A Day in the Life...

 

A day in the life of a 2nd year St George’s student

I am currently on placement in a Medical Assessment Centre (MAC). My day starts at 6am with the not so welcome sound of my alarm clock. I leave home at 6.30am in time to get to the hospital for the 8.00am ward round.

The MAC takes patients from A&E and the Medical General Practice Unit (MGPU), a ward that is open 10am–8pm and accepts GP referrals. MAC acts as a short stay ward, where investigations and diagnoses can be made. Patients are then either discharged home or admitted to another ward.

In MAC there are two ward rounds, the first is run by the MAC SHOs and the second is run by the consultant who is on-call. I join one of these teams, we review patients and create a plan for their ongoing treatment. After the ward rounds (approx 11am–12pm) all patients are presented to the rest of the team so that all clinical staff are aware of the treatment plan and there can be a discussion about any concerns and decisions about their discharge/transfer to another ward. A rather long ‘to do’ list is then created and this is shared out across the team. I generally help out by doing any venepuncture, cannulation or any ABGs that need doing. When these jobs are done, I try to make time to grab a drink and a sandwich – often easier said than done

Some days I leave the ward round early as the consultant who is my clinical placement supervisor comes in to offer teaching to all students on his team. If we have clerked a patient we can present it back to him, so that he can offer feedback. We discuss the patient’s symptoms, investigations and management. Alternatively, he finds a patient with good clinical signs and watches one of us do an examination on that patient, again so that he can give us feedback.

After lunch I generally head up to the MGPU so that I can practice clerking patients and presenting them to the consultant on-call. This also gives opportunity to practice clinical examinations. The nurses in the MGPU are very friendly, helpful and enthusiastic about the role and have been a great help in helping me obtain my DOPS (a list of clinical procedures that we have to be observed doing).

My day ends anytime between 4.30pm and 7.30pm. I then get back home, eat, read about the symptoms, diseases, investigations and clinical governance that I have come across that day. Bed is normally 9.30–10.00pm, otherwise I am shattered for the rest of the week.

Placement is great, it is what training to become a PA is all about. It is sometimes easy to forget this when you leave home in the dark, get home in the dark and feel that life is made up sleeping, eating, being on the ward and then trying to soak up an obscene amount of knowledge, but I personally find that a smile and a thank you from a patient, a compliment from a consultant or a lightbulb moment when textbook reading suddenly falls into place makes it all worth it.

To anyone reading this because they are considering applying to one of the course – I thoroughly recommend it!

 

A day in the life of a 1st year Birmingham student

At Birmingham the PA Diploma is a 2 year postgraduate course, requiring a 2.2 or above in a life-science or health-related subject. Teaching is predominantly through Problem Based Learning (PBL) and ‘at the bedside’ when on GP or hospital placements. From experience I can tell you that the course is very tough. Nevertheless, it is the most rewarding and exciting thing that I have ever done!

The day I have decided to detail to you is a Wednesday in early November. Despite the cold weather and an early start, I am still bright eyed and bushy tailed off the back of a very enjoyable day at GP on Monday. As well as learning about spirometry with the practice nurse and going on a home visit, I was given the chance to take a history from and examine a number of patients who had been scheduled to see me. I always find direct patient exposure like this particularly rewarding.

After my commute I arrive at the medical school just before 8am. I head straight to the computer cluster to check my emails and do some general reading. I read until 9am, the time that my PBL session is due to begin. The first hour is dedicated to reflection. After a short coffee break, attention then turns to the new theme – diabetes. Three students make case presentations, followed by questions, before we break off into our smaller PBL groups to discuss the cases in more detail and the topic in general. I leave the session having learnt a lot and a list of ‘learning objectives’ developed during the session.

After lunch, I head to the anatomy wing of the medical school where we have a teaching session on the anatomy and physiology of the endocrine system. The teaching is of the highest quality and as soon as the session has finished I head straight to the expansive library to read more on the topic. I stay in the library for an hour and a half before deciding to make my way home. Once home, I catch up with family over dinner before I hit the books! Specifically, looking at the diagnosis and treatment of diabetes.

