterfalls very, very quickly. A lot of talk about guess work and a lot of talk about September…

What Did I learn?
GAMSAT is absolutely a tough exam. I came away feeling drained, my back and neck hurt from being hunched over an exam desk and writing all day, followed by the hours it took to journey back. It was a long day and GAMSAT is a worthy adversary.

The experience was priceless. At the end of the day, GAMSAT is an exam, a test, just like any other. The rules are the same. The format is similar in terms of marking results on a piece of paper. It is so easy to get worked up and feel passionately about the exam and that’s okay! The reality of it is that you can only do what you can on the day.

Sitting the exam, in itself is a big achievement. I hadn’t fully believed it when I was told by a now-GP trainee, that sitting the GAMSAT is an achievement in itself. As the room was filling with candidates and papers began to get handed out, I couldn’t help but notice empty chairs. These chairs were for people, just like me, who had paid a lot of money to sit an exam that could potentially get them into Medicine. The difference? For whatever reason, these people did not turn up to take the test at all. Already, you are better off than these people.

The wait for results seems like ages. Here we are in the middle of April (just) and there’s still probably a month to go. Take this time as a blessing. Remember what it felt like to be cramming and stressing over one day? Appreciate that you have time to self-care and regenerate while you can. Whilst I want to spend this time cramming and getting ahead again with revision, there’s plenty of time to pick it back up in May.

It’s absolutely okay to not know what to do or to fail! Every step is a step in the right direction. It’s not easy to decide to take on GAMSAT or to even decide on Medicine. It’s not a straightforward line of travel, we can go off and do different things, come back again or even decide that this isn’t for us. For the time being, I’m happy to be taking some time away from GAMSAT until a few more weeks have passed. I also have UCAT to book and prepare for. I’m working on my work experience and volunteering and generally living life. I fully expect to have to retake GAMSAT in September but without a doubt, I’ll be far more prepared.

 

 

 

 

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Work Experience

GP Day Wednesday

I apologise in the delay for the last end of the week, here’s Wednesday in surgery.

Wednesday in surgery and it would be assumed that a morning shift for a GP and student would be relatively quiet considering I was only scheduled to be in for a few hours…

We saw a 5 year old boy with acute tonsillitis. His Mum told us how he had just got over his last case and was suddenly suffering again. A quick check over and all seemed fine in his observations, his chest was clear and he wasn’t struggling for breath. We took a throat swab just to confirm if the infection is bacterial. All, in all, it was apparent that this young boy had seen his fair share of GPs, even his throat swab didn’t phase him! He currently already had a referral back to ENT so we didn’t have to do any referrals this time, although it was discussed that the possibility of having his tonsils removed maybe the answer. He was prescribed with antibiotics as it was fairly certain this was an ongoing bacterial infection, despite the swab, and they were advised to come back if symptoms persisted, deteriorated and to call for his results.

An elderly gentleman attended surgery for a check up on a boil that was present near his stoma site. He had previously been in and started medication to help clear this up. The difference after his short course of medication had been noticed immediately and the boil looked very minimal, swelling and redness weren’t visible and it was healing nicely. He still had 4 days worth of his medication so was advised to continue and if he had any problems, he was to come back in, although we didn’t anticipate there would be any.

A middle-aged woman came in with persistent headaches, her temporal pulse was stronger on her right side, the side associated with her headaches. She said she suffered from similar symptoms expected from conjunctivitis – matted eyes in the mornings although, on seeking advice from an optician, her eyes were given the all clear. We performed a short eye exam and put dye into her eyes, examined them under UV which showed no fluorescence. We checked all her reflexes, BP and temperature. She was booked to get bloods taken as the Dr was concerned that the headaches could be something more serious e.g. query tumor on the blood vessel that supplies the brain and optics.

A male presented with a moles on his back that his wife had noticed some colour change. He had a history of BCC so they were of course being cautious. We examined the moles and all looked normal in appearance, were soft and squidgy to the touch. There were no signs of malignancy. After informing them that they were benign they were happily sent on their way but ensured that if they had any doubts, to return.

MDT Meeting:

Every week, the practice holds a Multi-Discipline Team Meeting. It gives the opportunity to discuss patients with District Nurses, OT, Physio, Safeguarding, Care and the Cumbria ICC (Integrated Care Communities). Patients are brought to attention and any concerns that are currently held for the patient raised. This can be as simple as discussing the fact that a patient has been admitted to hospital and is due discharge, the discussion of why they were admitted and what help; if any, that they require in place for discharge.

