Tag: GEM

Categories
The Application

When do you give up?

So, we’re very nearly at the end of August and two weeks today marks the 7th of September and the proposed start of term for Nottingham GEM.

I found out last Thursday (confirmed on Friday) that I am now second on the GEM waiting list. The list has had sone very strong movement and it’s been really quite consistent. That was until last week. Last week saw only one place movement.

I have 2 weeks to move 2 places. Seems easy enough right? So why am I panicking? Someone has to be number one when they stop the intake from the waiting list. Is that going to be me? Should I be booking the GAMSAT and UCAT (that I cancelled) and be preparing for another application cycle?

“One place a week and you’re in” – very true words of advice from a friend. “There’s always people who drop out last minute/ when the course starts!” – again, very true.

Let’s face it. It’s been a struggle the whole way and I never thought I would get this far or this close. It seems too close for it not to work in my favour but then again, this is GEM. It’s anything but predictable.

When is it okay to give up hope? I’ve been trying to keep optimistic and have been posting on TSR with positive, moral-boosting posts but really, I’m worried. I don’t have the hope or confidence that everyone else has for me. I also don’t want to admit defeat but I’m worried that I’ll be faced with reapplying and I’ll dismiss it. It’ll be my last chance for Nottingham and I don’t want to have to do it all again.

I think it’s really important to show the negative sides to a Medicine application. It’s not easy. It’s been a whole year of hope, progress and rejection. You can’t always feel on top of the world, confident and certain. Whilst having a GEM community on Instagram and TSR is largely a positive thing, it’s important to remember that we often only see the ‘highlights’, the good bits, the successes and the ‘worthy’ posts.

Obviously not all GEM/ Medicine ‘influencers’ are like that and I really enjoy seeing the human sides with all the emotions. The sadness, the anxiety, the pain and the struggle.

I’m finding that the waiting list and movement is constantly plaguing my life. I’m currently on a block of night shifts and I find myself waking up during the day to refresh my emails and check TSR. I know that there’s nothing I can do but a little message or a notification is the only hope I have at the moment.

As usual I’ll email to see if there’s movement at the end of the week. I dread the response. Especially if it comes back and there’s been nothing. I’m wholeheartedly praying for movement, even one place throughout this week. It’s the last of my energy clinging to the hope of a place in this years intake. Why couldn’t I have been 100th on the list?! That was I’d have known from the onset that it wasn’t looking hopeful?!

I finish my shift on Saturday morning and then I’m away for a few day’s, which also marks the start of my 2 weeks of annual leave. Hopefully it’ll take my mind off of it and I’ll be in a better mindset by being distracted! Wish me luck!

Categories
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
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 2019 Final Scores

On the 7th October, the UCAT Consortium released the final statistics and results for 2019 testing. As the interim results had shown, 2019 took a slight decrease from the average and the 2018 scores.

The 2019 scores are as follows:
Verbal Reasoning: 565
Decision Making: 618
Quantitative Reasoning: 662
Abstract Reasoning: 638
Total Mean Score:: 2483

My Scores:
VR: 580
DM: 640
QR: 670
AR: 660
Total: 2550

Compared to the mean:
VR: +15
DM: +22
QR: +8
AR: +22
Total: +67

My percentile was calculated at 62%, meaning that I scored higher than 62% of the 29,375 candidates who stat the UCAT this year – a total of 18,213 people.

That’s great right?!

Yes, it’s great. For a first time UCAT taker and Grad Med applicant, that is a good score. My only Uni choice that will take the UCAT is Warwick and whilst I was close to their lowest cut off last year, there is still a chance that I won’t make it for this year. The positives that I have are that I am above the average for VR. I will then be scored on being in the 62nd percentile and given extra points for holding a masters qualification. Hopefully, this will give me an advantage over those with a slightly higher UCAT score and only an undergraduate degree.

 

What’s Next?

