Where have I been??

This blog has sort of fallen to the wayside…but I hope it won’t sit there for too much longer! In the last two years, my world has almost entirely changed. Back home in Northern Ireland after a wonderful five years in Scotland, no longer a student, and now entering my second year working as a junior doctor. I graduated a year ago and have been working since – and loving it.

Coronavirus (COVID19) has changed the world and that on its own has had multiple ramifications. The one that is most relevant to this blog, is the lack of teaching opportunity available to me but that was unavoidable. I hope to rectify that this year. I have tried my best through the FiY1 scheme to continue teaching and carried out multiple scenario style, informal case discussions for my junior colleagues, mostly revolving around my teaching passion in emergency care and managing the unwell patient; I intend to continue to do this as time goes on, as well as getting involved in more formalised teaching. I have continued to teach my more junior colleagues practical skills such as cannulation and venipuncture, all which has been learned before by them, but a bit out of practice and most importantly, lacking confidence.

I hope that with the incoming academic year, I will have more time and opportunity to teach, formally and informally and by extension contribute more to this education based blog.

Reflections on Fourth Year and Advice for the new fourth years…

So it’s been a long year – 52 weeks to the day today since we started and today is the first day of our summer holiday. Has it been worth it? Absolutely – it has been long, it has been hard but it’s also been enjoyable; there’ve definitely been some laughs, there’ve definitely been some tears and most importantly, there’s been a lot of learning on a steep curve.

Some days were better than others, some days were longer than others, but the overall trend was a positive one. I saw people right at and near the start of their lives and I saw people nearing the ends of their lives and a lot of people somewhere in between; talking to patients, and sometimes just giving people a bit of a chat in what can be a scary period for any of us – it really is such a privilege.

So what advice did I get from the people in the year(s) ahead of me that I felt was invaluable and would like to pass on to others? And what did I learn myself that I wish I’d known when I started?

Before I move into this part of this post, I’d like to give a little shoutout to some people who are now starting their jobs as FY1s and say thank you to those people (they know who they are) as without their help and guidance, I’m not sure if I would have gotten this far this year without you – if you support and look after your patients as well as you supported and looked after all of us, I have every confidence you’re going to do very well.

Now for the important part: what would I say to me if I had to do it all over again (which is still a possibility…)

  1. Get stuck in as much as you can, especially before Christmas time, when exam fever is still just a distant dream on the horizon for everyone involved; there are honestly no better teachers than the patient’s you are seeing. Talk to as many patients as you can, whether that be talking to them in general, taking histories, examining them (all with their permission of course!) as everyone has a story to tell and some people have lived with their illness/condition for a long time and may know a significant deal about it, and sometimes it’s just nice as the patient to see a smiling face that they can talk to for a while.
  2. Portfolio – you will be told this 1million times by everyone and we always all make the same mistakes, year after year; do not leave the portfolio to near the deadlines. Portfolio is heavy if done all at once but luckily enough someone (I actually think the portfolio team…) have posted a thing advising how often you should do certain things, in case you haven’t seen it, here it is again:
  • Case discussions – 1 x 4-week block
  • Record of Patient’s Seen (RoPS) – 1 x week
  • PDPs – 1 x 4 week block
  • Reflective questions/Reflections – 1 x 4 week block

And remember that with some of this work e.g. case discussions, you’ll be doing them for block assessments anyways so just make sure they’re written in the right format and you can upload the same one from the block assessment into your portfolio – this really takes the weight off having to adapt 2 or 3 case discussions that were in different formats, into portfolio cases right before a deadline (which I did and it was fairly stressful!)

3. When you need help, ask for it – we have all been through it, and certainly myself and a lot of other people will be happy to help if you need it; as suggested above, it was invaluable having help from the year above us and now, we can try to provide that role for you, if needed. There are obviously other places you can go to for help; portfolio supervisors, educational supervisors, block supervisors, peer mentors, and of course the official university support channels. But the key thing is, that when you need help, ask because it is a long year as is, and will be harder if you are struggling with something the whole way through it too.