Patients raised today were:

  • A gentleman was discussed regarding his dementia and history of falls. He is often confused as to who visits him and when, does not know who his help is and there are cognitive concerns raised by his daughter. He has a history of strokes.
  • A breast cancer and Alzheimer’s patient who’s primary carer is her husband who is battling with bowel and ? bladder cancer. It is known that the wife is palliative. Concerns for her care as her husband is also in a position of needing support, himself.
  • A male who has been involved in adult social care, DN have noticed his right leg has been swollen, he is not eating or drinking and also appears to be wearing the same clothes he was wearing last week on their visit. He lives alone and is showing signs of self-neglect despite being supported by care 4 times a day. He is housebound and is very adamant that he does not require help and will decline it rather sternly when it is offered.
  • A patient being discharged from hospital imminently of spinal stenosis and is currently catheterised. She will be followed up but the discussion was surrounding her further care at home of which, she currently has a hospital bed at home and care being provided for her.

Home Visit:

Our home visit was to an elderly gentleman who’s son had requested the visit. We arrived and it was already apparent that this gentleman was struggling. He was extremely weak, pale pallor, visibly struggling for breath and breathing laboured. His oxygen saturation was low, his chest incredibly crackly and overall presentation poor. It was apparent that he would be an admission and due to his condition it was to be via ambulance. It was explained to his son that he should get things ready for an admission and that he was query chest infection that had progressed to pneumonia. Due to the lack of landline and being in an incredibly rural area, the call for an ambulance had to wait until we were able to get back to the surgery. Not ideal but overall the better option than hunting for somewhere with signal, risking it cutting out when the time taken to get to surgery would be quicker.

Overall:

For a short session, there was an awful lot covered. It was great to meet with the other healthcare and social care that work behind the scenes of patient care but are ever bit as important as any other.

What I learned:

  • It is important to build good relationships with other health/social care professionals – it gets jobs done quicker and is much more friendly.
  • Rural house visits are rural. Be prepared to travel.
  • You may also pass the ambulance that you’ve called for on your way home from the surgery.
  • When patients come back to see you again, it is not necessarily because you’re doing a bad job, it can also be to review how well treatment is going.
  • Your patient may be a young child but the majority of the time it may feel like their parents are the patient – they worry.
  • Patients do often take your advise and do visit when they are concerned about something as trivial-seeming as a mole – it can be really important that they do and you praise them for it.
  • Your instincts are not to be ignored in medicine.
Categories
Work Experience

GP Placement – Tuesday

Today we were at a different practice and completing minor surgical procedures. There was my Dr, myself and a qualified Nurse present for this.

We saw a total of 5 patients; 4 of which we completed procedures on.

Patient 1:

A male presents with a cyst on his back. Took him through and lying on the bed. The cyst was marked to show the margins and incision line (this was checked as the patient was standing – the cyst is pushed by two fingers either from the left and right or up and down to see which shows the most elasticity. The elasticity allows for suturing and minimises the risk of sutures bursting or the wound reopening and not healing.) Local anaesthetic was dawn and injected into the site, around the margins. The amount of anaesthetic used was as minimal as 0.5mls.

The site was checked to make sure there was no sensation and that the anaesthetic had kicked in. The initial incision was made with a round-bladed scalpel. This cyst was very superficial and could be seen very quickly from the first incision. With a bit of patience and retraction the skin was cleaned from the surface of the cyst. Forceps were used to help ensure the cyst was fully unattached before removal. This cyst was attached quite well and on removal, the base still remained attached. After a careful extraction of the base of the cyst, the sample was bottled and the would sutured with 4 sutures and dressed.

Patient 2:

Patient 2 was a male who had a mole on his back that he wanted removed. Again, it was inspected and found to be benign. We took him though and injected the local anaesthetic. Moles don’t need to be marked up as they have clear margins due to their colour and the procedure. Once anaesthetic has kicked in, the mole was literally scrapped away from the skin. Moles often will do this although it is not recommended that patients do this themselves! Once removed the sample is bottled and the wound is burned to prevent bleeding. (People mention the smell of burning skin and it doesn’t/ didn’t bother me but I can imagine some would be put off by this! It reminds me of when a big fly/ wasp gets zapped by the big killers!😂) The site was then dressed.

Patient 3:

Patient consulted for a mole. Mole was very ‘squidgy’, no colour changes or other features of malignancy. The patient was happy and so it was decided not to remove it.

Patient 4:

A lady came in with a skin tag on her neck. She was having problems with it getting caught on clothing or when she brushed her long hair. We agreed to remove it although had informed her that if she could manage with it, removal wasn’t necessary. Due to the location she was adamant that she would like to part with it.

