5th year in review

I have enjoyed 5th year, it was much more relaxed than the notoriously difficult 4th year, and it was nice to get back to general medicine and surgery after focusing on clinical specialities.

It started off with an amazing elective - I headed down under and spent most of my time on a massive road trip in a trusty bright yellow 4x4, and did very little medicine...

Choosing a deanery

Next 5th year begins, with a whirlwind of career talks it suddenly all feels very real - FPAS, UKFPO, SJT, EPM, PSA, what does it all mean!? Before I knew it was I was going to be making very serious life choices with very little information, as the foundation programme applications opened up in October.
This is a little gripe I think we all have in medicine, it's hard to think of many other job examples where you apply for the location of the job 10 months in advance, with very little information about the jobs/ availability/ working conditions, or anything really. My non-medic partner finds the whole process bizarre, and soon I felt like I needed to make a powerpoint to explain the convoluted application process to all my family members.
Eventually we decided to move down to London, and I tentatively researched the 3 deaneries and was horrified to see the score cut offs and competition ratios. This led to a lot of tooing and froing but I got a good decile + intercalation, and put down North East and Central London. This was mainly because most of the hospitals were actually in London, and it seemed a bit more affordable and nice to live in than North West London. South Thames was too sprawling for me, the idea of a guaranteed long commute didn't appeal!
Luckily this year we were allowed to change our deanery choices up to February, which I think a lot of people ended up doing last minute out of stress! I will leave it to you whether you think this is a good thing or a bad thing.

Our placements were mainly a mix of medicine and surgery with 4 weeks of GP. I found (to my horror) I was enjoying surgery more and more. I had always thought of myself as a proper medic, no cutting here thank you. But as I found myself gravitating to theatres (by choice!) and revelling in interesting cases, x-rays, and CT scans, I couldn't deny the growing enjoyment I was feeling. This led to some serious soul-searching, and massively influenced by job ranking for F1 and F2.

I've never been the best attendee... I did start to feel a bit guilty about missing empty afternoons on the ward, and or the 3rd IBD clinic of the month. I wonder if this is universal to medics? Talking to my friends it appeared lots of people skipped seemingly pointless aspects of placement, to go to the library and do more productive learning. I suppose it's an important part of being an adult learner, you identify what you actually need to go to! But I think now that I am a few weeks away from being an F1, I am desperately regretting leaving at 2pm on Friday - what if I missed a clinical scenario I will now be faced with alone! I suppose this is all part of the 'new doctor' jitters.

SJT and PSA

The year plodded on, I found the SJT a very challenging exam time-wise, and had about 30 seconds to spare at the end. I hadn't paid for any expensive courses, or bought any books, and I worried I would be at a disadvantage, but in the end did well. The PSA (prescribing exam) was fine really, if you can quickly search the BNF you will be okay!

I passed the PSA with a good margin, and managed to get 46 on my SJT! I was in absolute shock. It was a snowy day and I woke up to about 50 texts off various medic friends with their news and asking about mine. I still remember logging in and being manically happy and seeing I had got my first choice deanery. That good mood stayed with me for days!
There will also be friends who have not got what they wanted - it's important to check up on these people, and make sure they know they're cared for, and it's not a reflection of them as a person. I had a friend who missed out on his first choice deanery by one mark, and he was devastated - it's sad that the process appears to be such a lottery, and as he will honestly be a fantastic doctor.

