my august 2019 - august 2020 work notebook by katie leamon

In the UK, junior doctors rotate every August. From August 2019 - August 2020, I decided not to do, what we call, a 'training job'. This meant that the year did not count towards my future training in whatever specialty I choose (which happens to be urology). This was fine with me and this 'year out' was intentional. I applied for a clinical fellow role which had a large educational chunk to it and it was an amazing year. The highlights were the people I met during the year, the projects I got involved in and started personally and just seeing the difference I had made with the things I had done.

The educational element was something I had never encountered before; being a junior doctor here in the UK is very much 100% clinical time. This role gave me 60% educational time. To try and stay organised, I cracked out this Katie Leamon notebook. With its 300 pages, I was confident it would be enough for this year. Famous last words, eh? It was just enough for the year. You can see how battered it was after constant use... Just look at that spine!

I used post-it notes and Avery note tabs to separate out the different sections that were often referenced. By the end, this is what the top of the notebook looked like.

Every week, I would write at least two to-do lists. The one thing with education was I realised how much slower things can be. As someone who likes to see instant results (hence my choice to go into surgical training), I struggled with this a bit initially. However, over time, I began to sit back a bit and let things run their course.

My to-do lists were often long (usually longer than the one below but this was the one which had the fewest points with identifiable/confidential information on it). You can see that I almost used a bullet journal-esque key to denote a completed or cancelled task.

Below, I've taken a picture of a project I did outside of this role. I did some reading about renal and ureteric stones and these were the notes I took. Unfortunately, I can't show you something from the educational side as some of it is still a work in progress or is in the process of (hopefully) being published.

So this was the notebook which got me through a year of many projects and a lot of educational work. What I really loved about the year was how concentrating on things outside of clinical work made me want to go back into training; and how my clinical days made me miss my educational work!

I think it'll mean that I will always have an element of educational-related activities to my career at every stage and I'm curious to see what the future holds for me in this regard.

throwback thursday: medschool notes on psychiatry

Whilst doing a massive spring clean and clear-out of my flat, I found these notes I made on a psychiatry placement. These must date back to 2015! I think the pen used was a Pilot Kakuno (fine nib of course) and Diamine Prussian Blue as the ink. The ink seems to have faded a bit (despite not being in direct sunlight) and has turned into dark grey which is quite easy on the eye! The darker blue in the latter is Diamine Denim or Blue-Black - I can't quite remember!

For those of you still holding onto your university notes, what do you do with them? There is probably little to no need for me to keep them but they do look too nice to just throw into the recycling bin!

medschool essentials and ten things I wish I'd known

Today, I thought I'd share some of what I saw as essentials during medical school and what I wish I had known at the start :)

Textbooks
Most Used - The Oxford Handbooks (Surgery, Clinical Medicine and Clinical Specialties) were invaluable to me. You can access the other specialist handbooks online too if your university subscribes to OpenAthens!

Anatomy - I liked Netter's Anatomy Flashcards - they were pretty good for revising with on the bus/train/tube.

Pharmacology - I wouldn't recommend the Rang and Dale Pharmacology Flashcards as I found that they didn't go into enough depth. The actual Rang and Dale textbook is great though! Another useful pocket book was 'The Top 100 Drugs' by Prof Emma Baker.

Physiology - I liked Tortora's Anatomy and Physiology here though there are many others on the market.


Equipment
The basics: stethoscope, tendon hammer, pen torch and lanyard. Carrying them all at once is optional (I usually only carried a stethoscope and lanyard).


Stationery
Always carry something to write on and something to write with is my advice. You never know when someone decides to impart some piece of wisdom you never want to forget - clinical or otherwise!


Other Bonus Bits
Have you noticed how few dresses and skirts actually have pockets? I've managed to acquire a wardrobe where the majority of my skirts and dresses have pockets but when I first started... Well, carrying everything around was difficult (do I carry this energy bar or this pen torch? Usually food was the winner in such battles.).

Tissues are always good too. You may be asked to clerk a patient and things may get emotional for them (through no fault of your own)!

Finally, comfortable shoes must always adorn your feet. A six hour ward round is painful enough, why put yourself through more suffering?! Trust me, I've worn shoes that pinched my toes on long ward rounds and as someone who gets bored quickly and easily, they are ideal for preventing you from falling asleep... But are equally good at distracting you from what is going on around you!


1. Medschool isn't the be all and end all. Make time for hobbies.

2. It doesn't get any easier.

3. Ask more questions. And say yes!

4. Sleep is something for the weekends. Or at opportune moments if you're a good napper.

5. There is always more to know. Accept it.

6. There will come a point when you feel ready.

7. There is always time for the Student Union bar!

8. Your friends will be your future colleagues. As will everyone else in your year. And the year above. And the year below.

