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Still spinning on my side. Oh, ok. Hello. Hello, everyone. We are live. Welcome to the last evening of insight. I can't believe it's gone so quickly. Uh But thank you so much for giving up your uh Friday evening to be here with us today. Um Hopefully we've got a really nice session, uh lined up, you'll find this useful and it'll be a nice end to your week. Um uh For those of you who don't know me, I was here on the Monday, then I got ill and unfortunately, I wasn't able to attend the rest of the sessions. Um But my name is Hema. I'm the lead for S et In Sync and along with my committee here, Alana Most and the founder of in Sync Kirsty, who's now in Fy Two, we have all um you know, put together insight for you guys and been running the sessions week. So, uh again, uh it's really nice to have you here today. We have got a special session planned where we'll be answering your questions, we'll be going through uh what it's really like being at medical school and beyond and giving our top tips and advice on how you can get into medical school because we also understand how stressful that admissions process can be. So, um, as always, please put lots of questions into the chat and we'll be happy to answer where we can. Uh Kirstie, I don't know if you want to say a few words before we begin. Um I guess there's just a few admin bits that I probably said every day, but just to reiterate. So most of the sessions this week have been recorded. Um There's a couple that we haven't been able to record. So Wednesday night because there was a few kind of sensitive um bits of information and pictures of patients and that kind of thing. Although, although they were anonymized, we aren't able to share Wednesday night's video. Um Similarly, the the transplant lecture from Tuesday night, um we aren't going to be sharing the, the part of the lecture with the stories from the two transplant patients just because that's quite personal information. And I think that, you know, hopefully the people that were there on Tuesday Night found that really helpful. But hopefully you can also understand that why they don't want that on the platform permanently. But we will be able to share the, the part of the talk um at the beginning um Talking about cardiovascular disease and reasons behind needing a transplant and all of those things. There's also um also on our in sync med all account there is the five lectures from this series last year. Some of them are fairly similar. So you might find that there's a bit of overlap, but actually a lot of the content this year has been different. So if you've really enjoyed this week and you wanted to listen to a few more lectures, there are five other lectures on our in sync page. The other thing is um at the end of each lecture, you should get sent a feedback form automatically from med all. Sometimes it's going to people's junk mail. And also I think a few people have had issues with kind of typos in their email address and they haven't received that. So please just check your junk mail first. And then also if you, if you still haven't received it, please feel free to send us an email. I'll pop that in the chat and you can just get in touch with us and I can see if I can get a certificate certificate sent to you. The feedback is really, really important. The series has changed quite a lot since last year based on the feedback you gave us and we're trying to make it as helpful as possible. So please just take a couple of minutes to fill out if you can and then in return you'll get a certificate of attendance for the evening. Um I think that's everything. So I guess without further ado I'll, I'll hand it over to you here. Brilliant. Uh So how many have you got joined? Uh, so far? So we've got 44. We'll see if other people join us. Um But we'll get started, so I'll just share my screen. Um, ok. All right. So hopefully you guys can all see that. All right. Um So, uh, as I said, uh my name is he, I am 1/4 year medical student at University of Edinburgh and I guess it would be quite nice if uh most you want to introduce yourself next? Um Sure. Hi guys. My name is I'm one of the um members on the In Sync Committee. Um I'm one of the mentorship leads. I'm a final year medical student um at the University of Cambridge. And I, strangely enough, did my preclinical years at um Saint Andrews. So happy to answer questions about both courses. Um And I'll hand it over to Lana. Perfect. Thank you, Martin. Uh Yes, my name is Alana. I am also a final year medical student. Um and I go to Queens University in Belfast um recently sat my finals, so awaiting those results. Um So it is quite scary and honestly, the five years have flown by um I am the participation lead um on the In Sync Committee uh alongside he and Ausin. And yeah, looking forward to sharing some top tips with you guys this evening. Yeah, we've got some uh really good insight with us today guys. So you're in for a treat. Um OK, so let's uh just um get into this then. So as I said, please ask lots of questions. This is supposed to be useful for you. So the more you interact, the better this is gonna be uh for you. Um OK, so some of you who were here on the Monday might feel that this is a slight repeat on things, but we did have some issues with people joining. So that's why we decided to sort of go over it a little bit again. Um But as I said, you're welcome to ask questions. Um just to make this a bit more personalized for yourself. So what I, what I I'm gonna do is just talk a little bit through the preclinical side of medical school. So we should say that every university does structure their medicine course slightly differently. Some medical schools will have placements right from year one, other medical schools such as Edinburgh will have a very preclinical clinical approach to things where there's not a lot of patient contact in year one to year three. We also have the intercalation year as well offered at some universities which I'll come on to speak about in a second. So at Edinburgh, it's quite lecture based, we do have something called problem based learning. It's called PBL. You'll, you'll hear of it at quite a lot of universities when you're hopefully researching things. Um And PBL is really all about um you are given a, a case or something to discuss at the beginning of the week uh with a group of 8 to 10 other students in your year. And then uh uh the way we do it is we come up with questions that we want to find out about related to that case. And then uh we research it for the second session of the week later on where we come back and discuss. So there's a mixture of that as well as your usual lecture based learning, which is in a lecture theater for me. I started in 2020. So from that was uh a lot of it was in my bedroom. Uh and it was all online. However, hopefully for you guys that uh experience will be a, a little bit better and you'll actually get to know people in your year group and uh form better relationships with your professors as well. Um We go through basic physiology and that's covering all the different systems of the body learning your basic biology, cellular biology as well. Um So I think with most universities, they realize that lots of people come from different backgrounds and different schools and some of you might have been on gap here, others coming straight from school. Uh some people coming in from doing degrees already. So they tried to catch you up to a level where everybody is, uh you know, on, on the same lines and, and then you go from there. So you're not really going to be assessed on anything that you've not been taught, which is a really nice thing. The other really important thing that happens in your preclinical years is anatomy teaching. So anatomy again is taught in different ways. You can be taught through prosection or dissection. So, prosection is where the specimens from cadavers have already been dissected. Um And that's how it's taught at Edinburgh. So we have stations that we go around and we complete worksheets and uh we are allowed to handle the specimens, but there's no physical us dissecting them at all. Other universities will have a dissection based approach where you uh do have the opportunity to use tools and you're a bit more hands on with things. So that's anatomy and then you have um something called research and evidence based medicine. Now, this is becoming very relevant nowadays to modern day practice. Research is a big part of medicine. It's something that I didn't know a lot about when I was applying to medicine. Uh But it is a really vast career and there's lots of opportunities to get involved if that's something you're interested in. Um So, yeah, uh Edinburgh is just a module called RE BM Research and Evidence based medicine. Um And we learn about different research techniques and uh how to critically appraise research papers and make sure that the information we use in our day to day practice is reliable and it's coming from good sources. Um The other thing that's covered in preclinical is the social and ethical aspect. I think it's really important to understand that medicine is not just what you read about in the textbook, but actually there are many other factors which affect uh somebody's health. And especially nowadays, we have to consider the socioeconomic impact of the cost