Resilience in medicine

“Listen to the raisin. Put it to your ear. Try and hear the sounds. Put it between your fingers now. Let it role around. What is the texture like? Now smell it. Inhale deeply. How is this making you feel?”
This was my first lesson in Mindfulness.
I was a clueless first year medical student who was still getting lost around campus and defrosting her parents food and this was my first lecture of “Whole Person Care”, where I was going to learn all about caring for whole patient, not just their medical condition.
aunty duties
aunty duties this weekend
What I didn’t know was that I would also be learning about how to care for myself.
Our first task for this lecture. Examining a raisin. We were sceptical, surprised and too polite and scared not to oblige. We went along with it. Feeling silly at the start why were we listing to a raisin of all things? Then after a while we were engrossed.
By a raisin.
We gave into the moment. At one point, all we were thinking about was that raisin.
Someone wiser would say that we were practicing mindfulness. We were focused on the present.
Our teacher knew what would face us when we were doctors. We didn’t. They were trying to prepare us for that day in the not so distant future when we would be pulled in a hundred different directions and we would have to learn to quieten that voice in our head that was exploding with all we had to do. And instead focus on the scared 80 year old in front of us struggling to breath. To be mindful of the present and resilient to the inevitable stresses that would be placed upon us.

As we shuffled in each week we would learn about how to care for all of the patient including their complex emotional needs.

But more pertinent to me, I would learn the most important lesson of all my time in medical school. How to care for myself.
“You are like an elastic band. You can only stretch so far until you need to recoil” we were told.
At every stage of my time at medical school, neglecting the truth of the statement above would harm me.
When I would be to busy to eat on time, to go for a run, to see my friends, to see my family.
post running high
post running high
 At the end of third year. I was burnt out and unhappy. I was an academic success but I wasn’t happy. There was no resilience. I had stretched my band to far.
Time to recoil. I intercalated, went to Kenya alone and started writing a blog. I started doing more of the thing I loved again and discovered new passions.
If you aren’t able to help yourself, it can be very difficult trying to help someone else.
I went back to clinical medicine a happier person.
When I was working harder around exam time, I allowed myself to recoil just as much. I ran everyday, not just when I was stressed. I wrote a lot. A danced around my flat. I wore lipstick when I was revising and if times were particularly tough, a great pair of heels too. I had learnt to be resilient by learning, the hard way, how to look after myself.
This weekend I am building up my resilience ahead of my first set of nights as a doctors. I have been spending time with my family and my sister has been helping me attempt to eat my body weight is dessert. We did well today. Roll on the family BBQ tomorrow where we shall attempt round two 😉
Mad dash after the park to get ready for dinner so kept it simple.
Mad dash after the park to get ready for dinner so kept it simple
The Sophie affect (my sister)
All the good stuff
All the good stuff
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Tips and Tales from the foundation programme #3 Winnie’s Words of Wisdom

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Can we all just take a moment to appreciate this jumpsuit. Thank you.

I have just completed the daunting rite of passage of foundation year one. Starting out, I found there to be lots of resources for the practical challenges you may encounter during FY1, but guidance on how to simply be a good FY1 and what to realistically expect, best came from the wisdom of doctors that came before me. I hope I can do the same for you in some way.

Medical school cannot really entirely or directly prepare you for the challenges, trials and triumphs that come with the reality of foundation year one. However, you can make it through to the end. You have been beaten, broken, crushed, and battered by the gruelling experience of medical school, and as a result you are resilient, driven, competitive, fast-learning and adaptable.

To put it simply, there exists no other person more qualified or more suitably refined for this job than you are. 

Be prepared 

Getting off to a good start is really important, and I didn’t really appreciate this until much later on in the year. What I mean by this specifically, is making sure you’ve got all your mandatory and statutory training done and training for any software programmes completed as early as possible. This will set you up nicely for the year and will just mean that you won’t have that dreaded dark cloud of admin hanging over your head the entire time. I actively avoided all kinds of training, but it all eventually caught up with me and ultimately I ended up having to park myself in the library for hours to get it done before the deadline. Please try not to do this. Sadly, mandatory training is actually mandatory.  Getting all the training malarkey done early or doing as you go along will make for a more stress-free and more enjoyable FY1 life.