9. Machine washable clothing that don't need ironing after a wash are the holy grail.

10. It does get easier.

beginning a new chapter of my life: goodbye medschool, hello foundation years

Just a mere four years ago, I was preparing for a new degree: Medicine. I still remember my first day at medical school like it was yesterday; from the moment I woke up to the moment my head hit the pillow later that night. And now, I've somehow made it and become a doctor. How time flies? It's scary, yet exhilarating. Nerve-wracking, yet filled with excitement.

Throughout my first two and a half years at medical school, I never thought I'd ever feel ready to be a doctor. Now, with every signature comes responsibility; with every action I do, there has to be justification and with every patient who I care for as part of a team, they'll always remember me as their doctor even if I don't remember them as easily. This is scary. But by the time my penultimate year was halfway through, I began to feel less apprehensive and more appreciative of what a privilege it is to be in this profession. And by the time I came to do my assistantship placements in final year, I felt ready. Even if this is a pretty dark time to start work for the National Health Service (NHS) here in the UK and I touched upon it back in January 2016 here...

A little part of me is sad to no longer be able to say 'I'm only a student' but considering I'm now 26 years old, it's about time I grew up! Over the last four years, boy, have I done a lot of growing. My views on the world have changed considerably, my outlook in life is very different (much more optimistic and less apprehensive of new opportunities) and my self-confidence has increased (though that part of me still has a bit of growing left to do).

These next two years will also fly by; a lot of my seniors reassure (or scare?) me about this. And with them, I intend to grab every opportunity that comes my way; just like I did at medical school. 

For me, I learnt these five things over the last four years that will stay with me forever:

1. Grab every opportunity that comes your way. You may never get that chance again.

2. Say yes to everything (within reason). As a student, if I was asked to insert a cannula/catheter, etc, I never once said no. 

3. Remember to rest. I'm a workaholic by nature and need to feel productive. But I've learned to rein this in from time to time. 

4. You'll never know everything and that's ok... As long as you can admit this and still possess the desire to want to learn more and question everything. 

5. Even in the worst of times, it will be better soon. 

Life is undoubtedly going to get a lot busier for me but I still intend to keep this blog going :)

Above: some Instax films taken when I did a day as a tourist in London; post-finals, pre-foundation programme!

graduation gifts to mark a milestone

With graduation just around the corner now, I thought it would be nice to do a mini graduation gift guide. For this gift guide, I decided to look at pricier items (sorry, not sorry).

Stationery

1. A luxury diary from Smythson
Hit the ground running in your new career with a Smythson planner which'll keep you organised and looking chic. With its cornflower blue pages and contrasting bright orange colour, you'll never forget to take this everywhere with you. The only problem will be that once the year is over, you'll really want another one...

2. Pelikan Souveran M400 Fountain Pen
So I'm slightly biased here as I have this pen (it was a 25th birthday gift to myself!) and it's such a lovely pen to use. It's beautiful, sophisticated and feels like such a luxury each time you use it.

3. Smythson Panama Cosmetics Case (can also be used to store stationery!)
I love Smythson goods (can you tell?) and this cosmetics case would be just lovely in your handbag. It is versatile and if you'd prefer to keep pens and other stationery items in, I'm sure it'll last you a good many years.

4. Pilot Capless Decimo Fountain Pen
Another fountain pen, but this time, a capless one! This is the more lightweight version of the original Capless and if the reviews are to be believed, just as dependable and smooth a writer.

5. Aspinal of London Organiser
If you prefer to customise the contents of your daily planner, this might be the one for you. You can also have the option of having it engraved with your name, initials, your pet's name... Pretty much anything you want!

6. Midori One Year Diary
Finally, a one year diary. When I start my job in August, I plan on writing a few lines every day as an emotional outlet. Also good for those who like keeping a journal :)


Beauty and Fashion

1. Hourglass Ambient Lighting Edit in Surreal Light
A popular palette in the beauty world and a nice luxury gift for someone into their make-up. It also looks very pretty with its marble pattern packaging.

2. Liberty London Silk Scarf
The iconic Liberty scarf :) Good for someone into their fashion and labels!

3. Mikimoto Pearl Earrings
Pearl earrings are a timeless classic and these ones have a clover design to them just above the pearl. A good gift for pretty much anyone who has their ears pierced! They are work safe and will also look good for an evening/night out so they'll get plenty of wear.

4. Viktor and Rolf Flowerbomb Perfume
I'm biased here as I've been wearing this perfume for the last six years and it is my go-to fragrance. However, alternatives could be a Jo Malone perfume or even a custom one made at a boutique perfumery.

5. A Tiffany Necklace
A classic graduation gift here and only included because its so cliché! I'm not a fan of them personally but their simple design means that they are also timeless and go with pretty much any outfit.


Home

1. Fornasetti Profumi Sol Di Capri Scented Candle
Whilst browsing the Harrods website, I found these candles from Fornasetti Profumi. The packaging is just so pretty (there are many other designs) and once the candle has been burnt, they can be re-used for something else, such as storing little trinkets in.