4. DON’T forget to have a life outside medicine – this year you will have some early starts, some late finishes, some night shifts, day shifts, long days of tutorials, 9-5s etc. but don’t give up that sport you love, give yourself some time to chill out in front of the PlayStation (if you are so inclined), just get outside and walk around for an hour, go to the pub with a few friends every now and again, join societies still if you enjoy the things they do, because you work hard, you need unwinding time too or burnout will become all too real a reality.

5. Speaking of burnout – study as much or as little as you feel you need to initially, but don’t commit yourself to 10 hours a day right from the get go. This is a long year and you need to pace yourself; this is the definition of the phrase “it’s a marathon not a sprint.” There is still time for the final sprint in the last number of weeks/months before the exam period actually starts and its important to remember that because I personally don’t think I would have survived if I had started intensively working, right from the outset.

6. I appreciate the following point is not feasible for everyone – but when the week off in October comes around, or Christmas Holidays or the April break comes around, try to get out of Dundee if possible; a change of scenery is only ever a positive thing. Its ok to do some work over these times as well if you want to or feel you need to, but do take some sort of a holiday too, you do need some time off as well.

7. The fourth-year project – by now you should already pick one so I’ll not give my usual speel on picking one you’ll enjoy because it makes it easier to motivate yourself etc. etc. April seems like such a long time away, and in some ways, it is. I found it incredibly difficult to motivate myself to spend that “half day a week” doing it and ended up with a mad panic because in February I only had half of my project done – I got it finished but it was a stressful time; everyone told us not to do that but a lot of people did so again, the fourth year project is a marathon, not a sprint, try to get it done in chunks at a time rather than all at once.

8.  We’re all different and we all work in very different ways and remember that when people are talking about the block they’ve just finished; they may have not liked it at all and tell you how horrible they thought it was but that can also be because they simply have no overall interest in that specialty or find it really difficult to do and therefore get no enjoyment out of it; try to go in with a blank slate, regardless of what people said already because some of my favourite blocks this year, were ones my friends told me were the worst overall and vice versa.

9. Don’t fear blocks that get you out of Dundee, and don’t be disappointed if you end up spending the whole year in Tayside. Outblocks are a great opportunity to do things a little differently and an opportunity to really get to know some new people, both in your year and from other years/other universities because you have to live with them. Some blocks seem to better as out-blocks, others as in-blocks, overall they’re much for muchness and you’ll get a similar experience and learning from them all. In the same specialty, things that are common, are common regardless of whether you’re in Tayside/Fife/Lothian/Glasgow/Highlands and Islands etc. and this at the end of the day is the majority of what you will be tested on, not lots of minutiae.

10. Last but not least – enjoy the year to the best of your ability. Like everything, including real life, it will have its ups, it will have its downs. Sometimes you’ll feel like you’re doing what you love and everything is going swimmingly, other days you may feel tired and defeated but the important part is, that the more you engage with the activities of the year, the less you’ll feel like that and, I’m going to say this again because its SO important, but almost everyone needs a little bit of help sometime during the year, I needed a lot at times from my friends who were in the year above and also in my own year, so when you feel like things aren’t going your way, come find me, or someone else who has been through this year already, or someone you can talk to, or a support service within the university or anyone else you think might help – just find someone who can try to help you and then, it will get better again.

*additional point added in edit*

11. Don’t forget that you still need to eat, sleep, toilet regularly; ward work is great experience and it is useful to hang around waiting to see a rare and cool procedure but don’t skip lunch or dinner or have them very late every day if you can help it, you’ll feel rubbish and tired and demoralised very quickly!

Thanks for reading and good luck with Fourth Year – it really is an excellent year once you get the hang of navigating it!

Fearghal

#PressEdConf18

 

 

 

 

Computers compensating flaws

Can machines compensate for attributes one is lacking?