My reference came back earlier this week and I only need to perfect my personal statement and then submit my application to UCAS. After that, it’s a waiting game! I’m confident with my work experience and I have met the required minimum hours that Warwick are looking for, this will need to be submitted before selection takes place. Warwick have confirmed that selection dates for interview between the 17th-19th December. Of course, Warwick and the UCAT are only one of my options. I still have 3 GAMSAT universities in play although I do NOT feel confident about my GAMSAT score! I fully expect 3 outright rejections and should the case be that I am also rejected from Warwick (which is highly likely) I’ll be more than happy to admit defeat for 2020 entry. I will however, be back in the running for another application cycle for 2021!

Keep positive, realistic and work hard!

Categories
gamsat

The end of GAMSAT 2019

As many of you will be aware, GAMSAT testing for 2019 came to an end with the September sitting on the 11th. I booked the exam and felt optimistic that this would be my chance to see progress from March. I booked for Liverpool as I had sat there previously and had been advised that they use the same venue consistently for the GAMSAT testing – this saved me hunting for a hotel when the admission tickets were released and paying almost double the price. It also saved me making a gamble that might not pay off and having to travel to the venue in the morning, which again, could have posed a problem/ delays.

The Day Before:
As with March, I was in work the day before the exam. I work full-time and hadn’t wanted to take unnecessary time off that wouldn’t have been productive. Other than travelling down to Liverpool early, I wouldn’t have spent the day prepping or doing any further revision. Work kept my mind off the exam and the day went quite quickly. Now, I could tell a significant difference in my stress levels. Whilst in March I was quite tense and was obsessing about the exam, I managed to get through the day with my only concerns being related to travel.

It must have been a sign as I made the first half of my journey to find that Northern had cancelled my second train with very little notice (it wasn’t showing online and the station admitted that it had only just been relayed to them). This meant that I had over an hours delay/ wait before I could continue my journey. It wasn’t the smoothest of trips but luckily I did manage to navigate via an additional train journey and got into Liverpool just after 9pm.

I headed straight to the hotel (conveniently passing the nearest McDonalds), checked in and got everything sorted for the next day.

GAMSAT Day:
I got up and went for an early morning run around the streets of Liverpool before returning to the hotel for breakfast, which I had booked in advance. After plenty to eat, I checked out and made the walk down to the test centre. Registration opened at 8:15am and I arrived just after 8:20am. Registration was very quick and a smooth process. After depositing my bag and getting settled in my seat, there was still time to kill.

Once 9am approached, we were all eager to get started however there was delay due to travel (there had been a train broken down on the rails near Lime Street) and the weather wasn’t particularly good so the invigilators were allowing extra time; especially as candidates were still due to arrive.

At roughly 9:15, the announcements began.
“Hello and welcome to GAMSAT”.

The Morning Session:
Section 1 was relatively typical of what I expected following on from March. The texts covered medical labeling and autism diagnosis. Poems comparing nature and death. Themes of war posters and their meanings. Poems highlighting how underappreciated poetry is and a Greek comparison of Athens and Alexandria.

Overall, I didn’t find this section too challenging. It had been similar to previous tests and didn’t throw too much text heavy passages. Very light on the cartoons for interpretation. My only worry (which I realised later on during Section 3, did I put my signature in the ‘candidate signature’ box? Who knows? Definitely not me but I’m hoping for £262, my name and identifiable information will be enough for them to justify marking it).

Section 2 began straight after section 1 was completed. Topics weren’t great. Comments relating to taxes and tolerance.

Taxes touched on how tax policies are a reflection of a countries values. Tax evasion and tax avoidance. How if people are not relying on support from others (government/ society) then they will support themselves.

Tolerance was based around whether there should be limitations on tolerance and whether society is too tolerant.

Again, this was manageable and whilst I didn’t enjoy the topics, I was still able to write good amounts.