2. Johnston's of Elgin Cashmere Throw
A soft throw is an excellent addition to a bedroom or a living space that is crying out for something a little extra. This cashmere one will keep you warm and look good while doing so.

3. Neom Happiness Reed Diffuser
If candles aren't your thing, how about a reed diffuser? Great for those of us who are too lazy and accident prone to burn a candle!

Note: there are no affiliate links in this blog post. I will not receive commission for anything purchased through these links.

medicine: final year placement reviews

Now that final year is out of the way, I thought it would be apt to do a mini review of each placement for the medics out there who might be interested.

Assistantship Surgery

For this one, gynaecology was my specialty and though an unconventional surgical specialty (most of my friends had general, urology, colorectal, upper gastrointestinal, etc), I learnt an awful lot. Obstetrics and Gynaecology is a potential career path I may choose to go down and the team were just wonderful and friendly. The high turnover of patients meant that there was plenty of practice writing discharge summaries and practice with practical procedures. One particular highlight was taking blood from a patient who confessed she was a difficult patient and that it usually took people three or four tries before they were successful. I somehow managed to do it on the first attempt which was a lovely feeling!

The main brunt of this placement were daily, swift ward rounds; many discharge summaries and copious opportunities to take blood, insert cannulas and do other practical procedures. One of my favourite placements of this year without a doubt.

Assistantship Medicine

Coming off surgery where ward rounds lasted one or two hours at the most, it was a shock to go back to ward rounds that would last at least three and a half hours. Being on a Care of the Elderly ward, it was a good opportunity to revise general medical conditions and also learn more about the social side of things that often keep the patients in for longer than we would like. Again, plenty of discharge summaries, note writing and practical procedures. The team were lovely which always makes a difference but the five weeks were enough for me to confirm that being a hospital medic is not for me.

Assistantship General Practice

Before starting this placement, I was dreading it. General practice has a reputation amongst students for not being the most glamorous specialty and I suppose that is largely true. As GPs, one has to know which problems are serious enough to warrant a referral to a specialist and which ones can be safely managed within their remit in the community. Having spent five weeks in a well-ordered practice in a deprived area of South London, I got a feel for just how difficult it is being a GP.

Seeing a high volume of patients each week meant that I got to hone my history taking and examination skills within a limited appointment slot. The senior doctors encouraged me to come up with management plans and in the end, I ended up really enjoying my time there. In fact, I even kind of miss it! However, unlikely to be the career for me.

Accident and Emergency

Adrenaline pumping through the veins is a feeling I always try and seek so the Emergency Department was one I was looking forward to setting foot in. However, the only area that really appealed to me as 'Resus' - the part where the most critical patients are as the other areas felt largely like an extension of General Practice. Not hating on General Practice - just that I'm looking for something a bit more acute and exciting.

Critical Care and Anaesthetics

The best placement of my final year. Wearing scrubs everyday meant silks, wools and delicate fabrics could be worn with reckless abandon as they would only be worn in and out of the hospital! There is the perfect mix of having to know a bit about everything, the chance to do practical procedures and also the patient contact was still present within the field of Anaesthetics. I loved this placement so much, it is likely that this'll be the pathway chosen in a few years' time. At the moment, this list is acute care, anaesthetics and surgery so we'll see if things change!

Overall, I loved final year. It felt much more like being a doctor and it has helped me rule out and rule in specialties a little bit more - a list that'll inevitably chop and change in the near future. My advice is to just throw yourself into every single placement. Even if I don't think the placement will be the one for me long term, my goal is still to make the most of it - after all, if I don't decide to go into it, this'll be my only experience of it ever again! It's a privilege to be able to see a bit of most fields within Medicine and nothing gets taken for granted, at least not with me. :)

finals revision: how to cope!

This is my second time of doing finals and it has to be said, the first time was a walk in a park compared to this one. Having wanted to be a doctor for so many years, it is now within touching distance and the fear of messing up is so real. To get me through finals revision, here are the things I'm doing.

1. Food

The last thing you want to do during revision is to get ill so eating a balanced diet where you get your five a day is a must. Add in some exercise and it's the perfect combination for staving away those viruses that may knock you out for a few days. A few days you can't afford to lose. I like to batch cook things like cottage pie, divide them into portions and then freeze them. They are perfect for those nights where you just don't feel like cooking but want to stay healthy.

In terms of snacking, I like dried fruit and nuts. Salted cashew nuts are my current love but I am also known to substitute these with pistachio nuts. Though they are on the more expensive side, I think they are slightly better than crisps, sweets and chocolate (though some of these nuts have quite a formidable salt content!).