Well that depends on the issue really doesn’t it? Your phone might remind you about that deadline you otherwise would’ve forgotten about, your smart watch might remind you to get up from your desk in the library or your office every hour and stretch your legs, a GPS can compensate for my almost complete lack of direction.

But what about your organisational skills? I read a tweet yesterday which got me thinking, about paper documents versus computer documents.

I am very much a stickler for having backups; my documents are on my laptop’s hard drive, which is backed up 2-3 times weekly to an external hard drive, and backed up 2x monthly to an online cloud system and if it’s a REALLY important document like an essay I have due at midnight tomorrow for example, it also goes onto the pen drive that hangs almost permanently around my neck.

So it’s true that I’m much better at keeping things safe now than I used to be.

But I am still finding myself spending three hours looking for the notes I wrote in year two on whatever topic I’m trying to revise today. I still find myself traveling through reams and reams of disorganised chaos on my laptop. And my paper notes are much easier to find things in.

Because I don’t have to just click save and they vanish somewhere; everything I write on paper that I want to keep, is filed away neatly, in order, with colour coded file dividers. Whereas on my laptop, it saves it to a Folder I created with, for example, the pathname “my documents/medicine/year 2/Dermatology/week 1/notes/supplementary notes/textbook A” And I never remember what I’ve actually called the file to simply search for it.

In contrast, if I had handwritten my notes, I’d probably have all of my notes in one folder, simply entitled “dermatology” with a file divider for anatomy, physiology, pharmacology etc. But on the other hand I’d probably have lost the entire folder of notes by now…

So I don’t know what’s better; notes you know you have on your laptop that are impossible to find, or written notes that should be easy to find what you want, but you’ve probably not actually got anymore…

My point is, I don’t think that computers will fix an attribute you are lacking unless you change something too but it can likely help to make things easier in some ways, by making them more permanent…but only if you take the right precautions!

But remember no document is 100% permanent so back everything up, more than once if possible!

Fearghal

ps. There are apparently programmes like Evernote to deal with some of the issues I discuss above. Will try it out and maybe post again with thoughts!

Presentations

I may have blogged about this earlier already but here goes again…

Presentations should not be reams of slides to read off the board and pictures thrown about willy-nilly for the sake of detracting from the text.

P Cubed presentations rightly state that the presentation should be ” the product of 3  presentations” – p1 is the story, p2 is the media used to support it and p3 is the delivery. Therefore if you present a good story but the media you use to support it has no purpose, your audience may be less engaged; similarly if you deliver a 300 slide presentation over 1 hour with no real presentation skill and simply reading exactly what you wrote in those 300 slides, your presentation will fall short.

This is something I have endeavoured to do since I sat this SSC in Technology and Medical Teaching and I am writing this blog post now to point out that Microsoft Office’s latest update, now provides the capability that you can place a piece of media and text and it will suggest designs for your slide. I always struggle with slide design so hopefully this new feature will help people like me to get the p2 part of my presentations correct!

 

Fearghal

Filter Bubbles (Social Media Part 3 )

I recently had a chat with Natalie about helping to develop a module on the dark side of social media for the new intake of the Digital Teacher SSC in May. There is a TED Talk delivered by Eli Pariser about the idea of Filter Bubbles. This is a term describing facebook and other social media recognizing the things you like and dislike and filtering your information to show you people with similar views to you.

But this may mean you get less or no exposure to people with different religious/political/ideological ideas from you and where does that leave us? My personal opinion; intolerant. If you believe that everyone agrees with you and believes the same thing as you and respects the same values as you, how do you learn to appreciate other points of view? I like to use the analogy of school children. If you have never failed in your life at all and always told, regardless of how well or poorly you have done, that you are all winners, how does that teach you to cope with failure when you get rejected from a job interview for the first time or your exam results aren’t quite as high as you would’ve liked?

We learn from our mistakes and we learn from interactions with people with different opinions and beliefs and it is this that teaches us how to form a rational argument – if you are ignorant of other peoples’ viewpoints, you are more likely to become frustrated with it and attempt to put your view across in a way that becomes offensive or “pushy.”