of living. We're coming out of COVID. Uh people might be working multiple jobs and under high stress environment. So all of that is going to have an impact on people's health. And as doctors and future clinicians, we need to be aware of that. So they try to ingrain that into you right from um first year, so that uh you go in with that positive mindset. Now, as I said, II was gonna touch a little bit on the intercalation. So again, uh different unis will have different ways they do this at Edinburgh. It's a B ed I honors so Bachelor in Medical Sciences honors degree that you do in your third year. It is compulsory at Edinburgh. Other universities might even offer a master's uh or they might offer you to intercalate after your fourth year or, you know, there's different structures, varying things. Um but I intercalated in surgical sciences, which is actually quite related to medicine, I guess. But there are many other degrees that you can do um such as like Zoology, sociology, uh maybe even the option to integrate externally at a different university as well. But essentially you are going away outside of medicine for a year. And uh after that year, uh you've hopefully got a bit more research experience and a bit more insight to a different area that you were interested in. So at the end of my six years, I will hopefully come out with my M BC HB and my B med side. So um that's that now, the clinical side, I'm gonna hand over to Alana to speak a bit about perfect. Thank you. Hi. Um So yes. Uh So this is basically the clinical years um specifically within Queens University. They happen um from third year onwards. So I had years one and two which were very um uh lecture based um at Queens, we actually had uh ca cadaveric dissection and we're gonna, I struggle with that word. Um And so we, we did the dissection ourselves, which is really interesting. Um And I'm not too sure how many universities still use that style. Um So it was very, very interesting. Um And so I suppose that would be um one of the, the highlights of my undergraduate degree. Um And so I kind of just wanted to give you guys an idea of um what a typical day would look like. Um So you're kind of going from very lecture b being in university every day to being in hospital. Um And you're split up uh throughout the country depending on where you're based. Um The hospital could range from anywhere in maybe even further away from your house. Um And so for me, it was about 30 minutes away, so a typical day. Um and I do think I based this off my obs and Gyne rotation because I feel like it had the most structure to. Um so seven AMI would uh aim to be up um having some breakfast. Um definitely would recommend eating breakfast before going to placement. Um The, you, you definitely need something in your stomach. Um If you're going to be in watching C sections, um any, any form of surgery essentially. So definitely my top tip would be do not skip breakfast um when you're on your placement years. Um So then EMT be getting into placement then for about 830 this would start ward round. Um again, depending on which rotation that you're on ward round can last anywhere between 30 minutes to many, many hours. Um And it really depends what specialty you're based on within that uh award setting. So with this, then you are going around with the doctors. Um and they may ask you questions. Um And so you have to be listening. Um And so it's, it's best to obviously know a bit around the subject, know a bit about the patients on the ward um and be able to ask questions as well if the opportunity arises. Um So then 11, I aim to have some coffee. Um, hospital coffee is not the greatest, but it does tend to be quite cheap. So we do, we really appreciate that. Um And then I would aim to be going back to the ward. Um And at this point, then I would be trying to um uh finish some of my logbooks. So how they keep track of you in your clinical years is they give you a logbook at Queens. And so this would have a varying amount of tasks on it. So whether this be that you need to, you know, take six bloods during that rotation or put in a cannula or um you know, see ac section or uh be shadowing certain doctors. Um And so this would be my time to get some of my log book done. Um And that's what I would really be aiming to do before lunch time. And then specifically, um after lunch, I tended to find there was quite a lot of teaching that was supplied um within the medical education center at the hospital. Um And again, this is something I didn't realize um was such a big thing within hospitals and that they do have a dedicated building or most hospitals tend to um to allow you to go um and use that environment to study, but also they have a number of teaching rooms um that the doctors will come to and they will dedicate time out of their day to teach you on a specific topic. Um, and so this is really brilliant, um, as it gives you time to apply what you've actually been learning on the ward. Um, and also then to ask some questions that you didn't feel as confident to ask during ward round. Um, in the evenings, then, um, you would be catching up, um, and studying on lectures that they have aligned for you. So, um, your time is a bit more flexible when you go on to your clinical years. Um, sometimes there will be a set structure and you'll have lectures, um, certain evenings in a week. Um, but what I find, especially as I get into final year is that there, there isn't really, um, so much of a structure. It's more, um, uh, yourself who are dedicating time to lectures and to, uh, revising question banks. Um, and so it does become more flexible. Um, but you do need to take more care over what you're doing and how you're spending your time. So there is different rotations. Um, for me, the, uh, third year would have been more general medicine, general surgery. So it kind of just learns the basics of what a ward environment is like and how, uh, you would learn going forward in fourth year. Then I had more of my, um, special specialities. So we had pediatrics, Singye Psychiatry, um, emergency medicine, um, and things like that. So, it, it really does depend again what university that you do decide upon. Um But that was my experience and then final year was very much so a recap of the previous two years and kind of build up your skills again for finals. Um So for finals, you would have both written exams and clinicals. Um I've kind of addressed most of those points. Um I just wrote myself a couple of notes. I wanted to kind of give you from what my experience was. Um I did find it daunting. I went from school straight into medicine and that was a daunting experience because there's a lot of postgraduates like he had said that have done a degree before and you do feel that um they know so much more than I do. But um my, my advice would be, don't be scared of this. Um The you eventually do um become that equal playing field again that he was talking about. And at that which point, um it's uh it will be um many years down the line and you'll have completely forgotten about what you were worried about. So, don't be worried if that is something that you're thinking, um you have a brilliant experience no matter how you get into medicine. Um Another part that I kind of wanted to mention briefly is that with Queens, you do have some early clinical attachment. So uh I had something called family attachment where I uh was attached to a GP practice and they um allowed you to go in pairs to um visit a patient who had a chronic illness. So, the patient that I uh went to visit um and took a history from and had built up that kind of connection with um with someone with chronic asthma. Um And so this is um very obviously, very um interesting um in my first year and really allowed me to apply what I've been learning in lectures. Um So having that little bit of clinical time, I think, really did um encourage me to uh to kind of get through those first few years that are very much so looking at a camera screen, um specifically when a lot of lectures were put on zoom because of COVID. Um And yeah, I think that is uh most of my advice. Um any questions about Queens or anything else in general about medicine, ask away, but I think I'm passing over to most or maybe I'm back to ha sorry. He, what's the order? Yeah. Yeah, no worries. Um I, I'll just um take it from here. We actually do have a question in the chart by Josie saying, can you explain what the exams are like at the end and throughout? So, uh I think, II think it varies again, like unit to unit. Um I think uh Alana and most can definitely talk about the end because uh I'm not there yet. Uh I'll, I'll say a little bit about what has they are. Uh for me so far, I mean, uh most of the exams are MCQ based. So multiple choice questions um with a few questions where you have to type in a, a short answer. Um with anatomy, you can get like spot exams. So for us, we had to go around stations with an ipad and just, uh you know, label uh the different specimens, um, other exams I remember in year one and two, you could be asked to do some essays, especially around ethics. So that could form part of your final grade as well for those years. Um But overall it is just uh knowledge exams and uh anatomy things, other things to be aware of as well. Um Something which Elana did touch on is the logbook or this portfolio of things