Tag: graduateentrymedicine

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The Application

Where to Apply to This Year?

Last year, I applied to Nottingham, St George’s, Swansea and Warwick. All these programmes were the graduate entry, 4 year route (A101).

I’m starting to think about whether I would change my approach this year. It’s still early days and some medical schools have yet to finalise their 2022 entry requirements.

Nottingham A101:
2020 entry cut off: 55
2021 entry cut off: 58 (Rounded up the Notts scoring method)

St George’s A101:
2020 entry cut off: 58
2021 entry cut off: 60

Swansea A101:
2020 entry cut off: 60
2021 entry cut off: 62

Warwick A101:
2020 entry cut off: 2570
2021 entry cut off: 2720 (+/- depending on what you read and where…)

As you can see, there’s been some increases in admission exam cut offs. This is where the difference of an overall score point, makes all the difference and let’s not talk about Warwick’s huge, 150 point increase for their UCAT cut off this year.. I know a lot of people told me that an application will never be a waste but coming straight off the 2020 entry and into 2021 applications made me feel depressed. I knew there was a strong chance of increased cut offs and this is exactly what’s happened this year. I doubt that I would have been interviewed by any of these universities had I applied again for this year – hindsight is a wonderful thing.

Do I apply for the same places?

I’m still considering all 4 year, GEM programmes. As Warwick require the UCAT and the results are given on the day, if I score less than 2750/2800, then I risk being too low for Warwick, meaning it’s a wasted application. So.. Step up Ulster University! They’re in the process of interviewing for 2021, which is their first ever cohort for their graduate programme. Reading through threads and research, the GAMSAT cut off for 2021 was 55/56. A very obtainable score, similar to Nottingham, making them a really suitable place.

If I score high enough for Warwick, I will still consider exchanging Swansea (historically high GAMSAT cut offs) or St George’s (London living expenses), for Ulster. Ulster have become quite a favourite for me whilst researching the campus, the course and the location of Northern Ireland!

Why Ulster?

Ulster are a brand new medical school and 2021 will be their first cohort. A lot of people would see a new medical school as a bad thing however, it’s far from negative.

Their GAMSAT cut off has been amongst the lowest for graduate entry (similar to Nottingham).

The course is overseen and linked with St George’s in London. If on the rare occasion that Ulster do not get accreditation from the GMC, then you will receive a degree from St George’s University London instead. Essentially, the worst case scenario, is a degree from a university I would have applied for anyway. It’s the same course, qualification but without the London living costs.

Location-wise, Northern Ireland is a bit of a change but by no means impossible. Other than the initial moving fees, Derry/Londonderry is affordable and a beautiful place to live! If I have to relocate around the country anyway, why not Northern Ireland?

Will this change?

Probably! Let’s face it, UCAS opens next month, GAMSAT registration opens next month and UCAT registration opens in June. The deadline for UCAS is October (usually the 15th). That’s a long time off just yet!

Categories
The Application

Undergraduate Medicine or Graduate Entry?

When talking about applications to Medicine as a graduate, it’s often referred to as ‘postgraduate medicine’. The reality is, a medicine degree is still an undergraduate (UG) degree, regardless of whether it’s completed as a graduate or direct school leaver at 18. As a graduate you are fortunate to be able to apply to both degree programmes.

A100 Medicine:

A100 Medicine is intended for direct school leavers. The course is 5 years long and funding is provided by Student Finance England if it is your first degree. Applicants to an A100 course usually need to meet GCSE, A-Level, work experience and admission test requirements to be considered for interviews and offers.

Applying to an A100 Medicine degree as a graduate:

Many A100 medicine degrees will accept those with degrees already completed to their programmes. It is important to remember that the course is 5 years long (a year longer than most GEM programmes) and you still need to meet the course degree requirements. A100 would count as a second degree, there is no funding through Student Finance England for the tuition fees. Students may qualify for the maintenance loan but would have to self-fund the £9,250 annual, tuition fees themselves. This is usually a big disadvantage to graduates and a reason why many do not apply to the A100 courses. The bonus of an A100 degree is that the admission test (UCAT) cut off is often a lot lower than those needed for the Graduate Entry courses.

