25 November 2015

On the other side of the fence!

By Dr James Gill

WMS Alumnus and Academic Clinical Fellow

Being at WMS is a bit like having a virus… where you spend four years fighting as the medical curriculum infects and finally takes over your life. You are constantly buying tissues to try and stem the flow of knowledge that seems to pass into your ears before seemingly running, unhindered, straight out of your nose.

Simultaneously you are trying to get your exhausted body to jump through the hoops and requirements for progressively more difficult clinical examinations. The ordeal, the hardest four years you could imagine, finishes, when you finally rally and break the fever that is Medical Finals. With your graduation, and your immunity to the medical school complete, you move out onto the wards as an FY1.

The problem is that, a bit like having recovered from chicken-pox, you seem to have cleared the infection, but there may still be a few viral remnants lurking in a dormant ganglion! Viral remnants that begin to awaken as you battle the stresses and strains of being a junior doctor.

Out in the Real World, on the wards, you realise how good life was at WMS, and recall the fun you had there. Not only the fun, but also the direct access to passionate lecturers, who actually enjoy explaining about the latest, sexy, cutting edge treatments they are working with, or the inspired management plans they putting into practice on the wards

It’s the gleam in the eye of the lecturer, like Dr Ramesh Arasaradnam, when as he finishes a lecture, he starts to explain about the Electronic eNose he has built with The Warwick School of Engineering, allowing him to “smell” diabetic urinary markers, in a new way of identifying patients.

Or the passion with which Dr Vinod Patel and the Diabetes team discuss the latest anti-diabetic medications such as dapagliflozin and novel approaches to trying to manage diabetes, one of the greatest disease burdens of our time.

Seriously, if I had the time, or the money, I’d pay to come back and sit in some of the lectures that the students get here at WMS, both for the entertainment, but also in order to get an update on some of the latest clinical developments!

Out on the wards, as you start to interact with students and assuming a teaching role as a junior doctor, you begin to develop an itch. An itch like that which heralds the re-activation of VZV from an old chicken-pox infection… Suddenly after having fought tooth and nail to graduate and leave WMS, you start to think about applying for a job back at there!

As a GP Registrar, the opportunity arose for me to come back to WMS as an academic clinical fellow (aCF). After successfully passing through the hurdles and hoop jumps of the selection process (everything about medical school is a hoop jump, I think that the original doctors must have been failed PE teachers - anyway) I was back at WMS! - That itch had developed into full blown shingles!

Returning to WMS, you realise that some things are the same for both the staff and students. There are simply not enough hours in the day! Working as an aCF, whilst also undertaking GP training, is a little like doing two 75% jobs, rather than two 50% jobs. But as with undergrad medicine, the experience is worth it!

Working on the faculty side of the fence, you get all the joy of unfettered medicine, the pure biology, without the attached patient in preparing sessions. Yet at the other end of the spectrum, you also get to play the human aspect, working with students, to "question-smith" their histories. They're developing communication skills, and working on phrases to get the most out of patients during history taking, whilst looking for nuanced body language that might suggest a patient hidden agenda.

Working with students is challenging. But it’s also an amazing buzz! In many ways, having a role at the sharp end of teaching at WMS requires mix multiple personalities, a little Jeremy Paxman, a little Robin Williams, a little Barry Marshall and a little Tess Daily (although I’m still working on that kind and caring bit!), somehow Jamie Roebuck seems to encompass them all!

The buzz comes from the challenges the students bring, and their still un-medicalised approach the questions. Everything from the simple building block questions of medicine, “How does that work?” to the “Question-smithing”, the question honing, done to illicit the most information out the patients, with the least repetition. Sometimes I even steal phrases the students come up with to use in day-to-day general practice! I’m sure I get as much out of working as WMS as I put into it!

Building on the concept of getting things out of WMS - medics, GPs, (I’ve even heard some surgeons) are life-long learners. A major benefit of working at WMS is you are continually thrown curve balls by the students, meaning there is always something to look up, clarify, or read around for the next sessions to answer a question.

As an aCF you get to deliver sessions on a wide variety of topics, but at a depth of detail I haven’t needed since I was on the wrong side of my Finals Exams! The preparation for these sessions is time consuming, but its always rewarding, and certainly keeps my knowledge fresh!

Probably the most surprisingly enjoyable part of working at WMS is the iterative culture here. Constant improvement is welcomed. The “we can do better” mind set, really is a pervasive attitude. Yes, there is an element of red tape, as there is everywhere, but if you have an idea that you can demonstrate will support the students and improve their learning, and you have to passion for its development, you’ll normally get support for it, or at least the opportunity, to pursue it.

Some of the volunteers taking part in Biking4Breasts
One clear example of this has been the Biking4Breasts campaign, where the Medical School supported a campaign to purchase the latest in clinical breast examination models from LimbsAndThings, for use not only by students, but as an education tool for the wider community.

Students, staff, even the VC’s wife Lady Thrift came down to join the fun in the main plaza where we collectively clocked up 2,000.1km, cycling around a virtual track with our riders efforts displayed on the Big Screen in front of Rootes.

Volunteers taking the evening shift at Biking4Breasts
Just to go a little bit Marks & Spencer on you, “These are not just any Breast examination models…” the fidelity on these models is absolutely jaw dropping. Using these models, we can choose where to put the cancer models, which makes both teaching and examination setting, higher quality experiences. Again, all of this is directed towards bettering the student experience, and build better doctors. A simple GP factory, WMS isn't!

Working at WMS is frequently a challenge. Meetings about exam standards setting and question writing can become quite passionate, as there is always to drive to push a bit harder, just that little bit better for everyone. In any other environment, I don't think this constant culture of self-improvement and change would have been supported in the way it has been at WMS. But here, everything is always funnelled towards doing things for the benefit, and advancement of the students, which I think gives people the drive to keep pushing.

I've seen WMS change a lot since I graduated in 2010. It's changed further still since I've been here, and I hope I'll be able to contribute, and be part of, the next cycle of improvements and growth. One thing is for sure, whilst I'm at the medical school, the shingles has seemed to have gone into remission. Maybe I've found my place?

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