that you have to complete as well. So, although it's not like a strict exam, um we do have to write like case based discussions and we have to take off certain procedures that we've observed or actually performed ourselves, which can form part of your final grade as well. Um But yeah, Alana and most, you know, I'll pass over to you for the final exams. Yes. Um So the structure of Queens has actually changed in the year below me, but I'll kind of briefly mention kind of what I experienced. Um So you are studying M CQ papers, like he said, every year and then you also have um ay examinations. So, um, for my finals, I did two M CQ papers and then did three days of a are a little bit like, um, entrance exams to or sorry, entrance interviews to your medicine. So you kind of go around little stations, you'll get to read, um, what the station is outside the door and then you go inside and you have anything between 8 to 10 sort of minutes, um, to complete that station. Um, and then the examiner will be marking you as you go along and also, um, you'll have a patient, um, or aim patient within there as well and they'll be giving you a global score as well. Um And so that is kind of the more clinical sides of things. And at that point, you could be literally examined on anything. So you really are covering all bases. Um, and then, uh, as well myself and most, and K as well will have done. This is a prescribing exam. So you're assessed on how, um, you can prescribe certain medications, very time pressured. Um, but the exam is sat throughout all UK medical graduates. Um, and, yeah, I suppose that's kind of what my experience was, but maybe year most you want to share yours as well. Um, sorry, I'm just typing away on the chat as well. You're talking about exams, aren't you? Yes. Kind of just like what your finals were like or what you experience, perhaps most, you could target the que the next question on uh studying medicine at Cambridge. Sure. Yeah, that's fine. Um The question is how is it like studying medicine at Cambridge? And how is it different from other universities? Um So as I said before, I did my preclinical years. So my first three years I completed um at Saint Andrews and then I transferred down so I can give a little bit of insight on both um in terms of Saint Andrews. Um It's, I think very much similar to the Edinburgh style where um we had um all the lectures that um he has talked about and we had so a little bit of uh patient contact early on. Um but that was just once every two weeks um with Cambridge Preclinical medicine, it's very science based and you're learning uh um alongside the natural sciences and the vet TMD cohort. Um So you cover things that are not just related to human biology and physiology, but also um to sort of animal physiology as well. In general. There is much more of a science focus for the preclinical years in Cambridge and they, they have no um patient contact at all in their first three years. Um When it comes to clinical years, I think it, once you enter clinical medicine, it's broadly similar, I would say um and very similar to what Elana has um described. So going on on various different placements into specialties. The, um, day to day schedule looks different depending on what specialty you're on. Um, but I think the main difference you'll see for most courses, at least the, the, the ones that I'm aware of will be, um, seen in the preclinical years of how those initial lectures are taught and how much patient contact you might have in the initial period. Ok. Um, the next question, I think it's sort of been answered quite nicely there by Christy about uh ever having to do night shifts as part of replacement. Is it required? I not really, I've not been scheduled for any. So at the moment anyway, uh ok. So uh Sofia has asked, would you recommend staying at home for uni or living on campus? Um Yeah, that's a really interesting question and I think uh it is a lot of about preference and different people will be different about this. I mean, for me, I am staying at home. Uh I grew up in Edinburgh. I went to school here. So, uh for me, I did want to stay at home. I get along really nicely with my family. And uh you know, it was one of the big factors to consider when I uh chose Edinburgh as my first choice. So I think it definitely has a lot of pros. Um There can be some cons as well for sure. Um Talking about the pros first. Uh obviously, it's lovely to have support, uh, all the time. Um, you never feel isolated. Um, there's lots going on and, uh, financially I think it's obviously got its perks and, uh, my parents, they take care of me. So I get food and, um, you know, all that stuff that comes with staying at home, um, in the cons, I think certainly sometimes it can be difficult to concentrate when there's stuff going on at home. Um, just cause like, I've got two younger siblings and although they're not a lot younger, um it can sometimes be disruptive. Um but I think overall like, II personally believe it's more of a hassle to move out and having to navigate like a new city and find accommodation and all that. I think like for me that that's a bigger hassle than staying at home. So I would be on the home side but Alana and mustine, I'm not sure. Um Yeah, so I did, I stayed in northern Ireland for Uni but I did move um to Belfast. So the the city. Um I sorry that is my family leaving the house. Um I am at home this year. So um yes, I would really recommend um kind of doing what suits you. But um I really enjoyed living out. Um I lived out from first to fourth year um and then moved home for this year because it is kind of like half a year. Um or that's what I'm telling myself anyways. Um so essentially I would say do what suits you if you are moving away for UNI it's definitely not a bad thing. Um I think that you can really enjoy a new city um and really get um to a new culture and kind of explore um different parts of the UK or Ireland. Um And so, yeah, it's, it's really personal preference and I think that I, like I said, there is positives and negatives and um financially that can always be something that um has a sway. So yeah, I think my advice would be just do what suits you and if you are moving away, um really do take that as something positive because you will um you'll make friends, you'll meet new people and um you might have it. So yeah, I moved six hours away from home to go to UNI um which initially wasn't my, my preference. I am from Durham in the northeast and I applied to Newcastle and I didn't get an interview. Um, but then I got an offer at Bristol after I had an interview down there, which was really daunting for me because I didn't know anyone in Bristol. I didn't even know anyone at my school that was studying medicine. I was the only one that had got a place. So moving six hours away and not having any family to talk to about kind of the application process and what it was going to be like when I started, no one else had experienced that was really daunting. But actually I now work in Bristol and I've lived in Bristol for eight years. So my family is still miles away and, and II really miss them a lot of the time. But actually, yes, I won't lie and say it was a little bit scary when I moved at first, but so many people are in the same boat. And so I think if that's, that's you and you're in that position and you're a little bit daunted about, you know, perhaps there isn't a university close to you at home that does medicine or anything like that. I wouldn't worry about moving away from home. There's lots of positives to it. It's a completely new experience. Yes. Ok. You are a little bit thrown in at the deep end initially. But, you know, you learn other skills like cooking for yourself, doing your own washing all of those things that, um, that I actually found really helpful and you will meet other friends that are in exactly the same position. You might feel a little bit homesick, but worst case scenario, you have to go home for the weekend and that's fine. And so I think if anyone's feeling a little bit daunted by that, everyone will be in the same boat. And so don't, don't be put off, um, halls, most people will live in halls when they first moved to UNI and so that's all other first year students that have probably also moved away from home. So it's a really sociable thing to do. Everyone's in the same boat and, and I think it is a really good experience. Um, but like the other two are saying it obviously, you know, does cost quite a lot of money. And so I think if you have the option to stay at home, even for a couple of years, then, then that's great. And it also might mean that you, you settle in a little bit, a little bit easier at first. Um But certainly don't be, don't be put off the idea of moving miles away because sometimes you might just end up loving it. Yeah. It, I think it's also important to say that actually most people do move out. So you will find a lot of people uh like, like that if you have to as well. So it's something that you can support each other in. Um OK, the next question to answer just before we move on, I think to the next slide, we'll come back to all the questions, don't worry. Um Is uh one by Amina who says, how do you balance studying and free time? So, um yeah, most I'm gonna hand this to you. All right. Um Balancing your personal life with medicine is absolutely