Medical School at a Glance E-Book

Rachel K. Thomas

• Herausgeber: John Wiley & Sons
• Kategorie: Fachliteratur
• Serie: At a Glance
• Sprache: Englisch

Seitenzahl: 230

Veröffentlichungsjahr: 2016

Beschreibung

Starting Medical School can be incredibly daunting, and the transition to being a medical student can be enormously challenging. Medical School at a Glance is an accessible guide to help give you confidence and to gain a running start to your medical school training.

Covering core areas such as medical training, developing effective learning strategies, understanding common principles, learning how to behave in the clinical setting and how to interact with patients and peers, this book will help to demystify the process and prepare you as you embark on your medical career.

Providing an insider’s view of useful information to build a solid basic foundation for your learning, Medical School at a Glance is essential for those considering studying medicine or are in their first years of study.

Leseprobe

This title is also available as an e-book.For more details, please seewww.wiley.com/buy/9781119075912or scan this QR code:

Medical School at a Glance

Rachel K. Thomas, BM, BCh, BEng (Hons), BSc

With contributions from:

Diana E. Thomas, B.Sc (Hons), PhD

Rusiru H. R. Kariyawasam, MA, BM, BCh

Shreya Bali, BSc (Hons), MBChB (Hons), MRCPCH

This edition first published 2017 © 2017 by Rachel K. Thomas.

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Library of Congress Cataloging-in-Publication Data

Names: Thomas, Rachel Katherine, author.

Title: Medical school at a glance / Rachel K Thomas.

Other titles: At a glance series (Oxford, England)

Description: Chichester, West Sussex, UK: John Wiley & Sons,

Ltd, 2017. | Series: At a glance series | Includes bibliographical

references and index.

Identifiers: LCCN 2016030094 (print) | LCCN 2016030954 (ebook) | ISBN

9781119075912 (pbk.) | ISBN 9781119075929 (pdf) | ISBN 9781119075936 (epub)

Subjects: | MESH: Education, Medical | Physician’s Role | Physician-Patient

Relations

Classification: LCC R737 (print) | LCC R737 (ebook) | NLM W 18 | DDC

610.71/1–dc23

LC record available at https://lccn.loc.gov/2016030094

A catalogue record for this book is available from the British Library.

Wiley also publishes its books in a variety of electronic formats. Some content that appears in print may not be available in electronic books.

Cover image: ©Getty Images/Steve Debenport

Contents

Preface

Acknowledgements

Part 1

Starting medical school

1

Starting medical school

2

Medicine and surgery

3

Understanding medical training

4

Different learning mechanisms

5

Dealing with stress

6

Solving issues

Part 2

Learning important principles

7

Important common principles

8

Ethics

9

Communication skills and teamwork

10

Balance

11

Evidence-based medicine

12

Understanding guidelines

Part 3

Starting clinical activities

13

Behaving on the ward

14

Behaving in theatre

15

Behaving in clinic

16

Learning practical procedures

Part 4

Assessing a patient

17

Approaching a patient

18

Approaching an unwell patient

19

Taking a history

20

Examining a patient

21

Assessing a patient’s hydration

22

Assessing a patient’s nutrition

Part 5

Considering and managing a patient

23

Investigations

24

Considering diagnoses

25

Presenting a patient

26

Consent and capacity

27

Breaking bad news

28

Prescribing

29

Documentation

30

Discharge planning

31

Managing the acutely unwell patient

Part 6

Completing medical school

32

Examinations

33

Electives and special study modules

34

Understanding foundation school

35

Understanding later training

36

Other uses for medical degrees

37

First day as a doctor

Further reading

Index

EULA

Guide

Cover

Contents

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Preface

An alternative title to this book could be: ‘An insider’s guide to what I wished I knew before starting medical school’. It aims to provide you with tips so that you gain a running start to your medical school training. Some areas of knowledge are already ‘assumed’ during your medical course. These assumptions, for example about the course itself, interaction with both patients and medical professionals, and support progressing through medical school, can be assumed incorrectly. As a result, you have to learn some aspects, the time-consuming ‘hard way’ – by trial and error! Your time will already be a premium commodity, so minimising, or eliminating, time spent having to wonder about background issues will free up more time for you to concentrate on your studies and clinical activities. This book provides an insider’s view of helpful information to build a solid basic foundation for your learning, which you can then build on throughout your medical studies and career.