We took her through and injected anaesthetic. The tag was removed using a flat ended scalpel, the area was then burned to prevent bleeding and dressed.

Patient 5:

This gentleman had been to have a cyst removed previously. Unfortunately, he hadn’t eaten breakfast, had been up all night with his young child and generally felt unwell. He told me how he had seen the instruments being prepped, eyed the scalpel and felt very unwell. He did the right thing and informed the GP and nurse who both discontinued the procedure. He assures us that he was well rested, had eaten and was feeling very well.

He was a very nervous patient and was oversharing and very chatty as a way of coping with his nerves. We took him through and marked out his cyst which was on his scalp. Again, injected local and once anaesthetised, the initial cut was made. This cyst had been present for a while and proved to be a bit trickier to separate from the superficial layer. It also presented as being deeper than the first. It took time and patience to get it to the position of removing it, although once there, it was removed easily and came out all intact.

With the position of the cyst being on his scalp, the sutures don’t follow the same rule as the previous and stitches were thrown from front to back of the scalp. My GP took the time to explain that throwing a vertical mattress stitch in the middle of the incision meant that the edges of the wound would close together, evenly. This would prevent the edges of the wound overlapping, healing unevenly and taking longer to heal. Two more stitches were thrown either side to close the incision nicely.

Afternoon:

We spent the afternoon in surgery, again, a variety of patients and ailments. We managed to see 7 patients in our short session.

First patient was a gentleman who had a ?UTI. He had booked the appointment however, had previously seen a nurse practitioner who had prescribed some medication and things seemed to have settled. He described himself as being well. He had brought a urine sample and it was dip tested. The strip lit up like a Christmas tree! He had proteins present, blood present, the whole works. Despite his reluctance due to feeling back to normal, he was strongly advised to finish his medication and to hand in another urine sample after the course of treatment to rule out any other possibility.

A women with knee pain and had a history of neoplasia. She was advised to have bloods taken as a precaution before further treatment/ investigation.

An 11 month old presenting with chronic pain up to 20 minutes after feeding, up to 3 times a day. The baby would go rigid and arch his back whilst screaming out in pain. Mum had brought baby in and seen a Dr who had prescribed lactulose for constipation and mum had not been convinced so requested a second opinion. Baby’s chest, ears and throat were examined. His temperature was within normal limits. He was examined, abdomen was soft and non-tender. He was stripped completely and check for any signs of construction or lack of circulation. He was extremely happy and smiley all the way through. No signs of any other cause of pain and it was explained that we weren’t siding with a colleagues opinion and that we would always welcome any patient or parent to do the same, however on this occasion we would recommend taking the lactulose, even splitting feeding up with cooled boiled water to help as breastfeeding. Any more problems and come back to the surgery.

A gentleman who’s forehead was quite scaly and red. He was given some moisturising cream and steroid cream to treat. He also had some moles he wanted checked. Happy to report all were benign and posed no problems so are happy to be left alone.

Another young child with a viral infection. Temp was high, breathing a little laboured, ears red. Prescribed a course of antibiotics and again, if not seeing improvements, to return to surgery.

A man had a cyst on his neck. He previously had one on his face, was booked to see Dermatology at the hospital however, before the appointment it resolved itself. We both inspected the cyst and were happy it was benign however, due to its location, it would be removed by Dermatology. Referral completed.

An interesting one! A gentleman came in after having a punch biopsy performed for malignancy. The area where the biopsy was completed wouldn’t heal. It was inspected and pathology results consulted. He was referred back to his hospital consultant. It appears that the clinic letter stated that the punch biopsy was completed and malignancy was removed successfully. However, the pathology results showed that there was only the punch biopsy completed. The malignancy was never removed, hence why the wound would not heal.

What I learned:

  • Always eat breakfast before minor surgery.
  • How to throw a vertical mattress suture.
  • That cysts can smell.. badly.
  • Patients won’t tell you when they’re nervous.
  • A qualified nurse isn’t always required in minor surgery but it’s really refreshing to have a fellow healthcare professional assisting.
  • Parents feel extremely guilty when they are ill and then their child becomes ill. It can be emotional.
  • Consultants and GP’s can often get things wrong/ make mistakes, we are human. It’s important to check your work (or that of your secretaries).
  • A second opinion is never a bad thing or a question of someone’s ability to diagnose.
  • The importance of taking a full dose of antibiotics/ medication. You may feel better or normal but infection can still remain.

Overall:

I thoroughly enjoyed the minor surgery experience. I’m not squeamish and it was great to see that a GP still has the opportunities to use some finesse and surgical skills should they want to. I enjoyed having the opportunity to talk with a qualified nurse. Claire was lovely! We discussed the importance of asthma checkups (she runs an afternoon asthma clinic) and how asthma isn’t always a 100% foolproof diagnosis. It’s all a learning curve.

