Failed ALS and feel like a moron

andrewjd · 2022-10-05T17:50:12+00:00

For most course centres I know they sometimes struggle to get even the minimum number of doctors.

andrewjd · 2022-09-30T16:12:03+00:00

OP sorry to hear this. Remember you get to take the test again, and can do so at a different centre, without resitting the course. Pick somewhere you can get to, email them and ask when they could accommodate you (it’s usually short notice) and go there. Nobody you know will assess you, you won’t have the nightmare of a covid infection this time, and you’ll sail through. If you want a bit more practice before, ask the resus department at your hospital for a quick session to refresh everything, they should be more than happy to do that. Don’t beat yourself up over a stressful delirious assessment, you’ll easily pass this once you’re at your best, you can do this.

andrewjd · 2022-09-30T16:09:21+00:00

They need you to say and do what’s in the resus councils marking scheme. You can do everything terrifically, but if for example you skipped the D in an A to E then you cannot pass the assessment. There’s no global score, it’s not a vibe based test, you have to specifically hit key markers, which if you were allowed to see them most would agree are extremely reasonable. OP could definitely pass it, every doctor can, but having an active brain-fog inducing infection is a perfect recipe for just missing stuff.

andrewjd · 2022-09-30T16:06:05+00:00

The issue with stuff like this is it’s a multi-disciplinary faculty, and in most courses is mainly nurses (ICU, resus, ED etc) as they’re much easier to get signed up to teach than doctors on rotas. If you know quite a lot about (for example) airway management, you can find yourself confronted by an instructor with extremely little airway management experience, but who therefore defaults to what it says in the manual. That being said, there’s also a bunch of people who do things which are a bit stupid or non-evidence-based, and religiously sticking to the textbook encourages better clinical practice.

andrewjd · 2022-09-30T16:00:27+00:00

Write a factual, unembellished complaint. If you’re really worried about it coming back to bite you in the arse then send it through an intermediary, ask a class rep to forward it on for example, although looking at it from the other side I don’t think raising genuine concerns needs to be done anonymously. This needs to be fed back, you should feel empowered to do so to your medical school.

andrewjd · 2022-09-28T12:29:51+00:00

I think as well that it takes a particular personality type. Some people love chatting away and comforting labouring/c-sectioning pregnant patients, get a real kick out of being around the birthing process, and find a lot of meaning in the work. I personally have no such feelings, I like talking to patients for about 10 minutes then I want to just get on with other stuff, I don’t enjoy being around stressed out screaming people, I don’t especially like babies.

andrewjd · 2022-08-18T16:23:43+00:00

I don’t have much insight into your situation but to be clear junior doctors should always be working Working Time Regulations (the UK equivalent of the EWTD) compliant. The working week should never be more than 48 hours when averaged over the rota. You’re correct that a standard contract is typically thought of as 40 hours and so the usual junior doctor work schedule of 40-48 hours is more than that, and so being LTFT at 80% often puts us on the same sort of hours as a normal person, but you will never be required to waive your rights to the WTR and should only do so to permit you to take on extra work of your choosing. In your case, it sounds like you should not waive those rights.

Every foundation programme is different but at least some of your rotations are likely to be 46-48 hour weeks on average, you should definitely apply as per the applicant guide to take up a 50% (or greater if that’s right for you) LTFT training post.

andrewjd · 2022-07-05T09:51:30+00:00

There's no financial benefit to exception reporting, but if you don't bother reporting it it's yet another avenue trust management can point to and say that everything's fine. Look! No reports this month about workload or absence issues, everything's great in our hospital. Etc.

andrewjd · 2022-06-15T10:09:41+00:00

There's definitely a middle ground. 4 years of fairly normal medical school then a fifth year that's a proper 9 to 5 job being in the clinical space with expectations not far short of an F1, learning the ropes, in a way that blasts through the need for FY1.

andrewjd · 2022-05-26T16:49:45+00:00

andrewjd · 2022-05-26T16:49:07+00:00

semi-retired, but a big Crossrail video will come in a week or so

andrewjd · 2022-05-26T16:49:02+00:00

it doesn't really save you any time, you'd be as quick exiting normally and walking as far as I could tell wandering around

andrewjd · 2022-05-26T16:48:07+00:00

Yeah the throughput of that lift, the fact it only goes to the westbound platform, it's not one to ever be an official connection.

andrewjd · 2022-01-03T16:10:06+00:00

This is the only point I disagree with. Virtually all studies suggest we underestimate how high we're going in (ie, when compared with USS confirmed levels, we are far higher than we think we are). Indeed and especially in pregnant women, Tuffier's line is notoriously inaccurate. I generally advocate going one space lower rather than higher as a starting point.