possible. I think sometimes you get the feeling that medics are always studying and while there are days and weeks leading up to exams and in heavier lecture weeks, certainly where it does feel that way and it can easily become that way as well. Um It's certainly possible to balance things. So, um, during my preclinical years, I um I danced II do ballet and I taught ballet in my 2nd and 3rd years and that was a lot of fun. Um, and it, it provided a lot of structure and something additional outside of medicine for me. Um and starting clinical years, um my schedule is a little bit more um unpredictable now because of different placements and various commitments. But um I do things like this um committee position which I've been having a lot of fun with. Um I, um I'm part of my uni surgical Society as well. And so we do events for people within medicine, but also, you know, like to um I like to bake and I like knitting as well. Um And so those are things that I do to get my head out of medicine and to focus on other things so certainly possible to balance your time. Yeah. Um ii totally agree with um everything that you said mustine. And uh you know, I actually went to a talk recently and um this like it was a cardiothoracic surgeon from America and he got asked the same question about uh you know, work life balance. And I quite liked his answer. So I'm gonna steal his answer a little bit but he said that, uh there's no such thing as work life. It's just life. Ok. And you just have to prioritize and you just have to organize and know what you're doing when and when you're making study schedules, you wanna make them flexible and sustainable. So that when things happen, you know, when life happens, uh you're able to take that on. So there's absolutely room to do societies just like we're doing. Um, I have a youtube channel as well that I run, I post every single week. So I'm able to do that. I have plenty of time for my family as well and friends and sports. So it's absolutely doable, but it's all about how you organize and prioritize your responsibilities. Um, ok, so I think we're gonna move on with the slide show. Uh But we will come back to answering your questions as well. So if you like the sound of medical school and uh you like what we just said then, uh this is uh really important then, right? How do you get here? And I think you guys will be aware of this but um there's a certain amount of uh stress, blood, sweat and tears that you have to put in. Um, and the first part of that is your grades and your academic requirements. Now, I think that when I was in high school, I used to think, you know, uh so I'm from the Scottish system, so I did highers. And, um, I used to think what is higher maths gonna do for me or how is higher maths gonna make me a good doctor? Right. Unfortunately, that's just the way the system is. Ok. And you have to look up entry requirements, uh, for, uh, the different universities that you want to apply to and make sure that, you know what is required. And remember that universities, they are not necessarily trying to see how good your higher maths is. They want to see if you are academically capable of studying a difficult or challenging course because medicine is challenging. And so I want you to have that sort of mindset when it comes to studying for exams rather than what is the point of this because it can be difficult to stay motivated that way. Um My real advice here would just be to work hard. Now, I remember that there was certain people at my school who would go over and beyond, they would do more subjects than necessary and they would, you know, be trying to get uh talk with the uh you know, class I in, in exams and things and honestly, um some universities, they don't require you to have five. So just, you know, stick to what is required and uh just try your best. That would be my advice for grades. Now U A is going to be the next step uh that you need to tackle and normally people sit the U cat in the summer holidays before applying. So, you know, if you're applying in October, you want to get the U A out of the way, uh, in, in, in the summer or at September, uh, time sort of. And the, and the main advice here would be to just practice, practice, practice, use an online question bank. So you're doing it under time pressure, under those time conditions. U cat is not difficult. OK. A layman can do U cat questions. The reason it's hard and it's challenging is because of the time. OK? And time uh and the way you're gonna get fast at this is just by doing lots and lots of practice. Now, I did buy the books for it, but I'll be honest, I don't think the books are that useful. II just used the books very initially to familiarize myself with the questions after that. It's all about banging out that question bank. OK? I'm sure there's more to recommend there. Uh But med is the one that I used. OK? Just quickly moving on to work experience and volunteering. Now, this is really, really crucial. OK? This is something that uh II understand that personal statements are changing now. So this is why I didn't put it on here as well. But previously in personal statements, it was something that you could reflect on. Um also a at the interview stage, work experience and volunteering experiences are really good to reflect on, uh apart from, you know, being crucial to the application process, they do give you a lot of different insight to medicine, right? This is a career, ok. This isn't something that you're gonna do for the next 23 years. Now, this is something that you're committing yourself to for a long amount of time and you wanna make sure it's for you. So hospital based work experience is really good. But actually if you can get work experience in pharmacies, if you can get experience in care homes or charity shops or anywhere where you're working with lots of different types of people from different backgrounds. That is what's going to develop those communication skills, those empathy skills and give you things to reflect on in your interview. OK. So the last part is the interviews. Now, the interviews, they are a challenging part of the application process. They do cause a lot of stress. So I want you to remember that reflection is key. It doesn't matter what you've done as long as you can reflect on it. OK. Uh You can reflect on playing chess, you can reflect on uh working in a care home. You can reflect on uh teaching badminton to Children. Like all these experiences that you've been a part of these past few years you can speak about in your interviews. The other important thing to know is to read up about current issues in the field, to know about ethical dilemmas in the field. Nowadays, you know, with the junior doctors strikes, that's something to keep up with. Uh with uh COVID-19, there's been a big backlog. So lots of problems in the NHS at the moment as well. These are things to be well read on because they're likely to come up in your interview. And the last thing to say here is to practice with people in the field. Um medicine interviews are quite different to other interviews. So if you can uh get in contact with some medical students or other uh professionals in the field and they can have some mock interviews with you that will actually put you under pressure and uh try to gauge uh how you would do on the, on the day as well. So I know that was quite a fast whiz through uh and you'll have lots of questions. We, we will try to answer these questions in the chat because uh I know Chris, she's got something quite fun planned for you as well. I don't wanna eat into her time. So, unless there's something to add, Alana, most uh here, can I just uh move on? OK. Grand. All right. So the last thing that I'm gonna hand over to mustine, who's gonna give uh our top tips to you and we'll uh leave you with Kirsty after that. Yeah. So um I think important thing to remember going into this is that everyone is feeling the same way you can feel quite isolated when you're, you know, trying to write your personal statement and going through interviews, remember that everyone applying to medicine across the country is feeling very similar to you. Um As he, as he has said, um use your experiences in the interview and your personal statement by reflecting on them no matter how small or insignificant they may be. A lot of people say, you know, I haven't had any extreme or any truly unique experiences from my work experience or from my personal life. And I feel like I don't have anything to talk about. That's something that I try to stress to everyone is that your experiences are absolutely unique to you because you're the only one who's experienced and felt those um those events personally. And so think about what impact those experiences, no matter how small, what impact they made on you and, and how you've come away from those experiences. Now, medical schools will all have different requirements, grade boundaries are one of them, but many medical schools will also look at other parts such as extracurricular as your and um and and other activities as well. And so apply to your strengths and apply to what you think you may want from your medical school time. So as I said, Cambridge is very much more of a science background if you appreciate or want earlier clinical contact. Um then Cambridge may not be for you and other medical schools may suit your