A third year medical student’s experience

A BSMS 3rd year medical students writes about their time on the Moore-Ridings firm. (Please note that Mr Moore now leads a different firm with Mr Lamah and that his timetable has changed since this article was written).

Moore/Ridings firm: student experience 2009

The firm is one of the four specialised in GI surgical management, and normally consists of the two lead consultants, two registrars, an SHO and four FY1 doctors. It is based on level 9a in the digestive diseases centre, so it is next to endoscopy and outpatients at the RSCH. Due to being based in the BSUH trust, surgical lists and outpatients also occur at PRH.

I was in a group of three students for our attachment and it was made clear that we were always welcome, as well as being provided with a very clear timetable and an outline of what we should undertake so as to gain the most benefit from the rotation. This was invaluable in giving us the confidence to approach the varied and sometimes challenging situations of the next four weeks, and as a result we were involved in some great learning experiences. Although the attachment was longer, I will outline my first week, which whilst each week is different followed the timetable.

Monday: I walked into hospital to start my new attachment. I arrived at 8am and found the FY1’s who were checking on the in-patients experiences over the weekend, liaising with the nurses about management and updating the patient lists. It was great to be involved with this and useful to take a brief history from the patients using the SOAP method. This consists of:

Subjective (how the patient feels they are and their ideas, concerns and expectations)

Objective (observations, fluids and medications)

Assessment (history and examination)

Plan (formulating a management plan and informing the patient – not for the medical student to put into practice but to consider)

Mr. Moore led the main teaching ward round during which we all presented a patient we had clerked the night before. Over our time on the firm this proved to be extremely useful as it required practising a skill under pressure, got a lot of feedback, and was used to move onto teaching points. There was notable improvement from this first attempt over the attachment.

In the afternoon another student and I went to endoscopy, which was a useful learning experience. We performed a PR for the first time, having consented the patient, and were able to gain insight as to the feel of a normal and abnormal prostate. This allows experience to be gained which we cannot from the plastic models currently used for our OSCE’s.

Tuesday: Ward round with Mr. Ridings, which due to the number of patients this week on the ward round allowed a considerable amount of time to be dedicated to teaching. This was lead by the consultant but junior members of the team also taught in between patients. We were involved as we were encouraged to look at the observations and interpret them, as well as writing in the notes.

One of the FY1’s had prepared a teaching session on the “acute abdomen”, for afterwards which was an extremely useful platform from which we were able to build our knowledge during the attachment.In the afternoon we performed practical skills of blood taking, cannulating and practised our examinations under supervision.

Wednesday: Registrar led ward round at 8am which we could not stay for all of due to our scientific basis of medicine lectures.

In the afternoon I attended theatre with Mr. Moore operating. I observed and saw several operations including a laparoscopic anterior resection. We were always very welcome in theatre and due to my interest in surgery I spent a considerable amount of time there, which was always enjoyable and informative as there were considerable teaching opportunities.

That evening I went on-take as no other students are scheduled for take on Wednesday and the surgical patients who are admitted go onto the Moore/Ridings list for the following day. This was a great opportunity to clerk patients and then follow their management, as well as finding a patient to present on the post-take ward round the following day.

Thursday: I presented the patient I clerked, this time in front of the firm and the team on take the previous evening. Afterwards was a teaching ward round of the current in-patients. On Thursday Mr. Moore operated the CEPOD list so patients were listed in order of priority which was useful in helping us to understand the nature of surgical problems as well as complications both pre-op and post-op. I thoroughly enjoyed CEPOD as the RSCH is a busy hospital with a diverse range of surgical problems so I got to see some interesting and varied surgery. Students are not expected, though always welcome, to spend large periods of time in theatre but to use their time how they find most valuable.

Friday: I attended our symposia and so missed the main clinic of the week which is an unfortunate clash in the timetable at present. There is however a midweek clinic with Mr. Ridings and Mr. Moore runs a clinic at PRH so it is possible to gain this experience.

In the afternoon I scrubbed-in and assisted in a right hemicolectomy with Mr. Ridings. There are many opportunities to be involved in any aspect of the firm’s management of patients and to follow patients through their time in hospital. This patient spent a considerable amount of time on the ward and so I learnt a lot about how his management had been handled and used his case for my end of rotation CBD assessment.

Summary: It is made easy on the firm to gain a lot of experience and teaching but also to practice some of the skills it is not always easy to obtain in a busy hospital. I found that I gained a lot during my attachment and the best way to do this was to actively participate and take advantage of the opportunities offered.

Guy Mole, BSMS 3rd Year Medical Student, March 2009
GI: Gastrointestinal
RSCH: Royal Sussex County Hospital
PRH: Princess Royal Hospital
SHO: Senior house officer
FY1: Foundation year 1
PR: Per rectum
OSCE: Observed structured clinical exam
CBD: Case based discussion
BSMS: Brighton and Sussex Medical School