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So I haven't posted in a long time, mainly because I felt that I had nothing valuable to add.
But I've started fourth year = start of clinical years. FINALLY. Actually being in hospitals and feeling like you can make a difference (but not really because you still know close to nothing).
At Tauranga Hospital this year, I started off with General Surgery.
What I plan to do is just give a breakdown of all the attachments in separate posts (specific to Tauranga) and if you have any questions, leave them below.
For General Surgery in 4th year, the attachment is 6 weeks long. The assessments are:
1. 2 supervisor reports
2. POGS - hand in Monday after your attachment
3. Formative OSCE (i.e. doesn't count, but will be good for the end-of-year OSCE) - mid week 4 at Middlemore Hospital
4. CAT - last week
I appreciate that you probably have no idea what most of that means, so allow me to explain.
In Surgery, you are part of a team. There are consultants (2 per team in Tauranga), registrars (2 per team), house officers/HO (2 per team), and any students, 4th, 5th or 6th (6th years are known as Trainee Interns/TI).
At Tauranga there were 4 teams - upper GI, colorectal, vascular and breast.
I was attached to upper GI and vascular for 3 weeks each.
Your day starts with handover at 7.30am.
This is when they discuss patients who presented overnight or over the weekend. You will probably have no idea what's going on, and that's fine. Just be there and you'll start to pick up what they're talking about. When handover finishes, everyone gets up in a flurry so just make sure you follow your team to do ward rounds.
Sometimes consultants and registrars are both present at ward rounds, but it could be just registrars. They'll see all the patients under the care of the team. Surgical ward rounds are short and fast. Usually they will finish around 9am, and if there is theatre, likely at 8.30am. This is, of course, variable - depending on the number of patients. During the first couple of weeks, you'll likely feel useless and a waste of space. Your job is to close the curtains, grab/hold notes, and with more experience, start writing notes (with sign-off by a house officer). With more experience, you can start doing procedures - take bloods, insert peripheral venous cannulas, and urinary indwelling catheters. Just remember to be polite and ask a member of the team to contact you if an opportunity arises. It's scary the first time, but it's a great opportunity to practice.
When ward rounds finish, your team may have either theatre, clinic, be on call or have nothing on.
Theatre aims to start at 8.30am, but delays often occur. If you can scrub in, do so, particularly for open procedures because you won't be able to see much if you're not. With laparoscopic, you'll be able to see it on the screen so scrubbing in is not a necessity. Nurses are generally super nice and helpful, so ask for assistance. As a student, you'll likely get teaching and just hold tools, but it's a great way to understand a procedure. Normally you're welcome in other team's operating theatre rooms, so it's a good idea to go to them to have some awareness of different procedures.
If your team has clinic, there are variable start times. Clinic is when elective GP referred patients are seen, and are typically team specific. Morning clinics starting anytime from 9am to 10am is the norm. If afternoon clinic, starting time is usually 1.30pm. Just ask your registrar or consultant if you can sit in, and they will ask patients for consent. I found that clinics were very helpful in regards to learning, because you're able to ask questions and see a variety of patients and conditions. When you start learning examinations for the OSCE, you may also be able to practice those too, along with history taking.
If your team is on call, you will likely be in ED or APU (short stay equivalent of ED). This is when the surgical registrar has the phone, and GPs or ED will see patients and refer them to surgical teams. You and the registrar can see patients, exam, and admit them. However, these patients will not be under your team, and will be handed over to another team the following day.
If it's a day when your team has nothing on, this is a good chance to do some POGS. POGS (Pocket Organiser General Surgery) lists approximately 20 topics (acute abdo pain, trauma, leg ulceration, breast and skin lump etc) that you should cover, along with 4 special cases (1 of ethical, Maori, allied health (physiotherapy or occupational therapy is most common), and peri-operative (pre-op, intra-op and post-op)). This requires history taking, examination, provisional diagnosis, management, final diagnosis and follow up. There is also a page dedicated to forming questions and answers for each case. Try and get onto your POGS asap - its a monster and will save you a lot of stress. Discuss with other students doing general surgery to see if they have cases that align with the topics.
The CAT is a Critically Appraised Topic. You'll learn about it in fourth year formal learning. Basically, you find a paper (try find a randomised control trial), and you'll analyse it using Rod Jackson's GATE frame. For general surgery, you'll need to present your CAT in 10 minutes. Details will be given based on your hospital.
This is just a brief overview of the General Surgery attachment in fourth year, specific to Tauranga Hospital, but I hope it's given you something to be aware of. Leave questions below! :)
But I've started fourth year = start of clinical years. FINALLY. Actually being in hospitals and feeling like you can make a difference (but not really because you still know close to nothing).