strengths better um in the same vein or, you know, in a similar route. If you're interested in research and really want to get um stuck into basic sciences learning, then Cambridge or Oxford, those sort of more traditional courses may be better for you, but have a think about what you're most interested in, in experiencing in your medical school time. Um Medicine applications are unfortunately very competitive and so don't give up if you aren't successful the first time, um many people will, will receive quite a few rejections and myself personally will rec you know, I've also received quite a few rejections along the way. And so if you're not successful the first time, but you, you really do want to do medicine. Um think about uh the graduate entry medicine or taking a year out. Um The next one I think, or the next few ones I think are, are relatively um straightforward as we've spoken about studying medicine can be intense and it can consume your entire life, but it doesn't need to be. And so really think about um be staying connected to what you're passionate about and um keeping your hobbies up as much as possible. And lastly, just to finish up, um medicine is lifelong learning. So, um I used to think that once we graduated medical school that all everything would be fine and dandy and I would never have to do another exam again. But obviously that uh is not true. Once you graduate medical school, the journey has only really begun and I'm sure Christy will tell you more. But um you know, you, you have a minimum of five years before you finish medical training and up to 1010 plus years after graduating medical schools um to undertake more specialty training. So really medicine is a career with lifelong learning. It's a lot of fun. Um But just remember that the, the exams don't end when medical school finishes, I'll pass that on to Kirsti now. That's great. Thank you. So, I am, I have a little quiz to do later in the evening that hopefully will bring together all of the knowledge that we've learned this week. Um Don't worry if you've missed any of the lectures this week or you don't know, this is meant to just be an interactive thing to try and get you taking a history from a patient and, and all of those things. So try and put as many suggestions in the chat as you possibly can. Um the more interactive, I think the better and, and really don't worry if, if you don't know or if you think what you say is might be wrong or might not be quite right just in the chat anyway. And we can talk about it because quite a lot of getting to the bottom of a diagnosis from a patient is trial and error or adding in more tests or asking more questions. And so I guess the, the theme of the evening is to try and encourage you to be able to do that. Um I'm conscious that we've talked a lot about medical school and for, for you guys that are at sixth form at the moment, you probably haven't, haven't thought too much about what it will actually be like when you graduate. Um I know II covered this a little bit on Monday, but I thought I would do a really quick kind of five minute whistle stop tour of what it's been like since I've started work as a junior doctor. So I'm an F two now, which is a foundation year two doctor, which means I had, I've done one full year and I'm about halfway through my, my second year since I graduated. So there'll be plenty of time for questions while my next slides are loading. Um And I really am just gonna whistle stop through these. Um Essentially I have wanted to be a doctor forever. Um And I still think now even starting work that it is the right thing for me. Um I just wanted to really quickly touch upon as most you were saying the the training pathway and where you where, where you're at when you get spat out at the end of medical school into the the big bad world of being a doctor. So it's different for every specialty. So I'll not cover all of them because it, it's quite complicated. Um And I'm not gonna pretend to know all about it, but essentially when you finish medical school, the vast majority of people will go into what's called the foundation program. So if I was to compare this to other careers, that's a bit like an apprenticeship scheme, especially in your first year. So when you first qualify as a junior doctor, you get what's called provisional registration with the GMC. So that's the General Medical Council and that's the board that looks after all the doctors and make sure that make sure that we're doing what we're supposed to be doing in our role. And throughout that year, you have to keep what's called a portfolio. So it's a bit similar to like you did at medical school, but you might get some observed, um You might do some observed procedures or some observed history taking from a patient or people might watch you examining a patient and give you some feedback. They might also watch you doing some of your clinical skills. So taking bloods or putting Cannulas in and that kind of thing. And then at the end of the year, you collate all of that together and then you'll get signed off for that for that year. Um And then similarly in, in F two, so you now have full GMC registration, which essentially means the stabilizers are off a little bit more and you have slightly more responsibility. Um, but you're still within that apprenticeship scheme if that makes sense. So the vast majority of doctors will do F one and F two when they finish medical school after that, um, some people take a break and they do other things that they might be interested in. So they might do a year teaching medical students, for example, or they might do a year uh within a specialty that they're interested in, but not necessarily on a set training pathway. Other people might do what's called locum. So that's taking up um I guess part time, noncontracted work within the NHS. Um And they might also use that time to have a little bit more flexibility to explore the other things that they're interested in outside of medicine. Medicine can be a pretty hectic rota. Um you know, long shifts, night shifts, weekends, all of those things and lots of people use the opportunity after F two to not be on a rota for a little while and just take a bit of breathing space. So that's a fairly natural gap. And then after that, um you might consider applying to specialty training. So broadly speaking, you could go into a surgical type um training or you could go into a medical type training. Now, don't worry too much about what that means, but essentially most specialties. So um will have a medical and a surgical equivalent. So cardiology, for example, is the medical management. So you just use kind of medications and tablets and that kind of thing, whereas cardiac surgery is the surgical equivalent. So I hope that makes sense a little bit. And then also GP and psychiatry have their own training pathway. So most of them will have a broad training pathway for two years. And then after those two years in the third year, you'll then apply for the exact specialty that you're interested in. So for example, it might be gastroenterology or um neurology. For example, those would be medical specialties, other specialties go all the way through. But don't worry too much about that at the end of those kind of 89, 10 years, as most people were saying, you then would sit some more exams to become a consultant and that's lots of people would think the end of of that training pathway. If that makes sense, it's good to have a vague idea of this. Don't worry about it too much. It's really complicated and it's always changing, but it is something that they might expect you to have an awareness of at interview. So for example, have you thought about what's gonna happen when you finish medical school and what the training pathway will look like? So broadly speaking, two years, first foundation program, then you might pick a specialty and that could be up to eight or 10 years. And then finally, you become a consultant and that's really all you need to know and there's lots of exams throughout that, but I won't touch upon those too much. So in F one and F two, everyone gets automatically allocated um, six jobs so that, so each job would be four months long. And essentially that's just to give you a broad idea of the different specialties that you might experience when you start work and to give you a bit of a flavor of some of the specialties you might be interested in. The roles are also designed so that you gain a breadth of experience. So you experience medicine in lots of different fields, on lots of different rotors with lots of different teams. And it means you learn a lot for um throughout, throughout those six rotations. And essentially what they're hoping to do is mean at the end of those two years, everyone's got a varied, a varied range of experience from, from their foundation years before they consider applying to a specialty. So I won't go into that too much. But it's just to have a vague idea of the, the types of things and what work would look like when you finish medical school, the types of things that I now do as a foundation doctor. So things that I do on my own in the clinical time. So II often run, run ward rounds. I might have f one doctors underneath me that I'm expected to supervise or medical students that I'm expected to do teaching with on the ward. Um I'm on GP at the