2. A Timetable

The best way to ensure you cover as much subject matter as you want is to have a revision timetable. Mine is pretty rough - I dedicate sessions to medical or surgical specialties and then try and get through as many practice questions/chapters in the Oxford Handbook I can during that time. I often have post-it notes on my desk of things to look up later and I factor in revision sessions for these too.

3. Time To Relax

As tempting as it is to keep ploughing on with revision even after a mammoth eight hour day (with breaks of course!), sometimes a day where no revision is planned can also be good. At least for me it is. Choose your weapon - a book, Netflix, a workout, anything that does not have any link to your subject matter :) I like to mess around with my Instax and taking a walk because it kills two birds with one stone for me (leaving the house and doing something fun!).

Remember to factor in breaks during the days you do revise too!

4. Sleep

Chugging down Red Bulls may seem tempting to try and maximise the number of hours in the day but sleep is essential for memories. I try and sleep as much as possible but not too much so as to negate the learning I've done during my study sessions. For me, 7-8 hours is a good amount.

5. Environment

Consider your desk and tools! If you dislike clutter and find it counterintuitive to your productivity, then tidy up before studying. I tidy away everything at the end of each session so I get a fresh start. I also like to ensure I have my favourite pens nearby :)

Good luck to those you with exams in the next few months :) I'm sure you'll do great!

year three's medicine placement reviews all in one place

Now that final year is underway, I thought it would be a good time to do a Medicine-related post with a brief review of each placement I had in the last two years. Please bear in mind that I'm the sort of person who gives 110% in each placement, regardless of whether or not I'm interested in that specialty. If you're about to embark on clinical placements, I would recommend doing the same - it can be tiring but you get so much more out of things this way :) Plus, when you're actually working as a doctor, you may never get the chance to see some or do some of these things ever again.

Respiratory Medicine
This placement was in my second year and it was my first ever clinical placement. I felt like a deer in the headlights for the most part but the steep learning curve was great. The whole clinical team were absolutely lovely and I got a lot out of this placement. Whenever there was nothing to do, I'd go and clerk a patient and then compare my clerking to the patient's notes to see if I had missed anything. This medical firm was great for learning about a wide range of conditions because the patients tended to be on the older side and had many co-morbidities.

General Practice
General practice was not a career I'd ever considered and this still rings true now. However, I still had a good time on this five week placement. During this time, I was placed at a medical practice that had a great set-up. It was a large practice and with appointments only scheduled for ten minutes each, there was a high patient turnover and I saw a lot of different things.

Neurology
This was one of the placements I was dreading the most (as I have zero interest in neurology!) but I still got a lot out of it. The best thing was doing on-calls with the registrar in Accident & Emergency. During one of these shifts, I even offered up an important differential diagnosis the registrar hadn't thought of himself :) Being able to see brain surgery was amazing too.

Psychiatry
Again, another placement I wasn't exactly looking forward to but still got a lot out of! Psychiatry is super interesting and I met a lot of fascinating people on this five-week block. The work-life balance is definitely appealing and wearing an alarm on ward round was exciting (at least for me) but I don't think I can deal with the emotional ups and downs of this specialty. Plus, those ninety-minute clinic appointments would really test my attention span (which currently stands at an estimated ten minutes).

Obstetrics and Gynaecology
Even before medical school, I had a huge interest in O&G and this placement did not disappoint. It helped that I was given two consultants who were absolutely lovely and did a lot of teaching. I loved that there is a decent amount of medicine but also a lot of surgery in this field. The best part was being present for a number of births and I'm not going to lie, it was a totally emotional experience. This placement was full of long twelve hour day shifts, night shifts and often involved a lot of running around in order to clerk a patient straight after clinic, grab a snatch lunch and then go to theatre but it was totally worth it.

Paediatrics
Another amazing placement :) The best learning opportunities for me were in Paediatric A&E where I was allowed to clerk in new patients and then present to the registrar. Because no one had seen the patient previously, it meant that I was going in completely blind which helped build my confidence when I'd get the likely diagnosis and management plan right. I also learnt that I'm not actually that bad with children and parents and though it is highly unlikely I'll go into paediatrics, I got great feedback from the doctors on the team. One even suggested I'd make a great paediatric doctor...?!

Surgical Specialties
Plastics - Amazing week. Great opportunities to see some cool surgeries and I scrubbed in loads this week. I spent a morning in trauma triage where I saw patients first and then presented to a doctor. I also helped with admin tasks such as booking patients in for theatre - something I may be doing as a foundation doctor in a year's time anyway so a great learning experience. Full of hand surgeries and skin grafts and not so much of the tummy tuck or face lift surgeries ;)

Ear, Nose and Throat (ENT) - Unfortunately, I didn't get to see any cool head and neck surgeries during this week. ENT is quite paeds heavy so I drew on my experience from my paediatrics block. Not the best surgical week I had but still very interesting.

Ophthalmology - This was a really light week where we only got to see cataract surgeries (which you can do on Youtube and is super quick and quite dull). Not my cup of tea but the clinic experience was great.