This book does not aim to give in-depth coverage of specific areas, as there are many resources including other At a Glance titles, and the General Medical Council’s Outcomes for Graduates (originally Tomorrow’s Doctors) and Good Medical Practice for this. There are also many useful books by writers such as Atul Gawande and Ben Goldacre that can offer broader perspectives on medicine. The idea of this book is to help give you confidence, and to help you realise that you already most likely in command of some assumed basics underlying medical school.

Rachel Thomas

Acknowledgements

Thank you to all who have been involved in creating this book.

Thank you firstly to the contributors – Dr Diana Thomas for manuscript editing and general contributions, Dr Rusiru Kariyawasam, for chapters on dealing with stress, solving issues, communication skills, balance and other uses for medical degrees, and Dr Shreya Bali, for chapters on behaving in theatre, evidence-based medicine, guidelines and protocols, examining a patient, assessment and management of an unwell patient, and assessment of hydration and nutritional status.

Thank you to Camilla, Hugh, Matthew, Andrew and James Thomas, and Quentin Deluge.

Thank you to Camilla Thomas, Nick May and Dr Alexander Kumar for help with photographs.

Thank you to Simon Roer and colleagues at the General Medical Council.

Thank you to Karen Moore, Loan Nguyen, Francesca Giovannetti and Kathy Syplywczak for their continued assistance at Wiley-Blackwell.

Finally, thank you to all the doctors and medical students who provided valuable feedback on drafts of the book.

Part 1Starting medical school

Chapters

1

Starting medical school

2

Medicine and surgery

3

Understanding medical training

4

Different learning mechanisms

5

Dealing with stress

6

Solving issues

1Starting medical school

It goes without saying that medical school is an exciting experience and a big commitment. It will enable you to meet new friends, as well as discovering new social and academic opportunities. As with any big commitment it can be made easier with adequate preparation, well-informed expectations, clearly defined goals, and well-utilised tools and supports.

Succeeding at medical school, and then in the various careers that medicine offers, requires more than intellectual rigour. The human body is one of the most amazingly robust, yet phenomenally intricate, systems in existence. So intellectual rigour is indeed a requirement.

It is very important to not get bogged down in the sheer enormity of what must, at some point, be learned. There is no denying that there is lots of it! Get used to this fact, and then move on, as past this point it is much more interesting. The learning of the facts is just a part of being a ‘good doctor’ – an important part, but just a part (Figure 1.1).

You may already be familiar with the Hippocratic Oath, which is the historical oath relating to the upholding of ethical standards by doctors (Figure 1.2). This was updated from the Greek text to a modern version in 1948 (Figure 1.3).

Other parts include a strong interest in humanity in general, and particularly the sick. This may sound obvious, but it is key! As you will discover, patients tell you the answers, if you learn to listen and to communicate sincerely and effectively with them. Being able to understand their social context, and the impact of a disease on a person’s quality of life, is important. Being interested in diseases, their diagnosis and their treatment is also crucial. But it is likely that you are already equipped with these skills and interests, or medical school may not have called for you. So instead of being deterred by the sheer volume of facts, take comfort in the skills you already innately have.

At times, being at medical school is like being a detective, gathering all the hints, putting them into the appropriate order, and then piecing the underlying illness together. And there are many other areas – such as eliciting signs, learning the language, creating possible differential diagnoses, performing diagnostic and therapeutic procedures – which you will in time master with practice (Figure 1.4).

Different medical schools differ in their approach to learning. Some integrate clinical care very early on, while others ensure a theoretical foundation before you are let loose on the wards. There is no right or wrong way to learn medicine – as long as you end up being a safe doctor, then you have learned successfully.