moment. So I might do some home visits and go and visit some patients at home. And if they're unwell and unable to get to the surgery in the hospital, I might form part of the cardiac arrest team. So I might be expected to do chest compressions. For example, if a patient's heart has stopped on my surgical rotations, I got to go to theater and assist, which was great. And then often, sometimes I'd also attend clinics and observe other doctors that were more senior than me. So for my own learning, um some of the things that I have done outside of medicine, I think that's one of the things that we, we never really talk about that much is yes. OK. It's an amazing opportunity to be a junior doctor and it's really exciting and it, it is stressful, but it's very varied. But also all of the other things that you get to do whilst you're a junior doctor outside of work. But as part of your training program, so you'll see a few familiar faces down on the, the bottom left here and through this committee that I've um I was on in the last two years, we've got to go to several conferences on behalf of the Cardiothoracic Surgery uh Society of Cardiothoracic Surgery, um which has been a great opportunity to kind of hear from world leading experts within the field I've also got to present my own scheme. So this lecture series that I did last year, I got to present at a national conference for Junior Doctors, which has been a really amazing experience and a good thing for kind of practicing your presenting skills and, and speaking to an audience. I don't know if you can see here, there's actually a little face peeking out of a sleeping bag. So as part of my training, I got to go on a wilderness and expedition medicine course. And that was my job. I actually got paid to go on that course as part of my training and we got to learn about things like hyperthermia, hyperthermia, management of patients that might have fallen. Or if you, if you um come across someone in the community, how to do a basic assessment of them. And then also I've got to go to practical workshops if you can see in the top, top right hand side here where I got to practice putting a new valve and a pig heart. So a few things that might be slightly different when you start work, I think quite often the things are that are that make the job so good are also the things that make the job really difficult. So it's a big step up in terms of responsibility when you finish medical school and then you start f one no matter how much preparation you do in your final year, it will always be a steep learning curve. But it's also really rewarding to have that sense of responsibility and um you know, be able to care for patients based on all of the knowledge you've accumulated in the last six years. The other thing is, is the teamwork II really, really love that aspect of finally feeling properly part of the team. Um So sometimes as a medical student, you do a lot of observing and quite often it's quite easy to feel a little bit like a spare part and that you're, you're bothering people. But actually as, as soon as you start work, you really feel incorporated into the team and, and that's a really great feeling. But also the other side of that is that working in a team all the time also poses its own challenges in that sometimes people might not pull their own weight or have a different style of practicing medicine to you and, and working amongst those kind of um differences in opinion can be difficult. And then finally, as we've already touched upon the learning, it's really exciting to learn new things. I'm imagining you're all here because you enjoy that side. Um And that you like learning new things and, and all of that kind of thing. But also it is a commitment um having to revise for exams outside of work and that expectation to keep progressing, it's tiring. I won't talk too much about the strikes, but essentially Um, these are some of the quotes from my, from my flatmates. Um, it's quite a bleak time in the NHS at the moment. You'll see it in the news everywhere. All of these depressing headlines. But actually I just want to kind of bring it back to reality a little bit in that as hopefully you've seen this week, we've all echoed this idea that we wouldn't pick anything else. Um, so these are some of the things my fellow flatmates have said, who are also junior doctors. So I never go home and feel like I've not achieved something. Uh This is a career I can see myself doing for a long time, challenging, varied and even on the worst days, I couldn't imagine doing anything else. And this job really is a privilege and now I'm in it. I couldn't see myself doing anything else. So I'm just gonna wrap up on that side of things from the junior doctor, from the junior doctor side. Um And I suppose if there's any more questions in the chat, we could maybe discuss them now while my next slides are loading. Um um I think we answered this question on Monday, but if we could briefly just touch on a traditional method versus um more uh where versus medical schools which um have earlier patient contact. Um And our thoughts on this, if we felt if uh we felt more inexperienced one on placement. Yeah. So I suppose um I'm just reading the question but yes, I suppose Queens was quite traditional and its methods of teaching. But what they did provide was the family attachment scheme. Um And it wasn't very extensive. Um I would say that it was maybe one day every two weeks where you got to meet a patient with a chronic illness. Um But I feel like this was enough um in first year to allow us to explore what it meant to take a history. Um And also then uh what it meant to um actually connect with patients and develop those skills that Kirstie was talking about your empathy, your teamwork, your communication. Um And so I think that it was quite privileged um in order to be able to do that in first year. But um do I think that it was a disadvantage to not do that? Um I think that's a very hard question to answer, but I do believe that each medical school is catered um to really provide the best experience and whatever way they have designed their course um will support students no matter what. Um And so I suppose it's very unique to each of us. But uh that would be my experience of what Queens has kind of given to me. II realized that I said I would come back to your question about combating senior doctors if you don't think they're teaching you in a, in a pleasant way. I am, I suppose all of us probably have a story of a consultant that we've maybe been a little bit scared of or who perhaps has scolded us for not knowing something that to them is really obvious. Um, I think it's a really difficult one. It will always be a really difficult one and it's a hot topic because it's actually one of the really common questions that comes up in our, what's called the, um, remind me of the exam. We sit the ethics exam at the end of medical school. Oh, I think it's been taken out. Oh, has it? OK. Well, either way it is a common dilemma that you come across all the time in the you sh no one should ever speak to you rudely. No one should ever be disrespectful and that shouldn't be tolerated under any circumstances. There's lots of evidence now that incivility in the workplace and people being rude to each other is not only worse for, for teamwork, but has all of these effects later down the line in that it's worse for patient care. And so I do feel like that is getting better. The thing that they're really trying to promote is at the moment is something called a flat hierarchy. So instead of junior doctors being right at the bottom and the consultant being right at the top, um and the hierarchy goes a bit more like this in that you always feel like everyone along that line can talk to each other and raise a concern. So I'm not, I suppose I'm slightly talking around the question, but I would say that the culture is definitely changing. Now in that most consultants should encourage you to speak up. If you see something that you don't think is right, or if there's a situation you don't feel entirely comfortable with and also your colleagues should also feel empowered that if a if a member of staff, no matter how senior they are is talking to you in a way that's not acceptable in any environment. Not least the hospital that everyone should feel empowered to say something. Um So I II don't know if Mo Elana, you have any other thoughts on that, but I think the culture is changing. Um But there will always be tense environments where people maybe say things in a way that they didn't quite mean to. Yeah. And I think it depends on what the relationship you like, what the intended relationship is. So if this is a senior doctor who's supposed to be a lecturer or a teacher at your medical school, then there's certainly a responsibility there from the medical school to provide you with adequate teaching and a safe learning environment. So if you feel unsafe or you're feeling like you're not gaining what you're supposed to gain from the teaching session because a senior doctor isn't teaching you or providing you the adequate learning opportunity, then you need to speak with your medical school there. As first said, if this is happening in the hospital, there are certainly a change in attitudes and a change in, in um the heart structure now compared to let's say 5060 years