Trauma - A fairly good week but didn't live up to expectations. It was mainly orthopaedics and no interesting traumas came in when I was scheduled to be in theatre. That's definitely a good thing (as I don't want anyone to be hurt in any way, shape or form!) but not so good for my learning! The team were also very friendly and I could potentially see myself being seduced by the adrenaline of a fast-paced specialty such as this one.

Urology - This week was so good, it's rocketed to the top of my 'want to do' list. Urology is super interesting and with so many organs included in this specialty, I'll never be bored. It didn't hurt that urology is one where the work-life balance is pretty decent! During this week, I was scrubbed into nephrectomies (kidney removals) and if you get me scrubbed into surgeries, I'm pretty much going to automatically love your specialty... I also had a consultant who was cool as a cucumber and I pretty much want to be the female version of him. Also met quite a young, female consultant who is someone else I want to be like in the future.

General Surgery - Ended up seeing a lot of hernia repairs, haemorrhoidectomies and laparoscopic things. However, on-calls and A&E shifts were very interesting and I definitely enjoyed the super short ward rounds :) The clinics I attended were also very good and the consultants in them did a lot of teaching.

Orthopaedics - This week made me realise that my anatomy knowledge isn't as bad as I thought it was! Managed to answer some pretty probing questions about the anatomy of the knee in theatre which impressed the surgeon but at the same time, I realised that I may not be strong enough for this specialty! I'll either need to go to the gym more often from now on or just accept that this isn't the specialty for me (even if I really, really enjoyed it).

Breast - I loved this week. The team were really funny and we had a laugh in clinics and theatres. It was a super packed week but because I was allowed to see patients first in clinic, it helped me learn how to present a patient succinctly. Another surgical specialty I loved - they are fast mounting up!

Overall - My advice would be to get stuck in! The best thing to do is to be scrubbed into surgeries - standing at the back seeing nothing is no fun. Also, surgeons love it when you ask questions (and I have plenty as I want to do surgery!) so don't be afraid of them - they don't bite if you're polite :)

Geriatrics
I was placed with an awesome team who got me really involved in all aspects of the placement. I was writing in patient notes during ward round, doing junior doctor jobs (e.g. taking blood, inserting cannulas) and doing new patient summaries. It ended up being an amazing placement where I knew that I would learn something every day (which I did!).

Cardiology
This was only a two-week block but that ended up being plenty. Spent time in clinics, cardiac catheter lab, cardiothoracic theatres with plenty of bedside teaching scheduled in too. Learnt loads, not least the fact that I don't want to be a cardiologist.

Medicine (Gastroenterology)
My last placement before exams was on a Gastroenterology ward. Again, my best time was spent in A&E or on-call. Are you starting to see a trend...? I saw a wide variety of things on this placement and though the ward was fairly quiet with a low rate of patient turnover, I still found enough to do. Medicine placement is the perfect one to practice practical skills such as blood taking, cannula insertion, learning how to prescribe, insertion of urinary catheters, etc.

- - -

So there you have it; all of the placements I've had all reviewed in one mammoth blog post. I'm not sure how interesting or useful this is to those of you at medical school/thinking of medical school. If you have any questions, leave me a comment and I'll try and get back to you as soon as possible :)

timetabling: how to deal with a lack of structure on placement

This year has been all five week placements and sometimes, I'm given a set timetable to follow but other times I'm not. This can make it hard to find the motivation to go in or even plan your social life for the week! I thought I'd explain how I deal with a lack of structure on placement.

Firstly, have a week-to-view table that you can use to plan each placement day. You'll most likely be given dates and times where there'll be teaching so write those in immediately. Next, find out what clinics, theatres, other learning opportunities there are - find out when they happen and what time and then decide what you'd like to do. Fill your blank spaces with these. If you also do a sport/extracurricular activity on a regular basis, write those down.

I know this all sounds like common sense but I was surprised at how some of my fellow medical students hadn't even done something like this. Maybe I'm just obsessive about organisation but in medicine, I feel you have to be at least moderately organised to ensure that you get all your assessments done in a timely manner, etc.

Below are my weekly timetables; firstly in a blank notebook and secondly in my Hobonichi (which has been invaluable this year for keeping on top of things).

posters for those 'hard to remember' topics

Last academic year, I made posters for the major conditions we needed to know about and this year, I followed the same routine. Because the number of conditions I need to know about has increased by about a thousand fold (kind of kidding), I needed to be more selective with what things I dump onto a side of A4. Here are three examples :)

Multiple Sclerosis

I'm okay with talking about multiple sclerosis, theories as to its cause, investigations and treatments, etc but when you throw in the phrase 'internuclear ophthalmoplegia', I break out in a cold sweat. This made me decide that it might be a good idea to put it on a poster to at least try and make it easier to understand.