As doctors-to-be we are instructed that we should advocate for the patient but that we should not influence in them in anyway; it is important to lay out the options and exactly what each option entails, without appearing judgemental of their beliefs, opinions or decisions, regardless of our own opinions of the beliefs and decisions. If you have never been exposed to people, in reality, or online, of differing opinions, we will never learn to do this in a sensitive, appropriate way.

Students like myself need to be taught to think more critically about where they get their information from, because in this world of ever-changing information sources, online entities and social media track your likes and dislikes, so you might only be seeing the side of the story that the internet thinks will resonate with you best so that you click on more of their links and charge them more in advertising. This is a cynical view, I am aware, but taking 30 seconds to fact check something, as well as giving you another side to an argument that you may actually agree better with, in the end, is well worth that time.

The key point I’m making here is that due to the highly personalised feed of information we get from some websites and social media, you have to question the bias of the information that is presented to you, as you have to decide whether you are indeed getting the full picture of if you are getting fed what a machine thinks you want to know. And how well can a machine, using a mathematical algorithm, know the inner workings of your mind? Well considering that I don’t really understand my own thoughts, likes and dislikes very much sometimes, I imagine no computer knows anything about that truly, but simply carries out pattern recognition to identify themes…

Fearghal

 

 

Literature Searching…

I have an idea for a project for anyone doing Natalie’s SSC in May this year…Literature Searching guide! I’m in fourth year and trying to do my fourth year project and I have put all of my key words into the pubmed database, I have filtered it by full text but I still have 8000+ available articles; at least 20-30% will be irrelevant to my search.

I have no idea how to filter this down any further (any help – greatly appreciated!) but obviously I can’t read and analyse 8000+ articles in the next 1-3months – that would literally take all my time up…and there aren’t enough hours in the day!

This post may seem a little bit like a rant but here is a gap in the market that someone might be able to help fill for next year so next year’s poor fourth years (and beyond!) won’t have to struggle the same way I have too…

 

Fearghal

Technology in Medicine

You look at modern medicine and you wonder if people 20/30/100 years ago ever imagined the things we can do now. Again, this post is not specifically med-ed related but it was something I heard about on the news this morning and it “blew my mind.”

A young man, who had a terrible accident which cost him an arm and part of his leg, was in a prosthetics clinic when he saw a job advertisement; asking for an amputee who was a keen video gamer, to help develop a bespoke prosthetic.

Fast forward and now this same man has a functioning prosthetic, robotic arm, attached to a harness which has sensors allowing him to control it using certain minor movements in his chest and back. How incredible is that?

We are now at a stage in medicine that we can actually begin to give people function that is closer and closer to what they would have had with a “natural” (excuse the word its the best I can come up with) limb. Where will be in 30more years? Will we be wiring prosthetics like this directly to neurones to allow control the same native way we control our limbs? Or will we soon be adding other functionality to these limbs; like this man’s had a smartwatch, torch and a USB port, to act as a phone charger built in, right into his wrist.

But of course, there are ethical questions that need to be considered. Obviously to give a young man back function as close as is possible, to what he had before such a tragic accident is very important and an incredibly worthwhile cause and I support it wholeheartedly. But what about in other circumstances? What if I want to be a better athlete and wish to pay to have my perfectly good legs amputated so they can be replaced with faster, stronger, never fatiguing, machines?

There are obviously challenges to this issue but the premise, in my opinion, is incredibly exciting and if we can do this, now in 2017, where we are giving limbs to amputees that have more and more “native” function, imagine what we can do in 30 years time; maybe we’ll be able to give sight to children born blind for example. Who knows?

Robotic teachers 

Before I begin, this post is entirely based on opinion and all opinions expressed here are my own and I do not represent the opinions of others. 

Yesterday I was chatting on twitter with Natalie, the tutor for the SSC that started this blog, about an interesting, but equally terrifying new idea she had seen. 