The e-portfolio 

The saga continues! Make achievable targets in each rotation so that you do not have to catch up the whole time (which was the story of my life). Also try to do a reflective piece of writing at least once a week – there’s nothing worse than trying to reflect on something that happened six months ago. If you’re an aspiring GP you will have to become very fond of this, so start now! Try and maintain a good relationship with your educational supervisor. They will undertake regular reviews with you to ensure your e-portfolio progresses throughout the year. Any concerns with or if there are issues with your supervisor (whether educational or clinical supervisor), please do try and address them. However if these issues cannot be resolved, it may be possible to change supervisors, so don’t be afraid to take action if you have concerns.

The e-portfolio has quite a few components, which you will soon become very familiar with so I will spare you the details for now. However, I will just say that I regret not being more forward and assertive with asking for senior doctors to sign me off for certain things. I ended up doing so many practical procedures that were unaccounted for because I felt like a nuisance always asking doctors to sign me off. Please don’t have this same attitude. People are busy and sometimes senior doctors may seem unapproachable, however they have an obligation to teach and to ensure that you are progressing adequately through your first foundation year. So be politely but unapologetically assertive. 

First on-calls 

I was pretty terrifyied. But all the nursing staff and senior doctors know that this is all new to you, so everyone’s threshold for helping you out tends to be pretty low. Hospital guidelines are a magical fountain of knowledge, and I rely on them heavily until this day.  Secondly, make sure you know where the BNF is kept, or have a pocket prescriber handy. Don’t rely on asking people the doses of things as people, despite their year of experience, can make mistakes. Ultimately if your signature is next to the medication prescribed, then this mistake is unfortunately yours. I was once asked by a consultant on a fast-paced ward round to prescribe penicillin. He literally handed me the open drug chart, and of course I prescribed it. In my hast, I failed to realise this patient’s penicillin allergy. Luckily there was no harm done and this mistake was picked up before the medication was given. However, I was entirely to blame for this incident. My point is, try always to be vigilant, check things, ask questions and challenge things if you have any doubts. Rely only on objective sources for medication doses. My nose is forever and shamelessly inside the BNF, and if you feel you need it, yours should be too. Furthermore, for your on-calls, make sure you have all you essential medical devices and utensils i.e. stethoscope, pen torch, multiple pens, clinical notepaper, list of patients.  It’s common to be bleeped a fair bit during medical on-calls, but just remember that everything does not need to be seen immediately, and sometimes things do not need your ward presence at all.

Prioritise – this will come with time, as will your judgement on the severity and importance of bleeps.  Remember also that sometimes it is not possible to complete everything on your to-do list by the end if your shift. Try your best but it is important that you do not compromise the quality of your patient care because you’re rushing.  If you don’t finish, don’t worry and don’t be disheartened. This is what the gift of handover is for.

Help-seeking 

It is really important, especially on on-call shifts, to know when you are out of your depth and to know when and how to seek senior- or the relevant support. The source of help that you decide to seek is really quite case dependent. However, generally for medical problems on-call, your first port of call should be your senior house officer. If they then feel it’s appropriate to escalate, they will suggest calling the registrar. Whomever you do speak to when seeking help, make sure you know the following: name, date of birth and relevant medical background of the patient; their presentation to hospital and their current issue; your examination findings and recent observations; any results of relevant and recent investigations (Chest x-ray, bloods, ultrasounds, ECG); any treatments or methods of management implemented so far and the patient’s response to them. This seems like a lot to remember, but actually it’s essentially just the brief presentation of a clerking. It’s always a good idea to have the patient’s notes, observations chart and drug chart on the table in front of you, and also the investigations and imaging programme open on a computer. Make sure you also state clearly why it is that you need advice it or feel it is appropriate for the patient to be reviewed by a senior, and be ready to give a differential diagnosis (“I think this patient may be in pulmonary oedema”  or “I think this may be unstable angina”). After all of this, it may be that the person on the receiving end of your message thinks that you have inappropriately called them, and as a result you may end up feeling a little silly for your so called trivial predicaments. Just remember that no one will ever penalise you for calling for help, whereas if you refrained from calling for help is a potentially disastrous situation, you could land yourself in a bit of trouble.

Help with academic support and career advice, can be sought after in your clinical and educational supervisors, and help with emotional/ personal support can be sought after in colleagues and also in whomever is appointed as the pastoral figure.