Choosing jobs

Then comes the very stressful process of ranking jobs. In my deanery, you are essentially sent a spreadsheet with 300+ jobs, and are asked to rank them. There was no information online about any of the jobs, and I essentially just googled the hospitals. Luckily I was in a Facebook group where a few F1/F2s from the same deanery posted some reviews, I would have loved a bit more information though!
The process was markedly different across the deaneries - in some you were further subdivided and had to rank areas of the deanery before choosing jobs, in some they went even further and you picked hospitals and then only had about 10 job options to choose from.
I found the whole thing very stressful, it felt like it was a massive choice, deciding your entire life for the next 2 years.
It was a careful balance between location and jobs, with a seemingly perfect job combination, but one year is a bit of a commute away at a hospital with a bad reputation. In the end I tried to settle on location as my first priority.
My main job factors were to avoid A&E - I really did not fancy spending my winter in an understaffed, at-breaking-point A&E department. Many people were surprised at this, as they want to locum in A&E, but it's not for me at all. I also wanted a surgical job at the beginning of F2 to see if it seriously for me, and a possible career choice. This was actually incredibly difficult - there was at least 20+ with no surgery at all (not even OBGYN/ITU - apparently A&E can count?), and very few with surgery + no A&E.
In the end I managed to get my first choice at 2 fantastic hospitals (actually in London) - including 2 surgical jobs, gentle GP for a break, cardiology which I really enjoy, with no A&E or Psych (awful for some, but a dream for me!).
Ultimately you have to do whats best for you - if you don't have the most competitive score, you might put rotations with more undesirable specialities further up (i.e. psych) if its hospitals you really want, etc etc.

Finals

After all the excitement of everyone getting their jobs and deaneries, real life begins. I feel like finals snuck up on me, I had been so focused on other things. It didn't feel like last year, where I worked incredibly hard year round, terrified of the notoriously difficult exams.
Lots of people use 'Alasdair Scotts' notes - whilst they are a fantastic resource, I prefer writing and revising from my own, mainly using OHCM, patient.co.uk and passmedicine. Also some of his management plans are a little out of date.
I tend to revise in the library, finding being stuck at home too lonely. We all plodded through passmed and our notes, laughing at the same question comments and finding the same things hard.
I also spent 1-2 days a week doing about 5-6 hours of OSCE's. I find OSCE revision considerably more draining and difficult than revising for written/ picture exams. All the talking, all the preparation. As a little group we wrote our own stations and used books, which seemed to work well.


Now, all the advice from friends in the year above had been 'the written aspect is so simple you could sit it at the beginning of 5th year and pass, the OSCEs are brutal' - this turned out to the complete opposite. Perhaps med school like to mix it up?

The OSCEs were very fair and really okay, there was some stations I clearly messed up on and found challenging, but overall they were similar to what I was expecting. The written on the other hand, ye God. It was a brutal. Anyways, all over now!

After finals we had a long and good celebration, including lots of BBQs, nights out, and a weekend away medic grad ball, which was so fantastic, I will cherish all my memories dearly.


After all the ups and downs, the amazing experiences, friends, relationships, and genuinely farcical moments, I really can't believe it's all over.
Well med school, you've been a ride, what a joyous experience.
To a new chapter and beginning!

Passed finals - Doctor here I come!

So, I've passed finals and made it! Officially a Doctor.

It feels absolutely insane - how much I've changed since I started this blog in 2009, writing thought out and lengthy pieces about medicine applications, to now, choosing a foundation school, ranking jobs, and ultimately finishing med school.

5th year has been great, and I currently feel warm with nostalgia.

August sees me moving down to the Big Smoke to start my new life as an F1, and what a journey it has been.

Many congratulations to any other finalists out there - we're doctors!