First day nerves

Usually, the first few days of medical school are like any other first few days at university – they are often spent with administration and introductory lectures. Perhaps prepare a brief statement about who you are, why you want to study medicine, and any particular interests, as these questions are often used to ‘break the ice’.

Starting anything new can cause a range of feelings, from excitement, to nervousness and stress. The experiences are deeply personal and unpredictable. The extent that people feel these emotions, and actually show them, differs greatly.

So, if you feel a bit anxious, take comfort in the fact that you are most likely not alone. It is safe to say that many students on their first day suffer with nerves. This sense of nervousness can continue for some time. It will pass, as you become more competent and confident in your skills and knowledge.

Types of stress

Medical school is a unique experience. As part of the healthcare profession, you will gain access to areas of people’s lives that is unparalleled in any other profession – patients, who were strangers to you a moment earlier, will share deeply personal, and at times troubling, experiences and information. It goes without saying that this honour can cause a degree of personal stress, particularly when first starting medical school. The stress associated with patient deaths, non-accidental injuries and other aspects of medicine rarely lose their impact, but you will develop coping strategies over time. Aside from the stress that can be associated with patients and learning, there may be the added pressure of financial stress. Life does not stop when you start medical school, and in addition you may also have to cope with your own personal stressful life events such as bereavements and divorces.

Coping strategies

There are many and varied coping strategies for the stresses of medical school. These will be covered in depth in later chapters – however, for the first few days, meet people, find your bearings and accept that there is a long, interesting, winding path ahead in your career, a career that is simply like no other.

Start to enjoy the independence, choice and freedom that can come with starting a course at university, and become familiar with the various extracurricular activities and societies that exist. These will help you cope with stresses, and make your time at university more enjoyable in many respects.

General advice

Never be afraid to ask for help. Everyone had to learn once, and your seniors, your colleagues and your peers all know this, and thus will usually be happy to help. It is preferable to ask for help early – as often ‘a stitch in time, saves nine’.

Trust your own capabilities, and never feel pressured into performing a task that you do not feel capable of doing. Even if the task seems basic to someone else, it is important to have enough confidence in yourself to know both your capabilities, and your limitations. You will always have both, the important skill is recognising where the line lies between the two!

As will be covered in the following chapters, ensure you adhere to important common principles from your first day at medical school – including fully and correctly identify the patient, and respect their confidentiality. You are a doctor in training, and one day soon it will be you on the ward helping these patients. Start cultivating the habits you will require in your career – from adequate hand hygiene to thoroughly documenting actions and interactions – so that these will be second nature once you are actually working as a doctor. Start learning by looking at guidelines and protocols, and embrace primary literature and best current practice to help your learning.

As with any new skill, there is no substitute for practice. The fact that it is referred to as the ‘practice’ of medicine really gives this one away! While ‘practice makes perfect’, perfection is, at times, impossible to attain in medicine – what you can achieve, though, is the reliable and consistent delivery of superior quality care to your patients.

2Medicine and surgery

When graduating from medical school, you generally graduate with a Bachelor of Medicine (BM), and a Bachelor of Surgery (BS). Depending upon the institution, this may be a BMBS, BMBCh (from the Latin, Baccalaureus Chirurgiae) or various other professional awards. While named as two degrees, they are generally awarded as one degree.

The specialties are divided into medical or surgical specialties (Figure 2.1). Early training is split between the two areas roughly evenly, and then commitment to a specialty naturally leads to practising more of this area. There are generalists in each area – general practitioners (GPs) and general surgeons. These generalists may also have an area of special interest, such as a GP with a special interest in Dermatology.

Specialties such as Cardiology, Gastroenterology and Neurology are medical specialties. Generally, the medical specialties start their day at 09.00 hours, and have longer ward rounds.

