As I am in my "week off" I have been mentally preparing for my upcoming rural rotation. In case I forgot to mention previously, all my clinical rotations are 8 weeks long. The first week involves staying in a rural centre (in my case 8+ hrs drive away) and consists of an intensive orientation with lectures and procedural skills.
Weeks 2-7 are at another location (small rural town) where I stay at the local hospital and learn about rural med. From what I can tell will be a cross between general med and general practice without the luxuries of CT, Operating theatres etc. In Week 8 I go back to where I was for the first week and attend more lectures. The exam is on the Friday of week 8.
I am really looking forward to the rotation actually. The doctor (one doctor in this town) has to rely on his clinical acumen a lot (lack of access to many tests/pathology services). Of course anything major will be transported to a larger more metropolitan location or even back to a tertiary hospital, but we (him and I) will be there at the start. And while I appreciate that I still have a LOT to learn, I am not too nervous. I am, however, very glad that I have already done General Practice and have just gone through General Med. As I will be away from home and very homesick, I am sure I will update you much more frequently for this experience then I have previously (that is, if I can access the internet!!)
Wednesday, 29 July 2009
General Med - A wrap up (part 2)
On a More reflective note...
The rotation as a whole was draining, but fantastic. One of the key things it did was cement my clinical skills, which I must admit were lacking a bit having started this year with Psychiatry - where you DO NOT touch - and General practice - in which examination is very problem based and often sub-standard [done through shirts (limited exposure) and poor positioning for the sake of convenience and time].
There were days when I was totally enthused, and days when I felt exhausted and completely discouraged. But coming out at the end of it, I feel much more confident and I feel I'm clinically more efficient (and unfortunately perhaps a little more impatient with verbose patients).
In summary, I feel in this rotation I learned the most, but it took the most out of me...
The rotation as a whole was draining, but fantastic. One of the key things it did was cement my clinical skills, which I must admit were lacking a bit having started this year with Psychiatry - where you DO NOT touch - and General practice - in which examination is very problem based and often sub-standard [done through shirts (limited exposure) and poor positioning for the sake of convenience and time].
There were days when I was totally enthused, and days when I felt exhausted and completely discouraged. But coming out at the end of it, I feel much more confident and I feel I'm clinically more efficient (and unfortunately perhaps a little more impatient with verbose patients).
In summary, I feel in this rotation I learned the most, but it took the most out of me...
Tuesday, 28 July 2009
General Med - A wrap up (part 1)
Well I apologize that I haven't written more for this general med term. I meant to. The term was very hectic and when I finally got a moment to think, I just didn't want to write.
The tone of the rotation dramatically changed toward the end. It went from being part of the med team, being part of rounds (generally experiencing life as a junior doc on general med) to one of, looking for long and short cases, trying to fit in study where you could around all the scheduled tutes and generally in exam prep mode. It was a necessary shift in focus (if we would hope to pass the exams) but after that the registrars/consultants seemed less inclined to involve you in the care of the patients.
The assessment (like all so far this year) consisted of 4 parts worth 25% of which one part was the consultant's mark. On this rotation the other 75% was from 2 short cases and 1 long case done on the last day.
The Long case was a patient on the ward. You were told the patient name/bed number and went straight to that patient. You had an hour alone with the patient (mostly uninterrupted, there is always morning or afternoon tea or the tv hirer or some physio/nurse interrupting which you have to quickly deal with) to take a detailed history, work out active problems (noting inactive ones) and taking a detailed social history intergrating all with a physical exam. You then have ten minutes to organise your thoughts then you have to formally present the problem to 2 examiners (one being the specialist looking after that patients presenting/main issue). You are then asked to list problems, investigations, and might have to interpret an ECG, blood gas analysis or chest xray. You are pimped for about 10mins by the two examiners. An example might be... Mr S is a 60 yr old man who presented with increasing SOB and productive cough of two weeks duration. This is on a backgroud of Chronic airway disease, Ischaemic Heart disease, Hypercholesterolaemia, Hypertention and poorly controlled Diabetes Mellitus. He has a cumulated 90 pack year smoking history, still smokes and has been on oral prednisolone (30mg) for 9 months now for frequent exacerbations of his COPD".
The problem list might constist of
The tone of the rotation dramatically changed toward the end. It went from being part of the med team, being part of rounds (generally experiencing life as a junior doc on general med) to one of, looking for long and short cases, trying to fit in study where you could around all the scheduled tutes and generally in exam prep mode. It was a necessary shift in focus (if we would hope to pass the exams) but after that the registrars/consultants seemed less inclined to involve you in the care of the patients.
The assessment (like all so far this year) consisted of 4 parts worth 25% of which one part was the consultant's mark. On this rotation the other 75% was from 2 short cases and 1 long case done on the last day.
The Long case was a patient on the ward. You were told the patient name/bed number and went straight to that patient. You had an hour alone with the patient (mostly uninterrupted, there is always morning or afternoon tea or the tv hirer or some physio/nurse interrupting which you have to quickly deal with) to take a detailed history, work out active problems (noting inactive ones) and taking a detailed social history intergrating all with a physical exam. You then have ten minutes to organise your thoughts then you have to formally present the problem to 2 examiners (one being the specialist looking after that patients presenting/main issue). You are then asked to list problems, investigations, and might have to interpret an ECG, blood gas analysis or chest xray. You are pimped for about 10mins by the two examiners. An example might be... Mr S is a 60 yr old man who presented with increasing SOB and productive cough of two weeks duration. This is on a backgroud of Chronic airway disease, Ischaemic Heart disease, Hypercholesterolaemia, Hypertention and poorly controlled Diabetes Mellitus. He has a cumulated 90 pack year smoking history, still smokes and has been on oral prednisolone (30mg) for 9 months now for frequent exacerbations of his COPD".
The problem list might constist of
- Diagnostic and Management problem of Increasing SOB (DDX: Exacerbation of COPD or pneumonia, Lung cancer, Heart failure etc) - Including tapering steroids if possible (risk of osteoporosis, high glucose levels)
- Management of his IHD (Incl. Cholesterol, HTN etc)
- Management of His Diabetes Mellitus
- Assist lifestyle modification (Stress reduction, wt loss, quiting smoking)
- Assist with rehab to work or short-term financial aid (welfare etc)
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