Graduate Entry Medicine:

A101 Graduate Entry Medicine is an accelerated course specifically designed for graduates who have already achieved a degree or are in their last year of study. The course is 4 years long and whilst students have to pay £3,500 towards their first year tuition fees, the rest is covered by Student Finance England, NHS England and they are eligible for the maintenance loan and NHS bursary too. Graduates are expected to have met their degree, A-Level and sometimes GCSE requirements, as well as work experience and admission test cut offs.

Whilst GEM seems like a far better option for graduates, it’s a LOT more competitive than A100 Medicine and the cut offs for admissions exams (GAMSAT/UCAT) are a LOT higher.

How competitive is it?

Each year, roughly 10,000 applicants apply for GEM. The number of places available changes each year but is roughly 900. Some of the GEM courses also can’t be applied to unless you meet specific requirements e.g. Cardiff is part of a feeder-scheme that is only available to students from select Welsh universities and completing certain degrees. This restricts the number of places available even further.

Recent statistics show that there can be up to 35 people applying for each place on a single GEM programme (QMU, Barts).

For every place, there can be up to 11 people interviewing for the single offer ( Cambridge University).

Where to apply?

It’s always sensible to apply to universities that cherry-pick your strengths. If you scored exceptionally well in the UCAT, Newcastle A101 is a good choice. Their UCAT cut off this year was higher than 3020 which is stupidly high – keep in mind that the UCAT is scored out of 900 in each section, so 3600 is the maximum score attainable. A score of 3020 would put you in the 96th percentile, meaning that you scored higher than 96% of candidates. Meaning that Newcastle A101 targets the top 4% of UCAT candidates.

If you scored particularly well in the GAMSAT you could apply to Exeter A100 as their cut off is 66. Whereas, for a GEM course, you could apply to Swansea with a score of 62. Likewise, if you scored on the lower side of the GAMSAT, you would apply for places such as Nottingham A101 who have their cut off at around 58/59.

It’s important to remember that this year has shown a significant increase in both the number of applicants and the admission exam cut offs.

Is getting an interview good?

Yes! Of course it is! Medicine is still the most competitive degree programme that you can apply for. An interview can be the last hoop that you have to jump through to be offered that much desired place (if a graduate)!

There are 10,000 applicants each year and the majority of those are not invited to interview due to missing their grades/ degree classification, do not meet the admissions test cut off or do not have the relevant work experience. Getting to an interview is a huge achievement. The University of Nottingham claim that they cut the applicant numbers down by 80% simply by rejecting those that do not meet their GAMSAT cut off for the year. They then invite the top 20% of applicants to fill in a work experience questionnaire before shortlisting to interviews.

Can I apply to both A100 and A101 courses?

Yes and you should. If you meet the requirements for an A100 course and feel comfortable with working whilst you are learning, then an A100 course shouldn’t be hardship. Apply to a mix of A100 and A101 courses that suit your strengths and give you the best possible chance at interview.

Categories
The Application

Application Timeline for 2022 Entry

Explaining the timeline for Graduate Entry Medicine can sometimes be confusing – a lot of work happens the year/s before!

As of now (March 2021) this will be my (rough based on last year) timeline:

May 2021 – GAMSAT registration opens for September 2021 testing.

June 2021 – UCAT registration opens for 2021 testing (July – October).

July 2021 – UCAT testing begins.

September 2021 – GAMSAT testing.

October 2021 – UCAS deadline for Medicine & Dentistry applicants. UCAT testing ends.

November 2021 – UCAT results sent to universities. GAMSAT results released to September candidates.

December 2021 – Communication from Universities – Interview invites, pre-interview rejections and work experience evidence.

