My experience on 4th Year Speciality Medicine (SPM) by Beth

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One of the longest placements of the MBChB programme is the 18-week Speciality Medicine (SPM) block in 4th year. I did this placement from June to November at the Queen Elizabeth Hospital so I thought I would share a bit about my experience.

Before starting this placement, I feel apprehensive about how much there was to cover and how I would balance my time well between studying and gaining clinical experience. Suddenly I felt I had to know a lot more than being ‘just a 3rd year’, as 4th year sounds a lot closer to being a final year. Alongside the speciality learning experiences, there is the clinical skills passport to complete which has a range of clinical skills we need to be observed performing. They range from cannulation, giving intra-muscular injections to performing an ECG and catheterisation. On top of all this, there was various other aspects of the 4th Year curriculum outside of this placement to think about… so it felt very daunting to begin with.

I started my placement on Geriatric Medicine and gave myself some time to settle in and finding a good routine.  I aimed to try and spend as much time as I could on the wards on this specialty to ease myself back in since coming back from 3rd year – I felt I had forgotten everything. During those two weeks, I went to a few ward rounds, an Multidisciplinary team meeting (MDT), a TIA clinic and a falls clinic. I also really enjoyed spending the day with the Old persons assessment liaison (OPAL team). This team work in A+E and aim to clerk and assess elderly patients and help out the A+E doctors with their work load and decide the best things for this patient with an MDT approach.

I was able to get involved in assessing patients, whilst receiving consultant teaching at the same time. I was asked to contact the care home of a patient to take a collateral history from a carer, and I also saw one patient who did not want to be discharged from hospital. On further questioning, this patient was suffering with anxiety and felt very lonely and isolated where she lived and would feel safer in hospital. It was a reminder about how important taking a history from the patient is when coming to a diagnosis and deciding on a management plan. I was able to witness some of the things outlined on my learning objectives in practise when assessing elderly people, including assessing falls and capacity.

After a few weeks, I got into the swing of things and found I was able to balance my clinical experience with working in the library and started to enjoy my placement. I aimed to get all my ‘book work’ done within 2-3 days, if I could. I could spend then spend the rest of the time attending different experiences such as ward rounds, clinics and specialist procedures as well as take some histories and examine patients and attend scheduled teaching and lectures.

Despite being 18-weeks long with a 4-week break over August, this placement flew by and I found I really enjoyed it. It was very fast paced and quite intense, especially in the specialties allocated 1-week but I realised by the end just how much I had expanded my knowledge.  The clinical experiences I gained helped me to visualise and remember from speaking to patients, all the reading I had done. It was a privilege being at the QE Hospital too, because it has so many specialities and things going on – it is a really great place to be a student. However, towards the end I felt completely exhausted! Luckily it wasn’t long to go before Christmas where I could have a break.

All the studying would not have been impossible without caffeine!

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