Workshop

Last weekend, I was one of the volunteers to help out in the Global Health Conference attended by about 400 medical students from all over the UK. My personal highlight of the weekend was the workshop that I delivered.

Conducting a workshop is nothing new to me. I have, since my second year in medicine, been leading various workshops on training of generic skills like leadership, publicity, teamwork in medical student conferences; on teaching when I coordinated the after school club; on asylum seekers issues all the time since I'm too passionate about this; global health issues like the one on maternal and child health which I did at the start of term this year. I love workshops, right from the planning to the execution. The fact that it's meant to educational, fun and stimulating through learning by participation makes the design and planning so interesting. I usually start by getting my team to research around the topic, then pool our findings and see how we can fit the important bits in our workshop. Then comes my favourite part, which is putting our creative mind to the test and come up with ideas on how the message can be delivered, be it open discussion, debate, brain storming, games or puzzles. Ideally we aim to get the participants exercising both their bodies and their brains. Meticulous planning is necessary and time keeping is essential as people tend to become so engaged that they want to carry on talking and playing for longer than the allocated time.

This workshop is called 'In the Shoes of the Asylum Seekers'. It involves role play and participants acting as either asylum seeker or health care professional or ordinary English people. Every scenario is followed by discussion of issues that have come up during the act. The fact that two of my friends were able to help me out in facilitating the small group activities meant that the groups were kept small and every single participant were able to speak up. It went very well overall. Participants were engaged, and we received nice positive feedback. It was worth all my effort planning the workshop while juggling with the extremely hectic paediatrics placement and neglecting my exam happening next week. I'm too very happy!

Managing constipation

Constipation is a very common problem for people of all ages. I met a 7 year old girl on Friday who impressed me with her unique way of managing her problem. Basically for her it started when she was about 3 years old, complicated by a slightly deformed rectum and anus. Nowadays what she does is to make sure that she poos 2-3x a day, and to describe her poo according to the stool chart.

The aim is to have a well formed but reasonably soft poo, i.e. type 3 or 4. If she has no poo for a day, or if poo has been hard (type 1 or 2) then she will tell mummy and mummy will add movicol (an osmotic laxative, makes poo softer) into her breakfast. And she will let mummy know if she has done a poo at school or not. So now at the age of 7 she is an expert in the stool chart and managing constipation. She now rarely needs any laxative at all because it's all been so regular now with the sensible use of movicol.

You might think this is so simple but this is the very first time I have heard about constipation being managed like this. Usually doctors prescribe laxative for a fixed length of time, and patient would take it blindly, without consideration about what is happening to their own bowel motions. So more often than not, they will come back to the doctor, either saying that constipation is still there, or that they are now having diarrhoea, either way relying the doctor to prescribe some more medication to sort out the problem. I must say this too often happens to the elderly patients. I am going to start recommending this little girl's method of managing constipation to other patients from now on.


.

Keep up

From very early on in the clinical training, we have been told that learning medicine (especially in Manchester) follows the principle of how much effort you put in is how much you get. This suits me well. Armed with unrivaled eagerness at the beginning of third year, I went to the wards everyday 9am - 5pm. But it didn’t take that long for me to realize that the principle only works in the ideal world, and we are not living in one. Sometimes there is no patient to see, other times doctors are too busy. It’s mentally and physically draining. Still, I persisted. And generally speaking I’d say the effort pays off.

I always envy the way nurses are trained. When nurses or midwives ask me what time would I be in a ward until, my answer ‘we can leave whenever we want’ often surprise them. Student nurses are included into the staff rota and are expected to work in shift and contribute to the nursing team. Medical students, on the other hand, are free to do what they want. Easily, I can get away with just going into hospital for half a day in a week for the compulsory PBL session. There were some rare occasions when I have demonstrated commitment and people started to treat me as part of the team (in Renal, A&E, O&G). It is satisfying to get to know the team well, work with them and gain their trust so they let me do things, like a little apprentice. But I often feel disheartened because my hard work is not rewarded. Sometimes no one even notices.

During obs and gynae things changed. Mr S’ registrar said she noticed that I have been turning up for every single theatre sessions, which is unusual for students. During my labour week, I got along quite well with a student midwife, Nancy. Nancy and I looked after a lady in labour and after that she said something really moving to me. She told me that the way I interacted with the family, building rapport and helping out, has changed her perception of medical students. She has never seen medical student being so involved with a lady’s care before. Another midwife Gill also commented that she was seeing me so much more than the other students. I don’t think she’d have allowed me to assist in delivering the baby boy had she not seen me being that keen.

I would always remember one of the greatest compliments I have ever had from a patient. At 7:30pm in the emergency admission unit, a patient told the consultant ‘She was here all day and she didn’t stop smiling’, and the consultant continued ‘Yes and she’s very intelligent as well.’ It could have gone on to hug and thank the patient for noticing.

I have been complaining a lot about being tired lately. My concerned friends would ask if I have to go to lecture a lot. I know they meant well, but I just want to scream at them. We don’t HAVE to do anything in medicine. It is just me wanting to make the best out of all the placements. So it’s my choice then I exhaust myself and I should stop moaning.

Freedom and hard work are devil combination. Why bother to wake up at 6am for the morning ward round when it is optional and I know that my friends most probably are taking a day off? A lot of conscience and self discipline are needed to make it work. I am a creature far from perfection. Coming to the end of my fourth year, my enthusiasm is wearing off. Determination, without rewards and positive reinforcement, can only last so long. I thank all the people who keep me going.

.