Locum shifts 

Locum shifts are pretty much available in all trusts and are great for those who don’t mind giving up a bit of free time to earn a little extra cash on the side. If this interests you then you should email your administrator soon after starting to enquire about how locum shifts are advertised and distributed. Usually the rule is first come, first served, however I have heard of occasions when one specific junior doctor gets personally notified before others about locum shifts – which is obviously outrageous, so ensure that this does not happen! For some doctors, locums may be an absolutely “no-no”, and free time may be valued more highly than monetary rewards. But for others, it can be really worth it, especially if you suffer from shopaholicism or have picked up the travel bug (both afflict me).  The rate of locums are probably variable across different deaneries and perhaps even trusts, but generally for FY1s the rate is £25 per hour. This means that you could earn about a third of what you earn in a month, in just one weekend (12 hour shifts). That’s a pretty sweet deal if you ask me.

Academic stuff 

I’m not so much an academic myself, however there are things that you will need to complete as an FY1 regardless of you career direction. As a requirement of the e-portfolio, you need to complete an audit of some sort. It can be on anything, however if you have an inclination towards a specialty at this stage, then I would definitely base the audit on something relevant to that specialty. There are lot of opportunities that will arise throughout the year for courses, seminars, events, workshops, poster competitions, publications and all the rest of it. If you are keen, then look out for such emails! If you are looking to go into specialty training you will also need to start thinking about putting together a portfolio of all of you academic achievements. You should have a careers event during the year, which should further inform you about this.

Taking respite 

Being a junior doctor, the expectations for seniors can sometimes seem ridiculous; the sense of responsibility can be overwhelming; and on several occasions you will suffer the misfortune of missing an important family function, of your best friend’s birthday.  This is why you deserve a good old break. It’s really important to try and maintain a healthy life-work balance. I would really encourage trying to continue any extra-curricular activity that you did prior to starting FY1, or even trying something new. I would encourage you to be sociable. Its always really nice to vent to your fellow F1s – no one understands the perils and pain better than a fellow FY1. Lastly take annual leave, and enjoy it! Taking annual leave is different at every trust – sometimes it’s assigned to you in the rota, other times it’s first come first served. Don’t worry too much if it is assigned, it is possible to swap if you ask early.

Always just remember to work hard but play harder – it’s the key to survival!!! 

A few good resources

  1. http://doc2doc.bmj.com/assets/secure/youwillsurvive.pdf
  2. The Hands-on Guide for Junior Doctors (Hands-on Guides) Paperback – 18 Apr 2011 by Anna Donald (Author), Mike Stein (Author), Ciaran Scott Hill (Author)
  3. Pocket Prescriber 2014 (Pocket Prescriber Series) Paperback – 2 May 2014 by Timothy RJ Nicholson (Author), Donald RJ Singer (Author)

Massive thank you to Winnie for taking the time out of her holiday (what a massive babe) to write this. 

Tips and tales from the foundation years #2

So in my second post about tips for junior doctors, here is what one friend told m.

Remember to follow #tipsfornewdoctors on Twitter

Me (at stupid o’clock on facebook): Mate I need help with this F1 businees.

Friend (who instantly replied to my annoying message): Day ones starting you realise after 4 months off travelling and coming in 5 of those days of travels for clinical duties you know little and you’re the FY1. It’s fine we all fell like we know nothing unless you’re a sad person who went to *** uni who didn’t really have an elective and had to a month of shadowing and still is a crap doctor.

It’s nice to know what you’re doing but I would focus on the clinical things as that’s the most important.

Always rememember,  if you don’t know always ask!! Arrogance causes errors! Especially if you’re not certain yourself. You are never alone!

Beautiful beach and  waves of Caribbean Sea
Beautiful beach and waves of Caribbean Sea

Humility goes a far way. There are a lot of egos amongst doctors but your team will appreciate you more if you listen and can learn from them. But don’t take abuse or be bullied; that’s important. Speak up if someone is making you feel like you’re being bullied. Also trust yourself as well you are a doctor!

Time will build confidence and that will come as soon as you survive your FY1 on call.

Ok, I’m gonna sleep now.

 

 

Massive thanks for my friend who wants to stay anon for this.

Inspirational Women Part 4

This week Aawaz is interviewing future Cambridge Medical Student Nabila.
I came across Nabila on Twitter and thought her story about her entry into Medical School was definitely worth sharing. A true testament to persistence and hard work. Nabila has inspired me and I hope that you can learn something from her too.Please feel free to share this post with anyone you feel might benefit.