Specialties such as Urology, Otorhinolaryngology (ENT) and Trauma and Orthopaedics (T&O) are surgical specialties. Generally, the surgical specialties start their day at 08.00 hours, and have shorter ward rounds, as the consultants and team members are required in theatre.

There is often good-natured banter between the Medics and the Surgeons. The uninitiated may not be aware of its existence, but once welcomed into the hallowed halls of a medical school, it will show itself as frequent light-hearted quips in lectures!

Common aspects

At medical school, both medial and surgical areas will require fairly similar amounts of effort. You will need to learn the theory behind pathologies, and how to diagnose and treat them appropriately. You will usually need to attend lectures, tutorials and problem-based learning sessions for both. Obviously, medical and surgical interventions are not always the sole treatment for medical and surgical conditions, respectively.

Both areas will require you to learn structured clinical examinations of the patient, and to attend ward rounds and clinics. Key within each area is learning which includes reflection. Later career progression requires this more formally, so it is advisable to begin reflective practice in your time at medical school. The General Medical Council (GMC) has guidance on what is expected as both a medical student and as a doctor, so it is advisable to become familiar with areas such as professionalism (Figure 2.2) and your duties early on in medical school.

Both medicine and surgery have a similar approach to conditions. These include areas that are covered in later chapters, including:

Correctly

identifying

the patient

Maintaining

confidentiality

Taking a

history

Examining

the patient

Forming a

differential diagnosis

Documenting

in the patient notes

Requesting and interpreting

investigations

Formulating a

management plan

Communicating

with the patient.

It is key as a student (and later, as a doctor) to introduce yourself, and to explain to the patient why you wish to speak with them and examine them. It is important that patients understand that they can refuse to speak with a student, and that if they do it will not impact on their care at all. Most patients, if not too tired or in too much pain, will be happy to help you learn, but if this is not something that they wish to do, respect their rights, thank them, and leave them.

Multi-disciplinary team meetings

Multi-disciplinary team meetings (MDTs) are where different members from different areas of the patient’s care meet at a specified time to discuss the patient. These are excellent learning opportunities, where as a student you can start considering other aspects of the patient’s care. They also provide opportunities to learn from healthcare professionals who are in different areas from the one in which you are currently placed. These team meetings will help you consider:

Complex aspects of a patient’s care

Aspects of a complex patient’s care

and are usually scheduled on a regular basis.

       Teams involved in MDTs vary, but include:

Radiologists

Specialist nurses

Social workers

Physiotherapists

Occupational therapists

Dietitians

Pharmacists

in addition to members of the nursing, surgical and medical teams.

MDTs can help you understand key holistic factors such as packages of care (scheduled support to help a patient in their home) – as practising medicine is not just about pharmaceuticals and surgery!

Professionalism

All areas of both medicine and surgery require the utmost professionalism, with the GMC providing strict guidance on this. Professionalism extends beyond your interactions in the hospital and at medical school. Ensure that you pay attention to personal aspects of your life, such that they do not bring your integrity into question or disrepute.

Social media sites can easily be accessed by universities’ faculty members, future employees, colleagues and patients. Therefore consider this aspect before posting images on sites such as Facebook or Instagram. Consider changing your privacy settings so that only close friends can see your content, and consider requesting that friends respect your privacy by not posting images of you without mentioning it to you first. Twitter can be a useful avenue for connection with various health agencies, such as the World Health Organization and the NHS, but it is important to carefully consider tweets or re-tweets before making them. Some medical practices advise their doctors against having instant messenger apps such as WhatsApp, so ensure that you are familiar with local protocols. Remember that once in the public domain online, these comments and images remain discoverable in the foreseeable future. The GMC has issued guidance on Doctors’ use of social media to help with complying with good medical practice in these channels. Not complying can create serious implications and call your professionalism into question.

3Understanding medical training

Medical school

Medical school is obviously the first official step on your way to becoming a doctor. There are different types of medical schools. Generally, they can be divided into undergraduate entry and graduate entry courses. Each medical school has its own entry criteria, usually including independent standardised examinations such as the BioMedical Admissions Test (BMAT) (Table 3.1), the UK Clinical Aptitude Test (UKCAT) (Table 3.2), or the Graduate Medical School Admission Test (GAMSAT) (Table 3.3) and an interview and application process.