Categories
Work Experience

First Day on GP Placement

FIRST GP DAY – Monday:

I started my GP placement yesterday at a rural, yet busy GP practice outside of Carlisle.

Who we saw:

We saw a total of 9 patients in surgery and 1 patient was a home visit. I’ll briefly describe each to get a feel of the variety of patients, their symptoms and our treatment steps.

Our first Gentleman presented with ear scarring that was originally a large bump/ wound. He was given cream and had no/ to little effect. Due to this, he was referred to Dermatology but not before he also volunteered for his flu jab!

Woman presented with shoulder pain, not a lot that could be done other than pain management and an x-ray being booked.

The next gentleman was well known to my Dr. He is currently under review as he has had malignancy within his lungs. Thrilled that his chest and lungs sound clear. Booked for further review.

We had my first child in. He was a 14 month old who had been ill for a week now and has had a constant high temperature. Not eating or drinking and passing no urine. Mum was extremely emotional so a precautionary admission to the paediatrics on-call at the hospital.

An interesting one. A lady came in following recent tests. Her HLA-B27 (human leukocyte antigen) gene test was POSITIVE. Whilst a positive HLA-B27 gene is not always a sign, she fit many of the criteria for ankylosing spondylitis and as such, had her first diagnosis. She was referred to Rheumatology.

A young lady had concerns for scar tissue on her nose from where a doctor abroad had taken away a query cyst. Scar tissue looked normal and didn’t show any indication of malignancy.

An other young mum brought in her baby boy. He had a wheeze however didn’t show signs of laboured breathing. His ears were red but his temperature wasn’t highly raised. He was prescribed a course of antibiotics and mum reassured.

We had another review patient who came in and we requested repeat bloods and cholesterol.

Part of a GP’s workload also includes home visits. I was fortunate enough to be invited along – an elderly, almost completely bed ridden lady who also suffers from Raynauld’s Disease. She presented with the feeling of stocking legs where she felt as if she was wearing compression stockings and had pain. Her pedal pulses were check and we weren’t concerned that she was presenting with possible DVT. District nurses were informed and would visit to ensure all is okay.

We also had a few phone calls to make – one to a patient to inform them that results had come in and were absolutely fine. They were an anxious patient so calling was a way of putting them at ease.

The second call was a bit different. It was a request from safeguarding for information regarding a mother, her unborn baby and the baby’s father. The father had been red flagged at appointments as being under the influence of drugs. They requested any information as to his substance abuse, mental health and admissions.

What I learnt:

  • I was given the opportunity to listen to a child’s laboured breath sounds.
  • I was able to look at a young child’s ears and see how red they are.
  • I was able to examine scar tissue closely and confirm no malignant markers.
  • I was shown how to refer and fill in referral forms to the hospital for various specialities.
  • I was shown how to approve medications for repeat prescriptions.
  • I was shown the admin sides of a GP’s role.
  • I was fortunate to experience the reception side of a practice too.

Overview:

A large variety of patients, all requiring different needs and clinical advice. A large learning curve but more hands on than I imagined. It’s set this week up to be really, really, exciting!

Categories
gamsat UCAT

Revision Sunday’s..

I was up early this morning and finished my first ever run through of Friends from start to finish. I’m both heartbroken and thrilled; heartbroken it ended and thrilled to watch it all again! 🙂

My housemate, Lauren finished her MSc a few months ago and gave me her flip chart paper for revision, which was really kind!

I’ve started using a random quote generator and began to ‘brainstorm’ my ideas around it. Pros and cons, what the quote means, what the quote is telling you, whether I agree or disagree.

Hoping to get into the habit of analysing quotes and it almost becoming second nature. I used to love English at school and did really well at GCSE. Throughout my degrees, essays have been a big part of my learning so I do feel quite confident with the structure and building of an essay.

I’m hoping to also crack on with some science revision too. I’m thinking Physics as I truly detested it at school so will definitely need to begin from scratch!

A positive day for revision! 🙂

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The Application

The Journey Begins

I’m one of many UK Graduates who are looking high and aiming for Medicine.

I work full-time in the NHS, volunteer as a Community First Responder for the North West Ambulance Service and balance studying in between!

Currently, I’m focused on taking the GAMSAT and UKCAT in 2019 for September 2019 application to Med Schools.

My choices:
Nottingham
Swansea
Warwick
St George’s London

Trying to keep motivated with study and hoping blogging alongside will help!

Follow my updates on Instagram: @graduate_medic 🙂