Acute care 'sharp end' of medicine

My rotation just passed involved all the areas of acute care - anaesthetics, ED, ICU etc. It was fab as a medical student, especially on ED. Getting your own patients to clerk, do bloods and investigations on, take round to CT, refer and discuss with seniors, actually made me feel like a doctor. I felt useful and part of the team, helping to bring the waiting time down and doing jobs for everyone.
I was at a major trauma centre so my time on resus was great, very '24 hours in A&E', and also fascinating medicine. The acute assessment and diagnostic side of things is so interesting, especially with all the ultrasound technology etc. they have. Trauma pathophysiology really grabbed me, and also lead me to pick up a physiology book for the first time in about three years.
I can really understand how the faster paced, 'sharp end' of medicine grabs people, but I think for me I would miss the follow-up too much. Even now there's still patients who float into my head and I wonder what happened to them after they were wheeled away.
There were also some incredibly upsetting cases, a neonatal death, multi-mortality RTC etc. I can imagine it is a very emotionally draining speciality.
For example, an elderly lady was brought in with type 1 respiratory failure, severe confusion and drowsiness, and x-ray showed a florid chest infection. She was already elderly with multiple co-morbidities, and BiPAP on resus was failing to bring her O2 sats up. A quick decision needed to be made about escalation of care and DNACPR status, all the while still waiting for her family to arrive. Emotionally difficult for all involved, as DNACPR was decided and the lady eventually went into cardiac arrest and passed. Dealing with death in such a fast-paced way was not something I was used to. Previously, my main experiences with death had been in a Palliative setting, where it is profoundly prepared for, still upsetting, but much more time and consideration has gone into 'planning the death' for want of a better phrase. Although, the consultant told me it was unusual for someone like this lady (in a care home etc.) to not already have a DNACPR decision in place.

Anaesthetics was okay, I got to intubate, do lots of cannulas and LMA's, but I just didn't really enjoy it, not sure why. Maybe it was because of the acute NHS bed crisis, something that underlined all of my time in acute medicine actually. At least one list a day (normally many more) was cancelled due to there being no beds, meaning there was lots of running from theatre to theatre trying to catch them in time to be useful. Then of course there was competition with ODP students, paramedic students, and other medical students! I just always felt like I was awkwardly stood in corridors knocking on scrub windows and bothering people, maybe I just need more confidence.
I enjoyed ICU, but I didn't feel like I could do very much. And my feet! The agony! Those 12 hour shifts with little to do left me dreaming of bringing my own chair to sit on.

Overall, whilst really enjoying my time on the various acute specialities, I don't think they're for me. I can really appreciate why a F2 job in ED would be invaluable though, I feel like I learnt so much there.

First rotation of 4th year

I'm back in medicine after a year out intercalating, and whilst it has been nice to get back into clinical practise I was apprehensive. Trying to remember which blood bottles were for what, and even a basic neurological exam proved difficult for me on the first week back.
However, I did have a gentle start back I was on a oncology attachment at a DGH. I really enjoyed oncology, and am starting to think it might be the speciality for me. I feel like the marriage of science and art is ever present in it, as you utilise complex cellular, pharmacological and radiological knowledge, with a truly holistic approach to your patients. Working in a DGH and staying in hospital accomodation was nice as well. I really got to know the whole team and the clinical areas, and felt like I had more autonomy over my timetable than you find in the large teaching hospitals.
In DGH's I feel like you get a lot more teaching, and have much more free reign of the hospital. In the main city I train in, you often feel like a redundant spare part, taking up precious space and time.
The actual oncology attachment mainly involved clerking patient's and sitting in on clinics. I tried to make sure I clerked with patients with common oncological emergencies, like spinal cord compression and neutropenic sepsis. One (obvious) hard thing in oncology was of course the devastating impact cancer has on patients and their loved ones. I saw an absolutely lovely lady who presented with spinal cord compression, after being in remission for 9 years. Her and her husband were incredibly anxious and distressed, but trying to stay positive. Her bone biopsy quickly confirmed that it indeed was a recurrence of her previous cancer, with a prognosis of <1 year to live, really grim. Despite that though, the patients were truly wonderful - I know that is a cliché, but it is the truth, and with the constant advancements in technology and treatments, there is huge motivation and drive within all the staff. The doctors and nurses were all kind and a lot of fun, this reminded me of some advice an orthopaedic surgeon once gave me 'find a speciality where you get on with everyone', promising!