MND and Parkinson's Disease

These two topics are ones that I'm generally okay with but the different types of MND and the Parkinson's treatment options can be overwhelming, especially for someone like me who has no interest whatsoever in neurology. 

Malaria

Finally, malaria! Similar to the previous example, the different types of malaria and the treatment options can be quite easy to mix up so to put it on a poster can allow me to organise it all easier in my mind. It also gave me the opportunity to draw a cute little anopheles mosquito too (though they are not so cute if you think about the chaos they can create through a little bite).

I talked about posters here and also here if you want to see/read more :)

antibiotics: the bane of my pharm life

There's always that one topic that no matter how many times you make an effort with it, it'll still evade becoming a permanent fixture in your brain. Pharmacology is a topic that I'm usually okay with but for some reason, antibiotics are my Achilles heel. As a result, I've used a variety of methods to try and tackle this mammoth class of drugs.

Firstly, I broke each class down and then limited them to two post-it sized notes. I also colour-coded each one. On each post-it (or two for the beta-lactams and cephalosporins), I would have examples of them, a brief bit on mode of action, major side effects and common uses of them.

I then made an A4 image of how each class of antibiotics attacks the different elements of a bacteria cell. This helps a bit as I do learn quite well from images! And to go even more overboard, I also made a mind map (but this didn't help me so much if I'm honest). 

Finally, I have an A5 sketchbook which I've used to make longer notes on different medications used. I'm not sure the below layout is the best one for me so I'm still experimenting to see how I can best learn and retain all this information! Being on the wards definitely helps though as seeing it in practice means that it goes into my brain that bit easier and quicker.

I genuinely think there's only so much I can learn from the books when it comes to pharmacology. A lot of my existing knowledge came from being on ward round during placement and also looking at drug charts and testing myself. It's also good to have a junior doctor who questions you about the drugs on the chart too (I had one last year who did this on ward round and it helped immensely). 

Antibiotics are still a little bit hazy in my mind but they aren't so scary when you break them down and actually sit down and spend some time with them. Try and relate them to a patient who you've seen on the wards as that seems to have worked for me. I guess that's why they say experience is invaluable! 

Any tips for learning about antibiotics and all their different modes of action, indications and cover?!

medschool: respiratory medicine placement

Last year, I had three five-week blocks of placement: one on a 'medicine' placement, one on general practice and one on a 'surgery' placement. For my medicine placement, I was placed on a respiratory medicine firm and I knew it would be good based on reports from older students. Plus, some of the respiratory teaching we've had from various consultants have been excellent so I had high hopes.

For this placement, we were given a handbook of things we were recommended to attend - these varied from clinics to watching some lung function tests to attending teaching sessions. To ensure I was as organised as possible about all these sessions, I used my Iconic essay book to draw up a timetable for each week of the placement block.

To ensure I was as prepared as possible, I revised some common respiratory conditions and these included asthma, COPD and pneumonia. I made sure I knew the common presentations, investigations and management for each inside out just in case I was asked by a consultant or registrar. Personally, I think it's bad form to go into a placement without at least knowing these basics about the most common conditions.

Anyway, onto the bulk of the placement.

Ward Rounds

For me, ward rounds got a bit boring after the first few times. My placement was in November time so most of the patients were in hospital because of acute exacerbations of asthma/COPD or had pneumonia. Most of them had also been in hospital for quite some time so when it came to presenting patients on ward round, it became a bit dull after the third or fourth time.

However, that's not to say they aren't good learning opportunities - ward rounds enabled me to see how doctors determined management plans for patients and also learn how to write in a patient's notes. I also learnt about prescribing on drug charts and even wrote up a few drugs myself (but of course, had them checked and signed by a qualified doctor!).

Clinics

Clinics were a good opportunity for one-on-one teaching. The consultants on my firm were extremely friendly and keen to teach so I enjoyed all of the clinics.

Before each clinic, I would read up on the common things that may come up (so, for example, in the cancer clinic, I'd read up on lung cancer and their different types and also mesothelioma) so that I wouldn't seem like a deer in the headlights if the consultant asks me a question. I also tried to gain at least one learning point per patient.

Clinics can seem mind-numbingly dull to some but to me, they were an ideal time to shine. I could show the consultant how interested I really was by asking questions (and I was! Respiratory medicine is interesting!) and also get some one-on-one teaching which is actually pretty hard to come by.

Consultant Teaching

I was quite lucky in that there were a number of consultant-taught sessions throughout the placement. If you have these - go to them! Teaching is teaching and can help you reinforce concepts that you may have found difficult. We had sessions on taking different types of histories, interpreting blood and ABG results and also radiology interpretation.

Ward Work

I'll be honest here - I didn't take as much blood as I probably could have done and I didn't insert as many cannulas as I could have done either. What I did instead was practice clerking patients as it was recommended that we clerk an average of five patients a week - a number I did in fact manage. In hindsight, I maybe could have clerked a few less and inserted a few more cannulas. I don't mind doing practical procedures - I actually quite enjoy them - so this year, I'm going to try and get a few more of them done.

