Tag: becomingdrbex

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The Application

How to keep cool and plan your life when you’re on a GEM waiting list

So, it’s no secret that I was placed on the Nottingham waiting list for 2020 Graduate Entry Medicine. I was originally 25th.

At first I was a bit disheartened but welcomed the fact that I wasn’t closer to the 100’s as Nottingham can operate with high numbers on their waiting lists each year. I found it comforting to know that Sarb reassured me that I could email her when I wanted and as much as I liked to find out if it had moved.

Initially, I didn’t really feel like I had a chance and got on with life as normal. Occasionally there would be news on TSR to say that someone had an offer and that they are number X originally. I was able to predict where I would be/ how many places I’d loved. Almost weekly, I would email Sarb for an update, who by the way, I have found to be lovely and extremely efficient! I dread to think how many emails she gets daily from waiting list-ers asking where they are!

Over the weeks my position slipped down to 17th, then to 11th, then to 9th and as of last week, I was 8th. Yesterday, I was informed that someone had enquired about movement and that the list had moved by 20 places. Making me 5th.

The course is due to start on the 7th September and the list will be used until then. With quite a steady movement and at times a rapid drop, it began to seem realistic that the list will move 5 places in 26 days. I also learned that SGUL hadn’t made their offers unconditional yet, meaning that there could still be Nottingham insurance offers being held by their students.

“Shit! How can you cope with the stress and uncertainty of it all?” – text from my mum, yesterday.

I think GEM applications have always been filled with stress and uncertainty from day 1. You work so hard for something and when you’re placed on a waiting list, it’s easy to think it’ll never happen and then life throws you some optimism as a reminder that actually, you COULD make it.

So what am I doing to prepare for a possible place at Nottingham?

I’ve spoken to my landlord to let him know of my circumstances. He’s very chill and happy to be kept in the loop. I’d love to stay where I am but who knows if I can juggle a commute/ few days in Derby and keep my life where I am too.

I’m speaking to my manager/ work. Again, she’s very good to me and I’d love to give a decent amount of notice but of course we don’t know that yet. In the ideal world, I would be able to keep my job. My manager is also a reference. So providing Nottingham check them all (academic and work experience references) then my manager may already know before me about my offer.

I’m going to the bank on Friday to talk about them taking on my car finance (bank loans/ consolidation loans from your bank are at a much, much lower interest rate). This will ensure I can keep my car as I only have 2 years left to pay it off and the cost will be cheaper to manage on my student wage. I’m fortunate to have already applied for Student Finance.

I’ve looked at my options for parking and found it to be reasonably priced. I’ve also considered the options for accommodation/ hotels/ air bnb/ b&b. If I’m only in a few days which are consecutive, I’ll commute and stay over. I don’t want to be paying for accommodation/ rent for a property that I won’t use in my first semester/ term.

Now you wait?

Yep! Now I wait. A lot of things I’ve done are just to let people know/ keep them informed of my situation. I can’t really make any firm, life changing plans just yet. However, I hope I’ll be as ready as I’ll ever be, should I get an offer.

Do you really think you’ll get an offer?

I’m being cautiously optimistic but yes. I do think I will get an offer. I’ll believe it when I see it but I do think my chances are very good. I never thought it would come to the low, single digits of the waiting list and I dread to be that person who is at number 1 and never gets a place. Medicine is tough, especially GEM. I think I’ve done bloody well for a ‘practice’ application!

Categories
The Application

Finishing the 2019/2020 Application Cycle – My First

My first application cycle for medicine truly came to a close on Friday, when Nottingham released their waiting list rankings.

I opened the email and expect the words “you are 156th on the waiting list”. Scrolling through to the very bottom, I was instead met with the words “you are 25 on the waiting list”.

At first I felt relief. It wasn’t as bad as I’d thought. Then the self-doubt set in and I accepted that although it was better than I’d expected, it would never be good enough to meet an offer.

I did my usual routine of informing those nearest and dearest and viewed The Student Room. My placement on the waiting list seemed relatively average. There were other people who were pretty much guaranteed an offer and those who were resigned to not getting one due to the sheer size of the list. Everyone was very supportive and open about their rankings.

It was only then that someone mentioned that last year there were 96 people on the Notts waiting list and people in the last 20’s – early 30’s were given offers. I also always remember the story of someone getting an offer in September!

This application had started out as being a practice run. I then ended up scoring well on the GAMSAT. I then got selected to complete the Nottingham work experience questionnaire. I then got my interview invite and I finally got told that I would be waiting listed. Absolutely not bad for a first time, ‘practice’ application!

