University of Bristol at Gloucestershire Academy
Number 120
Monthly News
1st November 2013
Busman’s Holiday
Dr Philip Davies, Deputy Dean, Gloucestershire Academy
There is never a good moment to receive bad news, but being told
that your mother in law has been admitted to hospital as an
emergency on the eve of your holiday was certainly ill timed for all
parties involved. So it was this summer that I found myself
spending a week in an unfamiliar hospital supporting my wife and
her mother, rather that relaxing on a beach in West Wales.
Working in a hospital may feel busy when you are part of a team
struggling to complete all your tasks, but time passes much more
slowly when you are a visitor rather that an employee. It can often
be quite boring or frustrating. Having all this spare time and being
‘undercover’ does however give you a chance to observe hospital
working patterns from a different perspective and to realise that
there are so many different learning opportunities that occur all the
time on the wards; opportunities that are frequently underused or
completely missed. Having observed at first hand many of the
personal interactions that happen during a hospital stay between
staff, patients and relatives and in an effort to keep myself amused
during my ‘busman’s holiday’, I thought up a number of ‘games’
that could be used to help students (and staff) with their education.
I hope you enjoy playing them and perhaps thinking up some of
your own.
Happy families
Based on the children’s card game this is probably more difficult to
play now than ten years ago, due to the fragmentation of the firm
structure. The object is to collect a full set of members of a
medical team, ranging from the specialty consultant down to the
foundation doctor. Assigning stereotypical names to each set will
make this more interesting (for instance, Mr. Puff the respiratory
consultant and Miss Butcher the surgeon). Extra points can be
gained for spotting more senior members of the team at weekends
or out of hours. In the spirit of multiprofessional working all sets
have to include a pharmacist, physiotherapist, occupational
therapist or profession allied to medicine. Members can only be
counted if they are wearing a name badge or correct identification.
(we are going on a) Bare hunt
Record how many of the staff are adhering to the ‘Bare below the
elbow’ policy. You can also monitor how many times they clean
their hands as they walk around the ward. Mentally you can award
yellow or red card to members of staff who persistently digress
from the Trust infection control policy. You are allowed to double
your points if you feedback your audit results to a senior member
of staff!
DATES FOR YOUR
DIARY:EXAMINERS
REQUIRED: Year 5 OSCE’s
13th December 2013 @
BRI and Southmead
2nd Objective Long Case
Exams for Year 5;
20th January - 1st February
2014 @ CGH & GRH
Year 3 OSLERs ;
6th – 14th May 2014 @
CGH & GRH
Year 5 Final Long Case
Exams
26th February 2014 @
Redwood Education
Centre, GRH
If you are interested in examining
for any of the above dates please
email
[email protected]
USEFUL LINKS:Gloucestershire Academy
Website – Click Here
Gloucestershire Academy
Contacts – Click Here
Standing in a cubicle in the Emergency
Department or sitting by a bedside allows you to
‘overhear’ many conversations. Observation in
these settings is a useful reminder that curtains
so not provide adequate privacy when talking to
patients or relatives. Professionally you can
remind yourself that you should not listen in on
other conservations but if you gain consent the
following games are interesting.
Open or closed
Listen to someone taking a history and time how
long it is before they ask a closed question.
Research shows that most doctors do this within
40 seconds of starting to take a history so award
yourself extra points for every minute that passes
without closure. Note any good techniques to
keep questioning open or work out how you
would keep the conversation open if you are not
observing good interviewing techniques.
Spot diagnosis
If you are in a position to observe patients as
they arrive into the Emergency Department try to
make a spot diagnosis as they are transferred
onto a stretcher. Some diagnoses will score
more highly that others – hip pain and an
externally rotated leg would only score basic
points. If there are no obvious visual clues then
listen to the handover from the paramedic and
see if you can use the information they have
gathered during the patient’s transfer to make a
diagnosis.
Once you have made a diagnosis decide on the
first treatment that you would initiate and see if it
matches the one given by the staff.
Senior moments
Once you have observed a history being taken,
organise the facts into a summary to be
presented to a more senior doctor. Make a list of
any information that you think is needed that has
been missed out during the history taking
process. If you are lucky you may also observe
the senior review when you can compare the
questions asked by the senior doctor as they
appraise the history. Award yourself extra points
if you have thought of the ‘killer’ question that
they ask to make the diagnosis, which the rest of
the team have omitted.
Do you speak medicalese?
‘Your aunt had a STEMI on the ECG so we
cathed her and popped in a stent. She went into
VT but was shocked and is now on CCU after
being aced and blocked. Any questions?’
Perhaps an extreme example but it is interesting
to note how often staff will lapse into
‘professional’ language or throw in the odd
medical term to confuse patients or relatives.
Award points for every transgression into medical
jargon and mentally note how you would explain
this term in plain English.
Empathy
An easy game to play by simply counting each
time a member of staff smiles at you. Bonus
points are awarded for other simple acts of
kindness such as fetching you a chair to sit on or
rearranging the pillows after examining a patient.
Decide on which member of staff you are going
to award a star prize to. During my visit my prize
went to the cardiology registrar who made me a
cup of tea at 3 o’clock in the morning, despite the
number of bleeps they received indicating that
they had many more important things to do.
There are many more ‘games’ or ways of
learning on the wards that are not what we would
traditionally view as teaching, but provide
excellent and often low cost education. Many of
these have been drawn together in the excellent
book “101 things to do with spare moments on
the ward” by Dason Evans and Nikul Patel,
aimed I may add firmly at medical students rather
than nosy or irritating relatives.
My last game is based on self observation. Count
how many times that you say thank you to any
member of staff that is involved in looking after
you or your relative. You can never score enough
points to win this game, but thank you once
again to all the staff who looked after my mother
in law so well.