Other Bits of Learning

On this placement, I learnt a lot about asthma, COPD, lung cancer, mesothelioma and pneumonia. As a result, I felt extremely confident with these topics and very little revision was needed because I clerked at least one patient with each of those conditions.

There was a sad moment where I attended a meeting with a patient's family to talk about what action would be taken if the patient were to have a cardiac arrest. This patient was very, very poorly and they had deteriorated significantly over the last two weeks so the decision was taken to keep them as comfortable as possible. It was a sad moment when I went to the ward one day to see their bed now had a different patient in.

Respiratory medicine allowed me to see how patients were managed acutely (I had a week on an acute ward within this placement too) but also see how long-term inpatients were treated too. There were some sad times but overall, the staff and patients were mostly lovely and I learnt an awful lot in a short space of time.

Overall, I really enjoyed my medicine placement and in all honesty, I probably would have enjoyed this placement no matter which specialty I had been allocated to. The main thing is to throw yourself into it and just take an interest in patients! Remember why you went into medicine in the first place and use that motivation to get you through the hard times but also bring you back down to earth during those really, really good times.

medschool: learning whilst on placement (third year)

I've spent half of this academic year on placement and learning on placement is very different to sitting in lectures/tutorials. I thought I'd share a few things I did that have helped me get the most out of placement and also learn as much as I can. I'm not an expert and I'm only sharing my personal experience, and I'm sure as I progress through medical school, I'll only pick up new ways to learn. This post is more applicable to third year students rather than more senior ones.

Medicine Placement

On medicine placement, I was lucky that there was a lot of structured teaching from the consultants within the specialty I was allocated to. I had tutorials based around the core specialties (such as cardiology, gastroenterology, etc), history-taking and also things like reading ECGs and chest x-rays.

Learning on the wards was another story. I was placed on a very busy ward where a number of patients had been there for quite some time with some others who were acute admissions who would probably be in for a week or less. This meant that finding a patient to clerk was never an issue (in most cases, the longer a patient had been in, the more willing they were to talk) and I would definitely recommend that you try and clerk at least one per day. I managed this and it meant towards the end, I was pretty confident when taking a full history from a patient and examining them too.

After clerking, think of the top three differential diagnoses the patient may have (and if they've already told you, think of the other things it could've been that have a similar presentation) and then think up a management plan. Next, look at their drug chart and patient notes to see how close your plan matched their actual one.

Another thing to do is to present these patients you've clerked to doctors and even friends who are medical students. I definitely didn't do this enough (once a week on average for me) and I sorely regret that. Ward round is a great place to present patients and it also means you're less bored than if you just traipsed around aimlessly after the team.

Finally, medicine placement is an excellent time to do some practical skills such as venepuncture and cannulation. Ask the junior doctors what jobs need doing and then ask if you can help them. Attending ward round definitely helps with this; especially if you have a consultant who is super eager to teach.

General Practice

Unfortunately, I never got the opportunity to see any patients on my own but I did get a few opportunities to do a few consultations while the GP was in the room observing. General practice was a super chilled out placement for me but I learnt a lot. Ask questions - look up anything you don't understand and remember: common things are common! If you can, try and sit in with a variety of GPs - I did a physiotherapist clinic, a few diabetes clinics and saw a variety of conditions in the normal clinics.

Surgery Placement

My tips for this placement isn't that much different from the ones for medicine placement. Clerking patients on surgery placement is very different as, for example, you have to ask other questions specific to anaesthesia and relevant co-morbidities.

When you go to theatre lists, don't just stand and watch the surgeries. Seek out the anaesthetist on an occasion or two - I did this and learnt a lot about drugs commonly used and also about the monitors used during surgery. Try and find the list the day before so you can look up the procedures and patient's notes.

Finally, be enthusiastic and open-minded! I went into each placement thinking that there was a possibility I might enjoy it enough to consider it as a genuine career move in the future and this meant I asked questions, read up on conditions relevant to the specialties I was allocated to and just kept a log book of each patient clerked and condition seen. Don't go into a placement thinking you'll hate it - you might be surprised! And be respectful to everyone: patients, doctors, nurses, HCAs - remember, medicine is about team work and these people are the ones who will can give you a hard time if you're rude or never on time. A smile goes a long way!

Placement is much better than sitting in lectures all day so make the most of it. After all, once you graduate, you'll never be able to use that brilliant phrase that gets you out of everything ever again: "I'm sorry, I'm only a medical student!".

Just an aside - although I've written this post in reference to third year placements, I am technically in my second year of medical school of the accelerated four-year graduate-entry course, hence why when it comes to OSCEs and formalities, I am a 'third year'.

balancing university and 'life': my own experience

It's really easy to let university take over your life and in fact, I think I was guilty of this in my first year at medschool. In this post, I will cover work and play (or at least, try to!) so I'll begin with work.