ago. But certainly, unfortunately, you will still meet some people who, who aren't the most pleasant. Um And if you feel like it's crossed the line into bullying or something that's inappropriate, then it's important that you raise us with either the medical school or the placement leads. Um And yeah, and sometimes if you feel like you're not getting the learning opportunity from the senior doctor, then just I find walk away and find someone else and um you know, there are so many other doctors on the wards when you're placed and um and yeah, make sure that you're gaining the most and you're from that learning opportunity, but you're also feeling safe where you are as well and make sure to, to raise any concerns. Um If, if that's not the case, I think just to finish on a slightly more positive note in my experience, the culture is definitely changing and that idea that the consultant knows best and that you don't argue with the consultant. There's always a place for respect and respecting the knowledge that a consultant has. But actually, I think the consultants that will be rude to junior doctors are now few and far between and it's a lot more of a healthier working environment. So hopefully that's slightly more reassuring of a note to end on. So, um we'll try and answer your questions throughout or we'll try and come back to them at the end. But I'm conscious that time is marching on. So hopefully we can continue with, with this quiz and this might be a little bit, a little bit lighter for you all. So your challenge this evening is to find the diagnosis for our patient. Some of you I II think people are at slightly different stages of their learning. So if you know the answer straight away, please don't jump in, please try and trust the process and just go through it methodically so that everyone can benefit from it. Um but I'll talk you through it as we go. So this is John Doe. He is a 65 year old male and his presenting complaint is shortness of breath. So when you take a history from a patient, it's got a very clear structure. The first thing that they will say is the presenting complaint and that is always the words that the patient says. It is. So it's not a medical term, it's what the patient comes to you and says. So for example, sore foot or I feel short of breath or I've got chest pain, it wouldn't ever be. This person has a cellulitis because that's the medical term for it. So the presenting complaint is whatever the patient says it is. So this presenting complaint is shortness of breath in John Doe. So, what do you want to ask John about his symptoms if you post them in the chat? Now? Just have a think about what else you might want to know about his shortness of breath and I'll give you a couple of minutes to do that. Yeah, these are all great questions. So we want to know how long it's been going on for. Yeah. Um, think about some of the other symptoms that might come alongside. Shortness of breath. Yeah, exactly. So, does he have a cough? Yeah. So, does that happen during exercise? So that's what we call, is it exertional? Does anything make it better or worse? Yeah. Perfect. All of these things, chest pain. Does he feel tired? Yeah. And so essentially with all of these things, you're trying to ask different questions to narrow down the different diagnoses that the patient might have. So keep popping them in the chat, they all look great. Um, perfect. Ok. So this part of the history is called the history of presenting complaint. So, what you're trying to do is take a history of the presenting complaint, which is shortness of breath just to gather a little bit more information. So, some of the things that I'd come up with exactly, like you've said, how long has it been going on for? Quite a good thing? That's always, um, a, a key tip. I would say is why has the patient come to you now? So, is this problem getting better? But actually it's been going on for a little while and I'm still worried about it because it's still there after six months, for example, is it getting much worse? And that's why they've come to you or is it just the same? But it's been going on for a long time. The next thing that's really good with shortness of breath is to ask their exercise tolerance. So, lots of you are saying, um, is it worse when he's exercising? Is it worse when they're going for a walk or is he breathless all the time? So, exercise tolerance is just a fancy word for saying what can you do now on a daily basis? So, some patients might say, ah, ok. Well, you know, six weeks ago, I was able to walk for 20 minutes to the shop, pick up my shopping and walk back with all my shopping. No problem. What they might say. Now, is that actually in the last couple of weeks I haven't been able to get up the stairs without being short of breath. And that's a big change for me. So, this is a key thing to learn is what, how over, what time period have things changed? And then, like you've all been saying, what are the other symptoms? So, does he have a cough? And if he has a cough, is he bringing anything up with the cough? Is it green gunky phlegm. Is there any blood in there? Does he get dizzy at all? Does he feel more tired than normal? Is he having any fevers? So, is he feeling hot and sweaty? Does he have any associated chest pain? Does his chest sound wheezy and tight like he might have asthma or something like that? And then finally, has he had any weight loss? So that's what's called your history of presenting complain. And you're really just trying to find out a little bit more information about what symptoms the patients experiencing. So from that, you can come up with a list of what's called differential diagnoses. So essentially that just means based on all of the questions that you've asked, what, what diagnoses do you think are going on in your head? So I've just summarized what, what John would reply to your questions here. So John has been progressively more short of breath for the last six months. He used to walk 10 miles every weekend, but now can only manage to the shop one mile away and he has to stop multiple times on the way. So you can see there, his exercise tolerance has massively reduced. Recently, he had an episode where he actually collapsed after he was feeling dizzy. And as such, the G PGP had referred him to be seen in the hospital. He feels exhausted all of the time and he is getting some very mild chest pain, particularly when he's walking. He has recently had a cough with some green sputum, but no blood in it. There's been no weight loss, no wheeze and no fevers. Ok. So you've now gained one token from taking the history of presenting complaints. So all the tokens are gonna appear on the left hand side of the screen here. So you've collected one for taking the history. So based on the information you have, what are some of the differential diagnoses that you're thinking of? Some of them might be things that we've talked about this week. I can see that some of you are putting some in the chat already but just have a think about all the different um organs in the body that could be causing John to feel breathless and I'll give you a couple of minutes. Yeah, so definitely the heart and the lungs. Yeah. Ok. So those are the organs that we think could be affected. Now, what are some of the diseases that can affect these organs? So think about some of the things we've talked about this week or maybe other things that you might have heard of before. I'll pop the symptoms back on so you can have a look and have a think. Yeah. So all of these are great, great suggestions. It definitely could be a chronic condition. Can anyone think of some of the things that we've talked about this week to do with? The heart. So he's getting a little bit of chest pain when he's walking. Yeah, it definitely could be a chest infection. He's got, definitely got some green sputum, doesn't he? He could have an element of coronary heart disease. So, he's a 65 year old man. So, we know that age and male sex makes you more likely to have cardiovascular disease, fibrosis. Yeah. All of these things. Perfect. All right. So, let's skip back through. So these are the things that I thought of. So, um, broadly speaking, we've got things that are affecting the lung. So you might not have heard of some of these things, but don't worry, we can, we can talk a bit more about what they mean. So, things like a pneumonia. So that's the medical term for a chest infection, co PD or chronic Obstructive Pulmonary Disorder, um, which is a kind of scarring in the lungs. He could have a lung cancer. Yeah, he could have a pulmonary embolism, which is the medical word for a, for a clot on the lung. Um, and he could have something called a pneumothorax. Does anyone know what a pneumothorax is? I'll give you a clue. Thorax is another medical word for the chest wall. Exactly. So it's a collapsed lung. So pneumo means air and then thorax is the chest cavity. And then next thing is things to do with the heart. So, could he have heart failure? And his heart's not pumping quite as well as normal. And that's why he's feeling more tired and more breathless. Could he have mitral regurgitation or aortic stenosis? So, we know from, from the talks earlier in the week that those are faulty valves in the heart that could make his, you know, breathing a bit harder. Could he have angina? So narrowing of the coronary