I’m now in limbo and I’m having to decide if I pay/ register for the UCAT and GAMSAT. I am thinking that I’ll register the sit both and cancel if I need to. The UCAT is fully refundable yet the GAMSAT is a bit particular so will have to try and be strategic with that, although I may not sit it again at all. I don’t want to do it at home and my score can be used from last year.

Throughout I’m remaining optimistic and hopeful. The journey this far has been tough and has been a lot of blood, sweat and tears. The waiting list has moved since Friday and a few offers have been given out, meaning I should have moved up a few places. Time to keep my fingers crossed and prepare for the worst but hope for the best!

Categories
gamsat

Post-GAMSAT Results

As predicted, on the 8th November, September 2019 GAMSAT results were posted and I woke up to the email that we all dread to receive. I spent the morning pondering on whether I would even open my results or spend my next few weeks being in blissful ignorance. I was taking that long deciding what to do that I was running late for work.

Within the first 40 minutes at work, I was being pestered to open my results. When I was asked why I didn’t want to, people seemed shocked to hear that if my score didn’t meet the minimum cut offs, then 3/4 of my universities would be sending me rejections. I knew applying to so many GAMSAT universities was a gamble and up until this point, my only UCAT (previously UKCAT) university had been my only realistic choice.

Of course, I finally caved into peer pressure and was welcomed with the following scoring:
S1: 55
S2: 66
S3: 50
Total score: 55

I was thrilled! I’d improved in every section with the most being my section 3 result by up to 12 points! Overall an improvement on March by an overall score of 7. I had been told that there was no way you could improve to this level.

So, what did this mean going forward? All 4 of my university choices for medicine are still in play. Whilst my scoring is low and on the cusp of some, it’s not unheard of to get in with a GAMSAT score of 55. I also hold an MSc qualification which goes in my favour.

My Universities:

Nottingham – Last years cut off was 55. With Nottingham’s sensible and more lenient scoring (S1+S2+S3/3) I’m actually given a higher score of 57. Last year this would have gotten me an interview. As the percentiles this year are very similar to last, I’m hoping to just manage to get in with this.

St George’s, London – I don’t have high hopes for meeting SGUL’s cut off this year however, I’m not too bothered as the cost of living and studying in London could be a huge obstacle for me anyway.

Swansea – Swansea have had quite high cut offs and I imagine it’s due to their success in the league tables. I am sure they’ll reject me due to GAMSAT score.

Warwick – My only UCAT university and previously my only hope of getting into medicine this year. With a score of 2550 and band 2, it’ll be close as last years scoring was 2570. Again, I’m fortunate to have my MSc as good backing. The 2570 was the minimum score an undergraduate degree holder candidate got interviewed with, there is no say as to what the minimum score for PhD/ MSc holders was and I’m hoping this will swing in my favour as the higher qualifications are awarded greater points.

Waiting Game:

Last year Nottingham sent work experience request forms to all candidates that met their cut off on the 21st November 2019. I’m hoping to hear back from them this week to know if I’ve met their GAMSAT cut off and whether they are interested in interviewing me. I shouldn’t have any problems with my work experience and have all my references already gained.

Warwick advertise that they open their interview booking by the 3rd December. Again, it should only be a matter of time before they let applicants know whether they have met the minimum UCAT cut off and have satisfactory work experience to be invited to interview.

Swansea and St George’s will be letting applicants know of the cut offs shortly.

Food for thought:

Whilst everyone wishes for a GAMSAT score of over 70 or a UCAT score of 3000+ and Band 1, at the end of the day, if you make the minimum cut off then you’ll be invited to interview. I have found that the road to medicine is difficult and there as so, SO many hurdles to overcome, especially when Graduate Entry Medicine is extremely competitive. There are going to be failures and set backs.

I would love to be interviewed for Warwick and Nottingham and would be honored to be offered a place to study medicine at either! I’m incredibly humbled to be sat with a GAMSAT score I’m pleased with and still have a shot with my application for GEM 2020 entry.

Categories
UCAT

UCAT Score and Tips

Today I sat my UCAT exam and scored incredibly average – and I’m okay with that.

I was one of the first two people to sit it at the test centre as everyone else had the sense to book it for later on in the year. I was terrified, sat waiting to go in. I must admit, all the ladies in the test centre were absolutely lovely and supportive. They were asking questions about where I was applying and whether it was Medicine or Dentistry that I was interested in.