Cambridge University is consistently ranked among the foremost Universities in the world
Cambridge University is consistently ranked among the foremost Universities in the world

 

So Nabila, tell Aawaz a bit about yourself…

I’m a Kings College London science graduate and now a Graduate-entry Cambridge Medical student. I get actively involved in a ridiculous amount of extra-curricular activities from volunteering, delivering revision classes. One of my most recent endeavors which was setting up the Acts of Random Kindness Project; an outreach program to tackle issues experienced by vulnerable groups in the community. My future ambition resides in academic medicine where I get the best of both worlds; clinics and being able to teach and conduct research and recently published my first paper! In my free time I bake and run a cake business we recently started up called The Little Bakes Co. with my big sister.

Coming from a “non-traditional” medical background do you think getting into medical school was more of a challenge? And if so, how did you overcome them?

If you see it as a challenge then yes it is! The reality is medical schools will accept you provided you tick all the boxes i.e. Good grades, personal statement, reference and a good interview. It’s all a case of doing your research and applying to universities that play to your strengths.

However, grammar/ private schools are better equipped at preparing students for competitive courses such as Medicine and knowing someone from a medical background helps to gain an insight and relevant contacts for work experience. Hence why I opted for the Graduate-entry route as I had no contacts and felt frustrated with the lack of support services in place within my school. Whilst it was more difficult to get into Graduate-entry, I know whole-heartedly that I wouldn’t have stood a chance of getting into Oxbridge at 18. However, don’t let that throw you off, hard work and perseverance pays off in the end! Trust me, I regret not having faith in myself and reapplying for undergraduate Medicine.

What enabled me to get into Cambridge in the end was when I stopped comparing myself to others and focused on how I was going to utilise my knowledge and experiences to achieve my career ambitions. When I started to focus on myself and was grateful for what I was blessed with (which is more than most) then life became so much easier!

Do you have any tips for anyone with no links to medical profession who is interested in applying to medical school? For example, getting people to read your personal statement and work experience? Did you find any websites particularly useful?

My top tip is to realise that people with the same background as you have gotten in. Some people may get more support than others but individuals whom come from “non-traditional” backgrounds are equally supported by other means, e.g. by the Social Mobility Foundation. Students from “non-traditional” backgrounds are also able to apply to access programs such as the Extended Medical Program in Kings College London. This is not available to students whom come from selective schools, so utilise the opportunities available to you!

Few pointers I would suggest is to have a select few people to read your personal statement whom are able to critique your work e.g. Your referee, a teacher whom knows you well, a medical student (if possible) and that friend who is amazing at punctuation and grammar. There are university students who also run interview workshops and provide personal statement support within Universities such as U.CAN, PotMed and Mission Medicine. Professional organisations such as ICS Medicine also run interview workshops, however they are a tad more expensive but worth it if it gets you in! As for work experience, hospital experience isn’t the only experience you can get! You can volunteer in a hospice, a care home, one friend of mine even used their customer service experience in Laura Ashley in their Medicine personal statement. She is now in her final year of Medical school, so I can safely say her personal experiences helped her. However, perseverance is key! I had to wait over 6 months to volunteer in a hospital and had more than 15 rejected phone calls from hospices before one finally said I could volunteer in their admin department! Therefore take whatever opportunity you can get, it’s all about what you learnt from it that counts!

Getting into Medical School is tough. But you did it at Cambridge too! What do you think gave you the edge?

It’s actually no secret, the interviewers were very friendly and wanted you to do well. Oxbridge interviews tests more the way you think as opposed to how much you know and expect you to be able to justify your answers. Don’t get me wrong it was a tough interview and I researched extensively on anything and everything Medicine-related from practicing clinical and ethical scenarios, keeping a diary of what I learnt during my work experience to revising my A-level textbooks. During the interview I answered the questions as best as I possibly could and I added in some light humour.

Are you happy for people to contact you for advice or tips?

That’s fine with me. My twitter is @rehnnuma so you can message me on Twitter if you have any questions and I’ll try to get back to you as soon as possible.

However, a word of warning I won’t be able to provide details of my Cambridge interview for confidentiality purposes and I tend to zone out of social media when I have exams!

 

 

Aawaz would like to thank Nabila for taking the time to be interviewed.