January 2022 – Interviews begin. GAMSAT registration for March 2022 opens.

February 2022 – Student Finance applications open for new students. Deadline is roughly the end of May 2022.

March 2022 – Offers and waiting lists begin being allocated. GAMSAT testing.

July 2022 – Most offers/ rejections sent out. Waiting lists still operate.

September 2022 – Waiting lists close and courses start for 2022.

Exceptions or other time constraints – work experience must be completed by the October 2021 UCAS application deadline to be counted towards your application total (e.g. Warwick University).

Some universities send correspondence throughout the application cycle, others operate under radio silence.

Categories
Uncategorized

Rebrand/ New Logo

I’ve now branched out onto just about all social media. It’s spurred me on to have a bit more of a professional image/ logo so, here it is!

Categories
Work Experience

HCA Interviews – What Will They Ask Me?

Recently, my temporary contract (from my redeployment) came to an end. My Trust and manager informed me that there would be permanent band 3 HCA posts being advertised shortly. In January, the posts were advertised on the NHS Jobs website. These were open to both internal and external applicants. They were also a different number of positions for all the wards, not only mine.

I filled in an application and sent it off. It took about 4 weeks before I was shortlisted and invited to interview.

There were some HR related issues and my interview was cancelled on the morning it was due and I was offered the permanent role by my manager instead. Which was very convenient for me.

However, I was able to find out some of the questions I would have been asked. All candidates that were going to be interviewed would have been asked the same questions and their interview performance assessed by people they did not know or work with. This meant there was a very real chance that if I had interviewed poorly, I might not have gotten the job I have been doing for the last 11 months. A really scary possibility and something my manager was not informed of either. (She was interviewing too but kept away from our interview panels. It would have been better for the ward managers to interview the candidates for their own wards, to know who would be a good fit for their team and patients.)

Regardless, HCA work is deemed the ‘gold-standard’ of work experience. It’s invaluable. It’s hands-on, patient care. It’s patient centred and the chance to work as part of a multi-disciplinary team. It really sets you up for all aspect of working within the NHS.

INTERVIEW:

Will I need one?

Yes, you will. Every band and role requires an interview.

Who will interview me?

This depends. For my interview it was a Clinical Lead Occupational Therapist, a Nurse Consultant from another ward, and a Ward Manager from another ward. Sometimes there will be HR involved or people who already do the job. Usually it will be a Ward Manager or Team Leader for the ward/ department.

Will the interview be in person or online?

I’ve know of interviews being held in both formats but mine was offered online via Microsoft Teams.

How long will it be?

Mine was scheduled for 30 minutes.

WHAT WILL THEY ASK/ LOOK FOR?

All the way through an NHS interview there will be questions that should allow you to showcase your skills and why you are best suited to the job.

WHY THIS ROLE/ DEMONSTRATE YOUR SKILLS?

For a HCA role, you’ll be prompted to draw on your precious experiences to demonstrate you’re a good fit and can do the job. For example: I had the experience from doing the job previously but they would still look for the aspects of being caring, compassionate and competent. Have you done a caring job before? Do you teach or mentor? All really transferable skills!

SCENARIO QUESTIONS:

So, the NHS/ Healthcare LOVE these. I find they’re often easier to answer as you can put yourself in that situation and explain what you’d do. You don’t have to necessarily find appropriate examples of previous skills.

A PATIENT ASKS FOR FOOD/ DRINK OUTSIDE OF THEIR MEAL TIMES, WHAT DO YOU DO?

This is quite a common question. A patient makes a request for something that you don’t know what to do with. How do you handle not knowing something?

Refer to their care plan. It’ll detail if they’re on any restrictions or special dietary requirements.

Check their food and fluid chart – they may have missed a meal or been a significant amount of time since they’ve had a drink/ low on hydration.