VR:
I ran out of time in the first section and didn’t get a chance to go back and review any questions, there were even some questions that I missed entirely. I was adamant that a good UCAT score was out the window now. It shook my confidence enough for me to wonder why I was even attempting this.

DM:
I found DM to be not too awful. I had time to go through and answer the questions, flag those that I wasn’t too sure of and come back and review them. I didn’t feel as pressured for time as I had done in VR.

QR:
My most dreaded section. I know the maths is not ‘challenging’ but I hate maths. Always have, always will. Again, I didn’t feel as pressured for time but definitely was conscious of how much time I spent on these questions and working things out. I felt relieved when I’d worked out calculations and the answer I had gotten was actually in the list of possible answers!

AR:
At first, I was really thrown by these. I couldn’t grasp the pattern between the sets and knew that if I couldn’t find it, that the next 4/5 questions would need to be educated guesses. Once I had gotten into the swing of the questions, I was able to identify patterns quite quickly and blitz through the questions. I then went back and ensured the ones I had guessed had a second look over.

SJ:
Situational Judgement was structured a little bit differently as to how I had practiced. I wasn’t too concerned with the section at all and managed to get through with time to spare.

Overall score:
VR: 580
DM: 640
QR: 670
AR: 660
TOTAL SCORE: 2550
SJ: Band 2

At first I was a little disheartened with my score. It wasn’t close to 3000 like you dream of. Then I was relieved. I had worried that I was going to do a lot worse and had originally said to myself that if I scored over 2500, I would be pleased. Warwick’s cut off for last year was 2570, which means I would need a decrease in cut off score to be in with a chance of an invite to interview. I then released how pleased I was with the score. The difference between an invite to interview and my score last year was 20 points. If I had scored 600 in VR, I would have 2570. My initial and practice scores on Medify were terrible. I had contemplated not taking the exam today and very nearly cancelled it to reschedule.

I know where my faults are – I should have revised sooner, I should have utilized timed practices, I should have booked the exam later and most importantly, I should have been more confident in myself!

At this moment in time, I was capable of an average score, that’s just below last year’s cut offs. If the worst case scenario happens and I don’t get offered an interview at Warwick, my GAMSAT prep is not sufficient enough and I don’t get interviewed at my other 3 choices, then I will be taking the UCAT next year and I KNOW that if I retake it again, I will be aiming for that 3000!

Tips:
Whilst you’re probably thinking what can I possibly learn from someone who scored terribly?

UCAT and Medicine applications each year are down to luck. A score of 2570 would have gotten you an interview last year whereas a few years ago, the cut off was closer to 2700.

Self-confidence is really important! Exams are scary. Especially when they’re the obstacle that’s in the way between you and your dream of studying Medicine. However, you want this and chances are, you’ve spent the time revising, you’ve learnt the test format and you have a brain in that head. Give yourself credit for attempting and embarking on this journey. You’re probably capable of more than you give yourself credit for.

Buy Medify for practice. My scores improved HUGELY with Medify. I honestly don’t know what I would have done without it. If I have to take the exam next year, it’s the first purchase I’m making. Medify mimics the format and layout of the exam. There are minor differences but overall is the closest you’re going to get to the real thing. It’s also computer based so you can practice completing the test electronically instead of making the transfer from a book/ paper to a computer.

Flags are your friend – unlike American Football where a flag on a play is a bad thing, flags in UCAT are your friend. Time is definitely against you in some sections and instead of spending precious seconds struggling though for an answer on one question, flag it and return later. Don’t fall into the same trap that I did and run out of time – think of the precious points!!

It is recommended that you practice under test conditions – no noise etc. however, I found that I performed better with noise. A TV or another person sat in the room made a big difference. It also meant that when I sat the exam today, I wasn’t bothered by people getting up and leaving/ entering the room. It can be infuriating when you’re concentrating and the guy next to you is doing nothing but sighing because he’s hating his Driving Theory test..

Don’t be disheartened if you don’t get the score you were hoping for – I know I didn’t get that perfect number! Medicine is a challenge and its been made that way on purpose. There will be many people who will only dream of taking the exam. There will be some who take it and never do anything with it. There will be some who score exactly as you have and are proud to have achieved that! Remember it’s about the luck of the draw. If you don’t take the test and apply, you’ll never get that possibility of being offered a place. Getting a score that you’re disappointed with is not failure, it’s a stepping stone for your next attempt.

Categories
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.

 

 

 

 

Categories
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! 🙂

Categories
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 🙂