Tutors and teachers may be replaced in the future with robots who are capable of simulating “emotion.” Now I have a few objections and potentially strong opinions on this…I could talk for hours on this if I expanded on my thought processes but I will try to keep it to the medical education/profession theme. 

1) Since when is a simulated feeling ever as good as the real thing? My post previously (Simulation: A New hope) highlights the circumstances where simulation is the perfect way to teach and learn but a simulated arm for practicing venepuncture or cannulation, is a great way to practice the skill but does not give you the real FEELING of what you are trying to do actually…feels like?  

2) Simulated emotion is great when things are working fine; but what about when issues arise? For example what about when your student comes to you in floods of tears because they’ve panicked a week before their osce and have convinced themselves they’re going to fail? Simulated empathy and comforting/consoling would not work for me in that case. And the role of the tutor is to impart knowledge but they are also for many students (including myself when needed) a support structure that cannot be so easily replaced.

3) where is the “professional role-modelling?” (To quote Natalie). I find it much easier to get enthused and excited about a subject when the tutor is excited and enthusiastic about it. I have learned more on the ward in two night shifts over the last few weeks than I have in 10 lectures purely because the Junior Doctors who were supervising me were enthusiastic, motivated and clearly enjoyed what they were doing; and wanted to teach me. And no machine can really ever replicate that elation when you enjoy what you’re doing and want to share that excitement and knowledge

4) continuation of 3 really but it is much easier for me personally to enjoy teaching and learn more from a lecture where the tutor is present and interested; e-modules and video tutorials have their place but I had a whole 5weeks in 2nd year where at least 35-40% (through no-ones fault one of our lecture theatres needed urgent maintenance work done) of our lectures was delivered by podcast and while it was the same people delivering the content in video, it’s a lot harder to get motivated and im still convinced that it is that module which is my weakest, to this day. 

So in summary I wonder, has anyone actually asked students how they feel about this? This was the topic that started the conversation, Natalie asked myself and a few of my colleagues what our opinion was.   I do not personally believe that any robot can replace a good teacher and I fear that the result of this idea will be a generation of young professionals who are equally exceptionally knowledgeable as the current ones but who have no empathy or compassion who are as unenthusiastic and robotic as the machines we are replacing the teacher with. 

Simulation: A New Hope 

Simulation; what does your mind jump to? Mine jumps to things from movies like Star Wars where robots place you into augmented or virtual realities for training purposes, and if you’re a “text book” nerd like me, you’ll recognise the reference in the title. But we use simulation quite a lot in medical education actually; when we have simulated patients and people with scripts to learn from and practice from, even if we don’t always recognise it when we see it.

But nothing was like the simulation we carried out the other day; Dundee has a simulated ward, where practically everything is as it would be on the ward and we can feel what it’s like to be on the ward and as part of our transition block, we had to do 40minutes in the suite.

So I’m a newly started 4th year student and I’m just off summer holidays so I’m a bit rusty. But the simulation exercise was a great idea. The idea was that in teams of three or four, we received a handover from one of our tutors, the consultant on the ward, and had to manage the patients on the ward for 40minutes before handing back. It allowed us to see what life will be like as an FY1/2 without the fear of worrying about what happens when something goes wrong – and something will – but it’s a safe environment simply for a learning experience.

It was also interesting to have the experience of knowing that there was a nurse around to help you if you needed and you could ring the registrar, send off bloods  etc. But like in reality, these people are not there to respond to your every need and drop everything else when you need them; these things take time, the nurses have other patients to attend to as well…and this was the most valuable learning point for me.

This displayed that there is always help available when you feel out of your depth, but sometimes the help you need is also helping someone else and thinking on your feet to decide whether you can manage on your own for just a little bit longer, or if you need advice over the phone, or if you need to tell your senior to come see you now is an undoubtedly invaluable skill that I have not actually had to experience until now

So thank you clinical skills for organising this session, which allowed us to feel a bit more realistically what life in the ward is like, before we have real patients that have real illnesses and real worries to worry about!