 

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For more information on The Little Bakes Co: https://www.facebook.com/thelittlebakesco

 

Staying sane at Medical School: an idiot guide

It might seem like quite a basic thing but my experience is that it doesn’t come naturally to all of us and can definitely be neglected. In my first year of medicine I muddled through but with no real plan of how to look after myself and believe me, it’s just as important as getting through the degree itself!  This IS the end goal, but your health (and sanity) is a priory too!

Here’s a list of things that I do that might help you if you haven’t already got a strategy:

1- Exercise. I use to do this when I was really stressed and go running at ridiculous times of the night but these days I go as often as I can and it helps to relieve me of stress before things get bad.

2- Talk to somebody. It really helps me to talk about what I feeling am stressed about. I have been lucky to have supportive flat mates but if you want someone to talk to your university are also there to help. At Bristol you can find support at http://www.bristol.ac.uk/student-counselling/services-offered/need.html

3-Have proper breaks. For me this means going home. I use to think that this was a waste of time but now I see how important this is. There is only so much work you can do before you NEED a break. Medicine will NEVER tell you to have a break. There is always more to learn. But you need to give yourself a breather.

4- Allow yourself to question if Medicine is for you or not. In my third year of Medical school I hated clinical Medicine. So I took a year out an intercalated. It was one of the best decisions I have ever made. I missed medicine a lot and this was the confirmation that I needed that this WAS what I wanted to do. Medical School is a hard and long process and if you have doubts it’s OK. Most people I know have questioned why they are doing medicine at some point or another. Give yourself a chance to change your mind. It’s not the end of the world. I think it would be a travesty to get to 5 years of Med school and have hated it all along.

5- Get a bit of perspective. This can be hard at the time. Our work can take over our lives, but in the grand scheme of things, if your biggest problem in life is your medical school exams, you are doing ok in life. (Well, this is what I tell myself anyway!)

6- Don’t suffer in silence. People don’t write Facebook statuses saying “I failed my exam and I feel crap about life”. But they do. These things happen. A lot. And if you do fail an exam, or feel really stressed, hear me when I say YOU ARE NOT ALONE and this crappy period in your life WILL pass and you will be better for it.

7- Treat yourself. I have a mantra that I say to myself which is “gotta look after number one”. That’s you! My Mum has drilled this into me and in an all consuming emotionally, mentally and physically draining profession this is crucial. How you define this is up to you but make sure you do look after number one! Medicine is important, but at the end of the day, you should come first.

Coctail. Candles. Running. Family. Friends that became family. How I get through Medical School.
Coctail. Candles. Running. Family. Friends that became family. How I get through Medical School.

Fifth year fear

My friend often jokes that it takes her a whole year to come to terms with her age and just as she has accepted it. Bam!  Another birthday and the cycle repeat itself.

The same can be said as my years at medical school. Just as I got use to being a 4th year, I had to move on.

When I was in 4th year I use to look up to the people in the years above me and think that all those people were amazing. They had made it. They had succeeded.

Now I am in my final year of medical school I can see people doing that to me.

“This is my friend Salma, she’s a 5th year.”

This was how someone in the years below me introduced me to their friends. I could see the look in their eyes. That same “wow, you’re amazing” that I looked at the old 5th years with. But the thing is, I don’t feel “amazing” and I definitely do not “know it all”. It will take many hours of revision to get anywhere near the level that I need to be for my final year exams. And by the time I am finally comfortable being a 5th year I will have to move on to being an F1. Where I will again start at the bottom.

This isn’t a nice feeling.

No one likes to feel like they don’t know what they’re doing, but the truth is in medicine, there is just that much to cover, you are never going to be an expert on everything, even as a consultant!

My point is. It’s OK not to know everything. Yes you have to know how to treat someone with a myocardial infarction but no you don’t need to know it all!

During my first few weeks as a 5th year, I was paralysed by this idea of what being a 5th year meant. I expected myself to know all the answers and be slick with all my examinations even though it had been a while since I had done them all. I didn’t want to see any patients because I didn’t know enough yet.

Too many days into my placement and I hadn’t seen a single patient. I finally pulled myself together and took the dive. My history was all over the place and I forgot to check for hepatomegaly and splenomegaly and my reflexes needed (and still do) a lot of practice. When I finished I asked the patient for some feedback. She didn’t notice my jumbled history and examination. She told me “you have a lovely bedside manner”.

My point of writing this is to say that it is OK to be a beginner. Even that scary consultant missed the odd murmur or two back in their day. So give yourself a break and allow yourself to learn and re-learn.51mbx2bck0al