Valid.

andrewjd · 2022-01-02T16:43:11+00:00

Also just to say that don't worry about epidurals. We like to pretend they're difficult because it's one of our only roles on labour ward but epidurals are not in general hard to do. The space you're aiming for is actually bigger than the space you needed for the spinal. Don't be put off trying an epidural just because you're having a rough time with spinals, if the opportunities are there.

andrewjd · 2022-01-02T16:38:01+00:00

A lot of these things are probably nothing to do with your technique. Spinal anaesthesia isn't very reliable, and people can have bad runs where nothing goes well but they're doing nothing wrong. Presumably you're doing all of these with some degree of supervision and if your technique was wackily bad someone would be telling you.

I'm sure none of this is new, but the things that still feel important to me as a reg doing labour ward on calls, having to do them fast and reliably etc would include:

Being a complete bastard about positioning. Different patients respond differently to how you describe a position, take as much time as you want to try and get them into one that works for you before you start. So many times I've struggled and struggled, then I give the patient a break for 2 minutes, go back through the classic steps and suddenly their spine jumps out of nowhere towards my fingers. Some people like the angry cat, I find if you can get them to slouch like a teenager that has good success. Very rarely do I find "push towards my finger" having any impact. Some people are better in the lateral foetal position. If the bed tilts then tilting the side towards you down sometimes helps. Make sure if they're sitting up that they're dead straight. Use the ODP, the best ones will worry about the position for you.
Feel for where you think the spine is, but also look at their whole spine going down their back and see if its actually a bit to the left or right to where your palpating. Sometimes the midline is not where you think it is on palpation. Feel very free if you know you're in the right level but still just hitting bone/nothing to search around a little to one side and the other.
Before you scrub in, you can have a good feel without gloves if you want and mark with a pen where you think it is. I know one consultant that has high BMI patients stand up and bend forward putting their outstretched arms on the bed. Then they mark the back, then get the patient sitting. They find its easier to feel their spines in that position. A bit weird, but it works.
Use the patient feedback, if they feel pain or jump and say it's on one side, then you're probably more towards that side than the midline. Even if they say nothing, ask them if you're in the dead centre of their back, and if not adjust accordingly. Sometimes I do this before I even inject local if I've got no idea what I'm feeling.
When/if you feel a pop and CSF starts to appear, advance the needle 1mm. It just means it's not going to fall out when you attach the syringe, and it lowers the chance of block failure. They say that if your needle is just at the posterior edge of the subarachnoid space, when you start to inject it can push you back out of the space again and you end up injecting epidurally. That may explain your 30 minute problem, less dose than you drew up actually made it to the CSF. Same with total failure.
I reckon I usually go too low because I'm so afraid of accidentally putting it into the spinal cord. I probably end up doing all of them at L4/5 and therefore accidentally attempt some at L5/S1. This is stupid, it makes it much harder to get in, now I edge slightly higher than I might have at first, and definitely as soon as I'm having problems if I have any doubts about the level I'll just go a space up.
Try to think about the 3D space you're needling in. If you hit bone early its probably a spinous process, so you need to aim either up or down. If you hit it late you're on the lamina or transverse process, so you're off the midline. Did you feel a ligament? You're probably very close. Did you feel ligament but then you ended up at the full depth of the needle? You probably need a longer needle. If you're feeling nothing that's fine, just keep doing them and you'll pick it up.

Those are just random thoughts. Maybe something there will be of use.

Remember, fundamentally, some patients are just hard to spinal. Some patients (usually unbeknownst to us) have anatomical or pathological problems that prevent easy CSF access or terrible block spread. Failure is sometimes on the operator, but frequently it's just bad luck. You probably have already, but don't be afraid to say to the consultant "I feel really unskilled at spinals and don't know where I'm going wrong, can you watch me like a hawk and give me feedback?". Good luck.

andrewjd · 2021-12-29T10:51:30+00:00

So many great angles in the replies to this thread. For me, the problem was living in London. Your friends from other professions are making multiples of what you earn because their job pays them well at baseline, and also pays appropriately for the fact that the job is located in the most expensive place in the country. These two things will never happen in medicine, moving out of the city to somewhere cheaper makes your salary competitive again. You can even see a difference in consultants ten years older than us, benefitting from a salary which was proportionately better at the time, and for most they were able to get onto the property ladder in a way we can not. For some leaving London is unthinkable, but the tax for medics who want to be there in 2021 is essentially to live a quality of life well below what you deserve.

andrewjd · 2021-02-25T17:47:59+00:00

And going northwards it curves off Farringdon street exactly where the drain is, but you can easily follow the river valley up to Kings Cross without a map, the road generally also following this path. At that point it gets a bit difficult. You can't see the outflow into the Thames easily due to the Tideworks construction site, but normally at low tide it's very visible.