LUNCH!:
My favorite time of the day. Luckily, next to the venue in Liverpool, there is a little Tesco which must make it’s fortunes on the sheer number of GAMSAT-ers twice a year that frequent for much needed snacks.

At this point, my appetite was rather small. I knew that this was half of the testing day over. I also was well aware that this lead on to the dreaded Section 3 which was my downfall last year. In all honesty, I had very little hopes for this next half of the exam and again, I wondered why I had bothered to sit it in the first place.

The Afternoon Session:
After joining the queues and replicating registration again, it was time to be seated back in the exam hall. The afternoon session is Section 3 – Sciences.

As reading time commenced, I skimmed the paper and began starting to read through and work out some of the questions. At first the paper seemed overwhelming. So. Many. Questions. So. Little. Time. Where were you supposed to begin? I don’t even understand the question, let alone the answer!

I began by really concentrating on the questions – these are supposed to be answerable with actually very little science knowledge which meant that the answers were actually in the question somewhere. Look closely or you’ll miss it.

I set off at good pace and started to tick the questions off. I felt joy and relief when my questimated/ worked out answer was one of the options provided on the multiple choices.

2 hrs and 50 minutes goes incredibly quickly when you’re concentrating and giving your all to the questions. Inevitably, I began to run out of time. I was rushing towards the end to ensure that I at least had an answer marked on the answer sheet for every question. I went back and made somewhat educated guesses (let’s hear it for letter C!).

Before I knew it, we had the final time warning. I did what I could in the time and with a sense of accomplishment and relief, GAMSAT 2019 was done.

What I Leaned:
Sitting GAMSAT as a trial run/ more than once is absolutely priceless for expelling the stress and uncertainty of the exam. I was incredibly calm in comparison to March and I could definitely tell the first time exam takers.

GAMSAT is a gamble. You really don’t know what you’re going to get. After the curve ball of an exam in March, it would be easy to assume the same would be applied for the September sitting. This is not the case. Acer are cruel and they make you work for it. Don’t underestimate the exam.

So what? It takes you 8 attempts to ‘pass’ GAMSAT? I remember being told that someone had sat GAMSAT 8 times. Regardless of the financial element to this, 4 years of GAMSAT testing is hard going but not impossible. The majority of people who sit GAMSAT do so multiple times before they are ‘happy’ with their score/ get into University.

You’re never ‘too old’. I hadn’t really noticed in March but certainly in this sitting, there were a few people sitting who were middle-aged/ older than your average graduate at 22/23. Let that be a lesson that you’re never too old to attempt to follow your dreams or make a drastic career change. Life experience is why Grad Med doctors are so fantastic.

I made the right decision to sit the UCAT early and to not book it for after GAMSAT. Before most people had even booked their UCAT, I had sat mine in July. Whilst I felt out of the loop and extremely premature with testing (one of the first people to take the test at my chosen test centre), it helped hugely to get it out of the way. After the stress of GAMSAT, the last thing I wanted to have was the stress of having to cram for my UCAT, whilst having to finish off my application. It hugely paid off for me and I ended up scoring well in the UCAT despite being an early tester.

You never know how you do. I left the exam and felt that it was tough but I also felt a lot more confident than I did with the March sitting. I know many other GAMSAT-ers that felt it was the most brutal, soul-destroying exam that they have ever taken (including multiple GAMSAT attempts)! Acer will email to confirm that results have been published online but if you have applied, you will also get notification from your Universities as to how you’ve done.

Overall – I felt as content as I could be with the September 2019 GAMSAT. It was by no means an easy test nor an easy option. I’m applying for this year’s applications so will know when my Universities know. Am I worried that I might not get in? Absolutely not. Am I worried that I might get in/ an interview? Absolutely!

I have a personal statement to polish off and I’m awaiting my reference to be completed. It’s a month to go until the calm before the storm. I’m cramming in some extra HCA shifts to help wish the time away, my sister is also getting married between now and the 15th October.. Wish me luck!

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
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.
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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!

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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! 🙂