There are various websites, commercial preparatory courses and books available to help you prepare for the application process, as well as courses that can help prepare for the tests. However, arguably the best preparation is spending time in a hospital, and with other doctors, so that you have an amount of experience and realistic expectations of what a career in medicine involves. Speaking to other medical students and junior doctors about their experience is also very useful.

In graduate-entry courses the students are generally older, having completed another relevant degree before being admitted to medical school. With undergraduate courses, there may be several early pre-clinical years that are more devoted to theory, although this can vary. Some degrees are intercalated, where there is a year taken out to study another area, such as Business or Management.

It goes without saying that medical school is academically rigorous, so good grades at school in areas such as Science, Chemistry, Biology and English are advantageous.

You need to apply for both undergraduate and graduate medical schools through the online Universities and Colleges Admissions Service (UCAS). Within this, you need to complete aspects such as a personal statement, detailing why you wish to study medicine. There are various resources available for assistance in this application, as it, combined with your Admissions Test mark, decides whether or not you are interviewed. Remember that the purpose of the interview is to check your overall suitability for medical school – both your knowledge and your communications skills. Ensure that you have read some relevant health news prior to interviews, as questions on current events are common. Even reading Twitter feeds from health organisations can be a quick and easy way to keep up to date.

Towards the end of medical school you apply to the Foundation Programme (see Chapter 34).

Foundation Programme

After graduation from medical school, junior doctors enter the 2 year Foundation Programme. The first year is Foundation Year 1 (FY1), and the second is Foundation Year 2 (FY2). These early years are usually split fairly evenly between medical and surgical jobs, to provide thorough basic training in a broad range of areas. Full GMC registration is achieved after satisfactory completion of FY1.

In the Foundation Programme, you will have a Clinical Supervisor and an Educational Supervisor. Your Clinical Supervisor changes with each rotation, and is required to verify the satisfactory completion of clinical activities while under their supervision. The Educational Supervisor generally remains the same for the entire year. They help you with career-planning, goal-setting and objective-meeting. You are expected to meet with them regularly, and they are your first port of call if you are having any problems. The Foundation Training Programme Director meets with you at the end of the year, to review your progress and determine if you have achieved goals so as to be signed off for the year. There are clearly defined aspects that need to be completed satisfactorily in order to achieve sign-off (see Chapter 34).

Towards the end of the Foundation Programme, you can apply for further training (Figure 3.1).

Specialty and core training

After satisfactory completion of the Foundation Programme, you are able to undertake specialty, core or General Practice training (see Chapter 35).

At the end of satisfactory completion of your training, you are issued with a Certificate of Completion of Training (CCT). Once you have been issued with this, you are able to be entered on the GMC’s Specialist Register (or GP Register), and are able to work as a Consultant (or a GP).

Revalidation

Revalidation was created to ensure that all practising doctors are of a suitably high standard. During the first year after graduation, a provisional GMC registration is held. Most doctors only hold this for 1 year, although it can be held for up to 3 years and 30 days.

You must also hold a licence to practise, which legally enables you to work in positions in the NHS and to perform activities such as prescribing, and signing cremation forms. This is not just a recognition of qualifications. Evidence must be provided during revalidation to show that a doctor is fit to practise, provides good clinical care and meets the GMC’s professional standards on an ongoing basis to continue to hold this.

A designated body is the institution that supports the revalidation, and the responsible officer is usually a senior member of that organisation who makes the recommendation. During this first 5-year cycle after gaining full registration, you can only work in an Approved Practice Setting (APS). During the early years as a doctor, these requirements will usually be met within the training programme.

Hints and tips:

Spend as much time researching and

experiencing

aspects of medicine before you apply

Ensure that you have

realistic expectations

of medical school

Ensure

regular contact