Most importantly – ask your team. You’re not completely on your own. The staff you work with may be experienced and able to guide you, that’s why we work as a team. It’s all about support. Always ask if you’re unsure. It may seem really simple such as someone is thirsty and wants a drink but I have previously worked with a patient who is on restricted fluids. They may also be restricted for medical reasons e.g. an upcoming appointment or due to medication.

YOU’RE IN AN MDT AND THE CLINICAL TEAM ARE MAKING A CHANGE TO A PATIENT’S CARE THAT YOU BELIEVE IS NOT IN THEIR BEST INTEREST. WHAT DO YOU DO?

Again, really common scenario. Linked with professional disagreement/ how to challenge professionally. You may be applying for a band 2 position or a band 8b, it doesn’t matter. Everyone should be able to work and communicate what is both safely and in the patient’s best interests.

You can professionally challenge ensuring you explain why you believe this is not in the best interests of the patient. Give examples, if you’ve worked with them before then that helps.

Suggest that this change be made temporarily or on a trial basis. This will show that you’re open to change but aren’t fixed to a permanent care plan change should it not work.

HOW DO YOU KNOW A PATIENT HAS DETERIORATED?

Classic!

Deterioration is anything below the ‘normal’ or baseline presentation of your patient. If you have worked with them for a long time, you’ll know what is normal and what is not. How do you tell if you don’t work with them? PHYSICAL OBSERVATIONS/ PHYSICAL HEALTH! Check their BP, Pulse, O2, temperature. Make sure it’s written up in their NEWS chart and any scoring escalate to the NIC. If significant scoring, the on-call doctor will review, if life threatening, always call 999.

Little signs such as a patient not looking well – colour being off, sleeping a lot, not quite themselves are all signs of deterioration. THIS IS HOW I ESCALATED AND HELPED TO DIAGNOSE THAT MY PATIENT HAD COVID LAST YEAR.

HOW DO MAINTAIN PRIVACY/ DIGNITY AND/OR CONFIDENTIALITY?

A very common question.

Privacy and dignity can be anything from washing/ bathing/ dressing/ changing clothes or dressings and ensuring the patient is covered or kept away from an audience.

If breaking bad news to a patient, ensure they’re in a private or quiet area so that they can process this and display their emotions without fear of people watching.

In mental health, incidents requiring physical restraint are usually handled by ensuring the patient, staff and peers are safe, if this occurs somewhere communal/ busy, clear out the area of non-essential staff and patients that don’t need to observe someone at their worst.

These are only a few examples and not a complete copy and paste of the questions I was due to be asked but very similar.

Be sure of your skills, show how much you care, know the priorities and values of the NHS. Most of all RELAX AND BE YOU! If you don’t know something, be honest but explain what your steps would be to solve the situation, despite not knowing/ how you would expand your knowledge for next time. 30 minutes might seem like a long time but it’s definitely not long enough to sell yourself completely!

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Uncategorized

Back for round 2!

I’ve taken a good hiatus away from my BecomingDrBex accounts and blog. I have not applied for 2021 GEM and have therefore, stepped away from the applications and general buzz of medicine.

It’s been very therapeutic and I’ve enjoyed not having to worry about the deadlines, admissions exams, cut offs and impending interviews.

I’m currently in isolation from contact with COVID (despite a negative swab result) and have decided to give some time to the blog – mainly more detailed posts on the application process – admissions exams, interviews, choosing your universities to apply to and work experience. I had previously done a poll about expanding into video posts/ Youtube videos which was very successful. I’m hoping I can start getting this off the ground too.

As GAMSAT results have been released, it’s a gentle reminder that registrations have opened for March 2021 sitting. This time last year, I had never imagined that I would have to sit the GAMSAT again but know that if I want the best possible score, a March and September sitting would be wise. I’m going to also make up a revision plan for what I would like to achieve before the March exam, I’ll update my Instagram with all the information as I go.

I welcome any input into which topics you’d like to see covered – even if it’s in more detail from a previous post. I’m hoping some more dedicated blog/ medicine time will spark that passion again that I’ll need for next year’s application!

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!