Next I had a placement on GP, I find GP a snooze-fest, but I understand it's important. Our GP practise was particularly bad, we seemed to have 1-2 hours of clinic in the morning, a 4 hour gap, and then 1 hour of teaching in the afternoon... My placement group and I spent most of our time sat in a small pre-fab building doing SDL. I didn't see a patient alone until the end of my second week, back in 3rd year I had solo clinics daily! The disparity between different placements is always maddening, but hard to avoid for med school I guess. To be honest it probably didn't help that it was almost 1.5 hours drive away, adding a lovely 3 hour commute to what started to seem like a pointless day.
I just struggle to see the appeal of GP, I know it means you won't have nights and weekends, but honestly sitting in a room alone all day, trying to sort out complex (mainly) psychosocial problems and vague symptoms in 10 minutes, being continually vilified in the press, sounds like my idea of hell.
Once interesting difference was this was the first GP I was in to employ a physician associate (PA), a relatively new profession within healthcare, essentially brought in as a quick fix to plug the gap in doctors (as far as I can tell). It was an... interesting experience. Not necessarily positive, I've had much better experiences with hospital PA's. I can see the positives of the scheme, but I think PA's competencies needs to be more widely defined and understood, to be utilised properly.
Anyways, this once again just cemented that GP is not for me. We were all absolutely buzzing as we drove away for the last time.

Intercalation year

Hello,

Long time no speak as per! This junior doctor contract malarky led me back to the Blog-sphere reading Doctor's opinions, and I thought it was about time I revisited this old place. I still get weekly emails from GCSE students asking me about their grades, but sadly my friends, and even my friends siblings, are far from GCSE age and I honestly don't know what the situation is at the moment.

I have heard applications for medicine are down by 18%, so maybe this is the best time to apply!

I have taken a year out of clinical medicine to intercalate this year, and I'm really glad I did. I chose a degree that was 50% research based (I missed science a little bit) and I feel like I've learnt a lot of invaluable skills, not to mention possibly getting a publication out of it (fingers crossed).
Even simple things such as genuinely being able to critically analyse papers, write abstracts, and perform statistical tests haven't really been covered in my degree thus far, but are obviously really important for being a 'doctor and a scientist' and I feel like it will serve me well in my career.

Additionally, having actual free time has been a God-send. On clinical placement you're (supposed to be) on the wards 9 - 5pm, and then have a huge amount of SDL to do. This can be very draining, to the point where it feels like placement is a waste of time because you know the mountain of conditions and drugs you have waiting at home to be learnt. Evenings, weekends and holidays are quickly eaten up by all the things you could and should be learning. The medic type 'A' personality is no help here; things quickly become slightly competitive and stressful, and before you know it you're memorising the waves of the JVP because someone mentioned it once came up in the OSCE 6 years ago.
Intercalating has allowed me to have a job, be on two society committees, volunteer and still have time to take evenings and weekends off work. I've been on three holidays in 2016 alone, and it's just been fab. Having afternoons off and dedicated lab time, with work loads that actually reflect 10/20 credit modules (instead of the ridiculous 100+ lectures for 20 credit modules we got in years 1 and 2) makes a huge difference, allowing you to actually learn and digest the material, instead of desperately cramming it.

I would really recommend it if you have the financial means/ interest in doing so. The majority of my friends who've intercalated are glad they've done so, and I feel like it's boosted my confidence now that I have a greater knowledge in pharmacology, physiology etc.

So if you're thinking about it, research it and go for it! And don't worry too much about Student Finance etc.. Even with my year of Biomed before starting Medicine I still got a loan.

Goodbye for now, once my clinical placements start up again I am hoping to blog more regularly - and thank you to all the Doctors out there protesting, as a medical student whom this contract will greatly affect, I am exceedingly grateful.

Also a little disclaimer: I am quite ready to get back to clinical medicine now. Whilst I have loved having free time and getting back to my scientific roots, staring down a microscope has limits to it's interest, and I have definitely missed placement and all the highs and lows it has to offer. 

Tips for second year Medical Students

Second year is a bit of a hazy blur, but at my medical school it is another academic year.
I enjoyed it more than first year, as we started covering clinical conditions and pathology, and there felt like there was a light at the end of the tunnel to all the biochemistry!