At Tauranga Hospital this year, I started off with General Surgery.
What I plan to do is just give a breakdown of all the attachments in separate posts (specific to Tauranga) and if you have any questions, leave them below.
For General Surgery in 4th year, the attachment is 6 weeks long. The assessments are:
1. 2 supervisor reports
2. POGS - hand in Monday after your attachment
3. Formative OSCE (i.e. doesn't count, but will be good for the end-of-year OSCE) - mid week 4 at Middlemore Hospital
4. CAT - last week
I appreciate that you probably have no idea what most of that means, so allow me to explain.
In Surgery, you are part of a team. There are consultants (2 per team in Tauranga), registrars (2 per team), house officers/HO (2 per team), and any students, 4th, 5th or 6th (6th years are known as Trainee Interns/TI).
At Tauranga there were 4 teams - upper GI, colorectal, vascular and breast.
I was attached to upper GI and vascular for 3 weeks each.
Your day starts with handover at 7.30am.
This is when they discuss patients who presented overnight or over the weekend. You will probably have no idea what's going on, and that's fine. Just be there and you'll start to pick up what they're talking about. When handover finishes, everyone gets up in a flurry so just make sure you follow your team to do ward rounds.
Sometimes consultants and registrars are both present at ward rounds, but it could be just registrars. They'll see all the patients under the care of the team. Surgical ward rounds are short and fast. Usually they will finish around 9am, and if there is theatre, likely at 8.30am. This is, of course, variable - depending on the number of patients. During the first couple of weeks, you'll likely feel useless and a waste of space. Your job is to close the curtains, grab/hold notes, and with more experience, start writing notes (with sign-off by a house officer). With more experience, you can start doing procedures - take bloods, insert peripheral venous cannulas, and urinary indwelling catheters. Just remember to be polite and ask a member of the team to contact you if an opportunity arises. It's scary the first time, but it's a great opportunity to practice.
When ward rounds finish, your team may have either theatre, clinic, be on call or have nothing on.
Theatre aims to start at 8.30am, but delays often occur. If you can scrub in, do so, particularly for open procedures because you won't be able to see much if you're not. With laparoscopic, you'll be able to see it on the screen so scrubbing in is not a necessity. Nurses are generally super nice and helpful, so ask for assistance. As a student, you'll likely get teaching and just hold tools, but it's a great way to understand a procedure. Normally you're welcome in other team's operating theatre rooms, so it's a good idea to go to them to have some awareness of different procedures.
If your team has clinic, there are variable start times. Clinic is when elective GP referred patients are seen, and are typically team specific. Morning clinics starting anytime from 9am to 10am is the norm. If afternoon clinic, starting time is usually 1.30pm. Just ask your registrar or consultant if you can sit in, and they will ask patients for consent. I found that clinics were very helpful in regards to learning, because you're able to ask questions and see a variety of patients and conditions. When you start learning examinations for the OSCE, you may also be able to practice those too, along with history taking.
If your team is on call, you will likely be in ED or APU (short stay equivalent of ED). This is when the surgical registrar has the phone, and GPs or ED will see patients and refer them to surgical teams. You and the registrar can see patients, exam, and admit them. However, these patients will not be under your team, and will be handed over to another team the following day.
If it's a day when your team has nothing on, this is a good chance to do some POGS. POGS (Pocket Organiser General Surgery) lists approximately 20 topics (acute abdo pain, trauma, leg ulceration, breast and skin lump etc) that you should cover, along with 4 special cases (1 of ethical, Maori, allied health (physiotherapy or occupational therapy is most common), and peri-operative (pre-op, intra-op and post-op)). This requires history taking, examination, provisional diagnosis, management, final diagnosis and follow up. There is also a page dedicated to forming questions and answers for each case. Try and get onto your POGS asap - its a monster and will save you a lot of stress. Discuss with other students doing general surgery to see if they have cases that align with the topics.
The CAT is a Critically Appraised Topic. You'll learn about it in fourth year formal learning. Basically, you find a paper (try find a randomised control trial), and you'll analyse it using Rod Jackson's GATE frame. For general surgery, you'll need to present your CAT in 10 minutes. Details will be given based on your hospital.
This is just a brief overview of the General Surgery attachment in fourth year, specific to Tauranga Hospital, but I hope it's given you something to be aware of. Leave questions below! :)
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ReplyDeleteHow much clinical experience do you think you need before being allowed to write in the notes? I've just purchased a mont blanc fountain pen and I cant wait to make my mark!!!!!
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