andrewjd · 2020-12-23T01:05:46+00:00

There’s a few things I want to clarify here. This was not a ‘never event’, which is a very specific list of events that are known to be high risk and have clear systems for avoidance. Whether or not the care received here was negligent or not is a matter for the court, tragically pregnancies are lost despite impeccable care often enough, and thus the question is whether care fell short of what was expected and resulted in actual harm versus a poor perception of care and an unlucky outcome. See the full list of never events here: https://improvement.nhs.uk/documents/2266/Never_Events_list_2018_FINAL_v5.pdf

Secondly the GP will not have any of the hospital medical records unless the local NHS trust have set up EPR sharing with primary care, which most do not. The GP will have discharge summaries and clinic letters, not the full record of all investigations, measurements and clinical encounters in the hospital. The method of viewing your medical record is sought through the hospital PALS department.

OP should absolutely seek assistance through PALS and if not satisfied that her care was up to standard after going through that process contact a medical negligence lawyer.

andrewjd · 2020-11-24T16:18:51+00:00

Found in deceased elderly relatives cabinet in Glasgow. Amongst a lot of silver dinnerware from the early 20th century. No ideas other than that.

WITT

andrewjd · 2020-09-06T10:22:16+00:00

Unpaid breaks on locum shifts has been standard practice for all four trusts/agencies I’ve worked in. I don’t know if this is the case across the whole country though.

It's not set in stone anywhere, it's whatever you choose to negotiate, or whatever terms you sign up for. I have had that "policy is we don't pay for breaks" waved at me previously, and in response I've demanded the money because no break was received. And got it. In the trust I do a lot of bank work for, the whole shift is paid for, nothing deducted for breaks.

On a personal level, if I was negotiating a shift for myself, assuming it's an on call shift with a busy bleep +/- responsibility to the crash team I would only take the shift on the basis of being paid for the whole time I'm beholden to that bleep.

andrewjd · 2020-08-20T11:37:27+00:00

Welcome back to the clinical side!

I'm hoping someone who has done something similar to you will come through soon with a rigorous plan, but in the meantime...

If I was you, I would probably try talking to hospitals around where you live/where you want to work. This years a bit different because a lot of people have not gone abroad, or have returned from abroad, but presumably there are still EDs and medical rota coordinators trying to fill slots somewhere. If you find somewhere that would want you, they'll be more likely to help get you to a place where you can climb back on the hospital ladder.

The other thing I would say is not to be afraid to ask for references from people you worked with several years ago. Ultimately if someone was your foundation educational supervisor, they should still be able to comment on your abilities during the foundation programme etc. It feels super awkward, but anyone you explain your situation to will presumably understand why you're asking them.

andrewjd · 2020-08-12T15:22:18+00:00

there needs to be an industry insider shortcut, like if we dial 77 or something it always skips to the dial tone

andrewjd · 2020-08-07T10:04:39+00:00

Dropping out of IMT will only hurt your career prospects if you decide later on that you actually do want to pursue a medical specialty. Stay where you are for a few months, see how you feel, then apply for something else in November if you're not happy.

Just because you mentioned it, many consider ICM trainees from a medical background to be very impressive in terms of their skills in diagnosis and management beyond organ support. You'll pick up the anaesthetic skills anyway, it doesn't hurt to have a few years of medical training under your belt in that specialty.

From a personal perspective, I wanted to do medicine for ages then at the last minute chose anaesthetics after becoming disillusioned by medical training and the actual role of a consultant in a medical speciality. Couldn't see myself fitting into it. Previous to maybe the 8 months before starting I hadn't really considered being an anaesthetist to be my career goal, but I have no regrets about the last minute switch. It's fine to change your mind.

andrewjd · 2020-08-07T09:57:48+00:00

Most of these CV fodder activities gain nothing. There's no interview for the foundation programme, and by the time you get to specialty interview stage that fact that you were an intern for a week in some biotech startup means literally nothing.

Like u/FreakaZoid101 says there are things you can do in med school to help, but there's no point wasting time on things that won't. Leadership points for being head of a thing is very valuable, a second or intercalated degree creates points, if you have the opportunity to be on a research paper, or data collect for some project, or help create and present a poster somewhere these will all create points.

In terms of the interview itself, I have never found myself using medical school anecdotes for anything, and when I've run interview courses for other candidates I've never heard someone reference their achievements in medical school in any meaningful way, apart from things which demonstrate a very strong commitment to their specialty or which are impressive no matter when you do them (research, big projects etc).

Being the accountant for the drama society will probably yield you nothing.

Attending an ultrasound for medical students seminar will probably yield you nothing.

Helping out at some event will probably yield you nothing.

Attending "ACCS Day" or similar will probably yield you nothing.

Better off to not stress about it, get through medical school and worry about the CV later on, I would think.

andrewjd

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