Second year is the last year where you still have free time, as soon as the clinical years start you have 9-5 placement and extra work on top of that. In second year I probably had 20 hours a week and still plenty of afternoons off.

So essentially second year is your last time to play! Make the most of it.

• Make the most of your free time: this is the last year where you have a lot of free time for societies/ sports etc, obviously you can do these things in the later years! It's just a bit more stressful. So make the most of opportunities.

• Start thinking about your future career: Attend all the free talks with pizza and Consultants, these are valuable opportunities to think about what you might want to do. Start thinking about how you might bulk our your CV and applications, attend training courses and taster events, get involved with research projects over Summer or during term time. You may even want to think about entering some essay prize competitions, https://www.rsm.ac.uk/prizes-awards/students.aspx, that link provides a fairly comprehensive list of competitions available to medical students and trainees, but check individual speciality websites encase they have more. 

• Get into good working habits: In first year you might have/ probably got away with doing the minimum amount of work and cramming at the end. But this will have to change as you go on (sadly). In second year we had more exams and anatomy spot tests, as well some ridiculously large modules (I'm talking 100 hours + lecture time), which made me considerably more organised. Trial and test you own methods, from mind maps to a4 posters, but here are some pretty fail safe tips:

1. Attend everything - I cannot stress this enough. This may the only time you are taught certain material, you have access to world class lecturers and clinicians, use this, it is such a privilege. 
2. Make good notes at the time - pay attention, there is no point slogging into Uni and spending 5 hours with one head phone in, you might as well have just stayed in bed. If you make good notes at the time, even if you never review the material, it's there as a fail safe for revision time. Much less stressful than desperately calling in favours a week before the exam to get notes!
3. Review your notes - that being said, reviewing your work will mean you retain it for much longer. This is a pretty open ended one, a 'review' could be anything from reading them again at the end of the week, to making A3 posters you stick around your bedroom wall. A lot of medics have a liking for writing and re-writing their notes... this could possibly be argued as an exercise in procrastination, but for many it works well. Others teach the material to themselves, make mind maps, flashcards etc. There's many ways to review and retain information, find one that works for you. I personally try and summarise/ teach the lecture back to myself, review the weeks information on a Sunday, and then do colourful A4 revision posters around exam time. 
4. Slow and steady wins the race - the oldest advice is often the best advice! If you do work little and often, it feels much more manageable, and come deadline/ exam time, you should hopefully feel more confident. There's many ways to do this, some people treat Uni as a 9-5 and fill breaks with hour long work sessions, others blitz it all out on a Sunday afternoon, and some do a few hours in the evening Monday to Friday, and take the weekend as a complete break. You will know when is best for you, think about what times of day you work best, when you have priorities (i.e. sports training, volunteering), and how long it normally takes you to complete things. If you put away some hours now, trust me, exams and deadlines become infinitely less stressful, it means on the wards you will actually know things, and generally your life will be considerably easier. 

• Enjoy yourself: Make the most of your medic and non-medic friends. Soon the non-medics will be graduating, and in clinical years you see much much less of your medic friends, as you're all off on different placements across your County. Have loads of fun and make the most of every opportunity, medical school really is great. 

I hope this has been slightly useful, I was going to add in a point about textbooks, but I generally feel that the people who want to buy loads of text books will do, and the people who were never going to, never will, despite the endless advice about asking older years and checking out the library, who can resist that heavy book deal at Blackwell's. 

Till next time.

Coming back!

Wow it has been a long time!

I still get regular emails from comments on my GSCE-related posts with the usual 'I'm doing 16 GSCE's and 4 early A-Levels can I get into Oxford?' but sadly they didn't inspire me much to reply (I'm sure the information is already there...).
I passed 2nd and 3rd year and am intercalating next year, however I will start uploading posts again on surviving the academic and clinical years, and whether or not to intercalate!

Thank you to anyone who still uses/ reads this blog.

Wannabe (and closer to being) Doctor