Firstly, I try and work whenever possible. Sometimes, I'm really not in the mood for study so I'll take that evening off or a few hours off and that's okay with me. I do feel a bit stressed and guilty for not doing work but then I think about how important it is to have a balance and I don't feel quite so bad. Occasionally, I get into a mood where I feel super productive and it's during these times that I take advantage and get a lot of study in (but with study breaks every hour!).

As my commute is an hour and a half each way, I try and make use of this time. I'll spend half of my journey relaxing and the other half going over things with flashcards. Flashcards are something that I count as an essential when it comes to studying and that's particularly true for me when I could potentially end up wasting 15 hours a week doing nothing whilst on the bus.

During particularly stressful times, I will light a candle a few hours' before I am due to go to bed. I leave the candle on my bedside table and when I tuck myself under my duvet, I get a faint smell of vanilla which aids relaxation. I think the tea lights shown above were only £1.50 (for the whole pack!) and although the aroma isn't the strongest, it does the job.

Make time to wind down and relax with friends... Once every few weeks, my friends and I will get together and do something that doesn't involve work. One of my favourite things to do is laugh and make other people laugh so it's safe to say that one thing that keeps me balanced are my friends.

Do more of what you love. For me, I love cooking and baking so once in a while, I'll spend a afternoon in the kitchen cooking and baking. Although I love hanging out with friends, I do love being in my own company too and this 'hobby' (if you can call it that...!) allows me to do just that.

Finally, the most important thing you can learn to do is to say 'no'. I know it's hard when a friend decides to arrange a night out as it might feel like you're missing out but on a few occasions, I've declined invitations as I'm aware of my own limits. Burning out is not fun and it's not worth risking it for 'fear of missing out'. 

Overall, I think it is quite easy to get caught up in studying 24/7 and not allowing yourself to let go for fear of guilty or anxious feelings. I appreciate this - I've been in that boat earlier this year - but each time I felt guilty or anxious, I'd remind myself that by having these breaks or times where I just focus on play instead of work, I'm allowing myself to stay sane. And I think that's the most important thing to remember: that by having this balance, I'm keeping my sanity and balance as an all-rounded human being. There's more to me than just studying and letting it define my personality is not how I want others to see me.

my preparation for exams (term two)

For this second lot of exams, I took a different approach to revision. I decided to use mind maps, hand-drawn diagrams and flashcards as my main modes of revision and I decided not to write out lecture notes as I found it time-consuming and really not that helpful.

An example of a hand-drawn diagram I made is this one:

In the above diagram, I also colour coded - for example, Na+ is in orange, H2O is in blue, etc.

Mind maps were useful for anatomy and for more complex concepts. For example, I attended a lecture on the digestive system and I wanted to condense the sheer amount of information I needed to learn for the exam. In order to do this, I connected all of the clinically relevant things in one mind map. I made it a bit more interesting by adding some colour but there was no colour coding on this occasion.

With my bus journey being one hour each morning and each evening (sometimes more if traffic is bad - it was ninety minutes throughout March due to roadworks), instead of spending that time staring into space, I made flashcards to use for my commute.

The flashcards are very boring and not exactly aesthetically pleasing but they do the job. I only made flashcards for things I found it hard to remember and the condensation of information on each card means that learning big chunks of information isn't as intimidating as they could be than if I was just reading them off some lecture slides.

In terms of organising my revision, I allocated two days to each condition studied (so, two days for each week) and this allowed me to decide when to start hardcore revision and also ensured that I got everything done in time for the exams. Of course, I revised at the end of each week too so I managed to avoid cramming (something I'm not a massive fan of but did a lot in my first degree!).

Finally, I made use of practice questions I found online, in books or supplied by my uni. They were invaluable in showing me where the holes in my knowledge were but also helped me learn new things. In fact, some practice questions I did came up in the real exams so this is one thing I'll definitely do again next time.

my desk - studying edition

I'm thinking that this could be a new series on this blog where I post my desk in different scenarios. To kick it off, I have my desk during a revision period where everything is in chaos. There are two pictures in this blog post: one of my desk from the night before (it was what I woke up to) and then a picture of the desk, primed for revision after a bit of tidying.

So, from the night before, you can clearly see that it is seriously messy and not in the right state for some hardcore revision.

However, after a bit of tidying (putting things back into their usual place, and just some general TLC), you can see that it looks a bit more ordered and serene. On my desk, there is water (never underestimate the importance of keeping hydrated during study periods), pens, paper and my notes. Other things of note are textbooks and pocket books that are useful for practice questions or to look things up.

I'm sorry about the quality of the pictures - they are horrendous and I am hoping to invest in a better camera in the summer after selling some stuff on eBay!