I work until about half past 9, at which point I decide that it is best to get a good night sleep ahead of Thursday morning. At 9AM I have to attend a prosectorium session on the kidneys and urinary tract. Typically there are three or more specimens to examine and the experience as a whole never fails to leave me motivated to work hard for the rest of the week!

 

A day in the life of a 2nd year student on A&E placement

I am now on my third 6 week placement, the medical assessment centre seems a life time ago! I am now in a busy Emergency Department in SW London – I LOVE IT!! Before starting the course I always thought that the Emergency Department would bring me out in a cold sweat, but as I have progressed through the course I have become increasing interested in emergency medicine.

The A&E that I am on placement in employ two newly graduated PAs – before I started my placement I was excited about seeing how they worked and their day-to-day responsibilities, now that I am there I am amazed at how professional, competent and quite simply fabulous with patients they are! Anyway enough of me harping on about how amazing it is, on to what I have been doing.

A&E has triage, minors, majors, resus and paediatrics. There is also a GP there during working hours who helps with the minor illnesses.

So far I have mainly worked in triage, majors and resus. In triage I have been working with the nurses to improve my DOPs (venepuncture, cannulation, ECGs etc) and also learning how they decide where to allocate each patient to. It is the job of the triage nurse to assess patients, prioritise them and work out where they will receive the best care.

In majors I have been clerking and examining patients and then presenting them to either a registrar or a consultant – lots of chest pain, abdominal pain and elderly patient who have fallen. The doctors are all very supportive and enjoying teaching, so I have had good opportunities to discuss differentials, investigations and patient management.

Resus is much calmer than I imaged, although saying that I have not been there when any MIs or traumas have come in. Despite the calmness I did manage to miss a HUGE vein when trying to cannulate someone in front of the consultant – smooth!

I have so far avoided minors. I feel I need to spend more time reading and revising the Musculo–skeletal system, X–ray rules and radiology before I will be useful there or in a position to learn - maybe a job for this weekend!

I am so excited that I am slowly nearing the end of the course, can’t wait to get out there and get working. Fingers crossed that A&E posts are advertised!

 

A day in the life of a new graduate at Kingston A&E

I have been working in A&E for nearly three months and just love it! My colleague, Hannah, and I qualified from St. George’s, University of London in October 2010 and we started in the department at the end of November. As of this week we started shift work which means we have shifts between the hours of 9am–10pm and one weekend a month.

My average day is something like the following:

9am–12pm

Firstly I have to get changed into my new ‘Physician Associate’ scrubs to be on the floor by 9am. There are four sections in the department; Re-sus, Majors, Minors and Paediatrics so I make my way to majors and see how many patients there are that need to be seen. The department is usually quiet (NEVER use this word in A&E!) at this time, so if there is no one in majors I go and help in minors which generally deals with fractures, abscesses and lacerations. There always seems to be a run of the same pathology which is great, as you can see three ankle pains in a row with totally different management.

We are not scheduled to stay in one area so we move to which ever department has the highest number of patients to be seen. Also, we see the next patient in the pile regardless of the presenting complaint and after assessing the patient, we would come up with a management plan and run it past the registrar, or consultant, before discharging or referring the patient.

12–2pm

By this time I am usually back in majors seeing anything from a fractured neck of femur to an MI. Any unstable patients are taken through to re-sus where we work with a registrar to help with the patient management and it’s a great place to learn and be hands-on. Although we are very junior we still see the same conditions as the junior doctors, but we discuss our patients with a registrar fairly early on to ensure the patient has the best care. Also, as we cannot prescribe yet and pain management is a major part of the initial stages of emergency care, we rely on our seniors to prescribe medications.

2–2.30pm

Lunch!

2.30–7pm

Depending on the number of patients needing to be seen, I like to see some paediatric cases every day as I find that part of medicine quite scary, as you can see a febrile baby or a child with a rash and both of those could be very minor or very serious! The paediatric nurses are amazing and very experienced and always know exactly what is going on before you even see the patient.

By the end of the shift we both log the number of patients we have seen and their diagnosis so that we can gather some information about our development. Even though it is really challenging and sometimes quite intense, A&E really is the best specialty as it encompasses everything we were taught and uses so many of your skills and clinical knowledge every day. We love it!