Bursary Report by Daniel Desogus (Summer 2016)

Firstly, I would like to thank Dr Lewis and the trustees of the Kidderminster Medical Society for choosing me to receive the bursary. It has helped me immeasurably and I am so grateful for it. I started my first year at Warwick Medical School in September last year and I really can’t believe how quickly it has flown by.

It has not been an easy year. I have sadly lost several family members in the last year which added to an already difficult year. Along with the accelerated structure of a graduate entry medical course, it is the hardest I have ever had to work, but I have thoroughly enjoyed my first year at Warwick. I sometimes still cannot believe I am at medical school or that I have just finished my first year. Being a doctor has been something I have wanted for as long as I can remember and I finally feel like it is within reach.

Warwick only offers a graduate entry programme for medicine, so the intake for the course is larger than some other universities who only have a limited space on their graduate entry programme. A big advantage to this is the huge diversity in student backgrounds that there is there. Students were of all ages, with different levels of experience and previous degrees in a large variety of subjects. This meant that colleagues on the course all had their own unique perspectives and ways of thinking, which helped a great deal in the case based learning sessions.

The case based learning system at Warwick falls somewhere in between a traditional taught course, and a problem based learning course. The year is split into five subject area blocks which last five weeks each. Students are split into case groups at the start of the year comprising of eight or nine people and a member of academic staff who acts as facilitator. Each week a new case is given, with three group sessions for each case and new information released each session. Within the group we set our own learning objectives each session and split them between group members, who would then have to present their topic at the next session. These cases were supplemented by lectures which (usually) were related to the body system covered in the case.

At first I was sceptical over case based learning. Experiences with case studies in my previous degree hadn’t been overly successful. Although enjoyable, I found it difficult having to rely on other group members, who sometimes were unreliable or didn’t put the effort in. However, this year my opinion has been completely changed. I thoroughly enjoyed group sessions and as a group we grew, improved and bonded. Everybody was reliable and put the effort in, which resulted in me learning a great deal from these sessions. Everybody also had something to bring to the sessions, with different backgrounds and areas of expertise, meaning we all managed to benefit from working together.

Learning was split into five blocks. Block one covered homeostasis and metabolism. Block two was blood, lungs and heart. Block three was brain and behaviour. Block four was locomotion, muscles, bones and skin. Block five was reproduction and child health. Throughout these blocks core themes were taught covering anatomy and imaging, physiology, pharmacology and cell and tissue biomedicine, as well as values, law, ethics and social and population medicine. Along with this we spent Friday’s at University Hospital Coventry & Warwickshire where we had anatomy, radiology and clinical skills teaching.

The anatomy at the hospital was based in the surgical training centre where we mostly used plastinated specimens that related to the body system we were currently studied. Although the plastinates were excellent for pointing out structures, they didn’t compare to the occasions when we had real tissue to study, which were always fascinating and one of my favourite things to study.

Clinical skills training was taught in small groups and involved discussion and teaching of an examination or skill, followed by practice within the group. We covered many skills, learning at least one new one each week. Clinical skills covered included less invasive examinations such as systems exams and blood pressure, as well as history taking both within the group and with simulated patients. We covered many skills throughout the year, however it didn’t really sink in just how many we had learned until it came to revising for OSCE’s and realising just how many things there were to cover.

Clinical experience with patients initially started within the first few weeks when our case groups each got assigned to a community placement. Our group was based in Atherstone, a very small town in north Warwickshire. Our tutors there were two excellent district nurses who both lived locally and knew the area and patients well. We had several days based there, where we initially started by learning the area and researching the town and population, before moving on to seeing patients. We saw three patients there, with each half of the group seeing a different patient. Patients were chosen so that we each saw an infant, an adult and an elderly patient, each with a chronic illness. We had time speaking to patients in their own home and also spoke to family members and staff from various agencies responsible for their care, including district nurses, GP’s and carers. The emphasis was not on the patient’s symptoms or treatments, but on how the illness affected the patient’s lives. We then had to prepare a presentation for the other half of the group explaining what we had learnt from each experience, how the patient’s life had been affected and other possible agencies that we think could benefit them. Each patient we saw was an eye opening experience and I found the days to be enjoyable and hugely beneficial. It added a personal perspective that can often be lost in a clinical setting or in lectures and emphasised how an illness can affect somebody’s life, as well as the lives of their family.

After Christmas we had clinical placements for half a day each week at one of the local hospitals. I was based at George Eliot hospital. It is a smaller hospital than UHCW, however groups were smaller meaning everybody got to do more and spent more time with supervising doctors. Groups were taken around the hospital by a supervising clinician, where we were taken to patients and had the chance to take histories and practice clinical skills. Clinicians would also teach us better techniques or ask questions, as well as helping to link knowledge from lectures to the clinical settings. Each week I saw a different clinician with a different specialty, meaning I got to experience different areas of medicine, practice different skills and learn about different systems. Some of the clinicians had also prepared presentations or learning materials as well which were always informative and helpful. Whilst on clinical days, we had to prepare two written presentations which covered diagnosis, treatment and a short essay that involved research into evidence based medicine. I really enjoyed the clinical days at the hospital. It gave a true taste of what it is like to work in a clinical setting and helped develop skills further, as well as helping me to tie skills from different areas of learning together.

Revising for exams was difficult. We had formative exams at the end of each block, but these didn’t count for anything and were just so we could judge how we were progressing. There were no Christmas exams, so the whole year came down to a two-week period in the summer. There was such a large volume to get through and it felt like I could never learn it all. The exams themselves were long and covered such a wide area and even after written exams were finished I couldn’t relax because OSCE’s were the following week. However, I found OSCE’s less stressful as we had so many opportunities to practice them. Even though I walked out of exams feeling like I hadn’t done badly, I still didn’t really believe I had passed until results day. When results came out I was thrilled to have not only passed, but to have passed well.

I finished the year by going on holiday with my girlfriend. She has just finished her final year at Hope University in Liverpool, so we have both had challenging years. We enjoyed the chance to relax and spend time together, as we hadn’t seen each other as much this year due to the distance and workload.

The last year has only strengthened my desire to become a doctor and I am now due to start second year in September. Second year should have even more time in a clinical setting, as well as learning more procedures and more complicated cases. My girlfriend is moving down to Coventry to get a job and to live with me and we are getting a house together and I am really looking forward to the year ahead.

Finally, I would like to thank you all again. I do not think I could have found the money required to pay my course fees in time if it had not been for your generosity. It has helped me pursue the only career I have ever wanted and I will always be thankful for that,

Daniel Desogus