arteries that are causing chest pain, particularly when he's exerting himself? And then finally, could you have anemia? I'm not sure if that's something anyone's heard of before. Does anyone know what anemia means? Sometimes anemia can be present in kind of people that don't have an iron rich diet. So vegetarians or people that don't eat enough spinach. Exactly. Iron deficiency. So iron deficiency is a cause for anemia. But anemia actually means reduction in the red blood cells. So, if you have less red blood cells carrying oxygen around the body for whatever reason, then you're gonna feel more tired than normal because you don't have the same oxygen carrying capacity around the blood. So that's another reason that people might feel breathless. Um, ok. So we've got a good list of differential diagnoses. Now, what else do we think might be useful to know, to start narrowing things down a little bit. Don't worry if you don't know, but think about the other factors that might contribute to people's people's health. Yeah, great. All of these things. Exactly. So this is the rest of the history. So the way the rest of the history works, you've had your presenting complaint, you've had your history of presenting complaint, but then you want to know what his general overall health is like. So the next thing you'd ask is his past medical history, which basically means, does he have any other medical conditions that aren't related to this condition that he's come in for? Does he have any regular medications? So that's the drug history. And does he have any allergies that always comes under that section? And this could be allergies to pollen or plasters or it could be allergies to medications. The next is the family history. So, is there a family history of genetic lung disease, um, or other problems that might affect the lungs or the heart, for example, um, that might be relevant to this, this presentation and then finally, the social history. So social history is a bit of a funny one. But does anyone know what, what some of you have said them already? But does anyone know what comes on the social history? Yeah. All of those things. So classically, the thing not to miss in the social history is smoking is alcohol, is occupation because they might, you know, they might work in a really dusty environment that means they're inhaling things into the lungs that are causing him to be breathless. What's his general lifestyle like? Yeah, all of these things. So that's under his social history. In more elderly patients, the social history might involve asking for example, who lives at home with you. Do you have any extra carers that come and help you do your kind of activities of daily living at home? So, washing and dressing and cooking meals, um or do you have any family nearby that come and help you? So that can all be relevant parts of the social history? And it can sometimes let you know how frail a person is. So if they say, oh, actually I'm 95 and I still do all of my shopping by myself. I live on my own and I'm completely independent and that's very different to a 65 year old who has a, a Zimmer frame can't get to the shops and needs his food delivered. So that's a really important part of the social history as is things like exercise. So if this is a 65 year old that's running marathons every day, that would be, that would be very impressive if he was running marathons every month, for example. Um But all of a sudden he couldn't, you know, he couldn't run five miles. You'd be really worried about this gentleman. Ok. So these are the parts in the rest of his history. So he tells you that in his past medical history, he has well controlled asthma. So he really only had a, had it as a child, but it's never bothered him anymore. He has high BP. He has high cholesterol. So that's kind of fatty arteries. He's got type two diabetes and then he's on lots of other medications that help control these conditions. I won't go into them all too much. But basically these drugs correspond with these conditions that he's got, but he's got no allergies to any drugs. His son has eczema. Now, the relevance of that is that quite often people that have eczema might also be slightly more susceptible to asthma and hay fever. And then his mother died of a heart attack, but he's not sure how old she was when she passed away. He doesn't think she was really young. He's an exsmoker. So he used to smoke one pack a day for 30 years. So that's quite a significant smoking history. He lives at home with, let's say he lives at home with his wife. Sorry, I haven't written that there, but he's completely independent. He keeps pigeons as pets and he's currently still working as a roofer. So just keep all of that in mind. You've now gained another token for doing the rest of the history from this patient. Well done. So, based on the information we've now gathered, can anyone think of any of these diagnoses that are slightly less likely? Don't worry if you don't know, but maybe you can pick out one that you think. I definitely don't think he's got that two. Yep. Great suggestions. Ok. So the things that I picked out. But don't worry because you're not in my brain. So you might not necessarily have picked this up. So, the things that I don't think he has, I don't think he's got pneumonia because I, an infection is usually a much shorter time period and you'd think he'd be more unwell with fevers and that kind of thing if he had an infection on board. The other thing I don't think he has is a pneumothorax. So, um pneumothorax, like we said, is air on the outside of the lung where it's not supposed to be. Now, usually they present as a really sudden onset breathlessness. Some people can be slightly more susceptible to them, um happening with no injury, but most commonly pneumothorax is associated with kind of blunt trauma to the chest that causes the lung to deflate. So I don't think he's got a pneumothorax because it's too chronic. A history for that. And then finally, I don't think he's got asthma because even though we know he's got asthma, actually, his chest hasn't been wheezy and his asthma hasn't bothered him for years and years and years. So I don't think that that's the cause of his breathlessness this time. All right. So I've then grouped these into the slightly different areas that could be causing your symptoms. So, problems to do with the lungs, problems, to do with the red blood cells and then problems to do with the heart and these are the things we've got left. What would you like to do next? So, you're in the hospital, you can do whatever you want. What kind of things would you, you want to do with the patient to find out what's going on? Yeah, definitely. We might want to do some scans. What are some of the th simple things that we might want to do first? Yeah. So we might want to listen to his lungs. Exactly. Blood tests. Yeah. Gonna do an assessment of the patient. Yeah, all of these things and ECG as well. Great. Ok. So like we said, we want to do, first of all, we want to do an examination and then we want to do some investigations. So things like bloods. So you've got two more tokens well done. So on examination, his lungs sound completely clear and the air is entering both sides of the lungs. Normally there's no crackles that might indicate infection and there's no wheeze that might indicate things like asthma. His pulse is 72 BPM, which is normal and it's regular. So he's not got any funny heart rhythms and it also feels nice and strong when you listen to his heart though, you hear the normal love DB that you might normally hear, but then you also hear an extra heart sound. So that's what's called a murmur. So just bear that in mind when you do his bloods, you do a HB which is another term for, for it's the shortened term for hemoglobin and that's normal. So that's what's gonna tell us that the patient isn't anemic. So he has a normal amount of red blood cells in his, in his bloodstream, his white cells which are the cells that fight off infection are also normal. So that proves that he doesn't have a pneumonia because if he had a pneumonia and his immune system was trying to fight that off, the white cells might be slightly elevated. And then finally, you also send away because he said he was bringing up some gunk, you send away a sputum sample to see if that grows any bugs and see if he's got a kind of chest infection that you can't necessarily hear on the lungs, but that doesn't grow any bugs. So, you know, he's not got a chest infection and then the things we might want to do next. So like you said, some of you said an E CG and you also wanted to do a, a some scans. So first port of call, we're gonna do a chest X ray because that's a really easy cheap screening tool that doesn't expose the patient to lots of radiation, but can tell us a lot about the way the lungs look. And then next, we might also do an E CG. So that's a tracing of the heart to see that it's beating normally and hasn't got any funny irregular rhythms. So you do those and again, they're both normal. So things you might see on a chest X ray are pockets of infection you might also see. So for those of you that attended the thoracic talk, this patient is a smoker, remember? So he, he stopped smoking now, but he smoked for 30 years and he's now got breathlessness for the last six months. So, what things might we see on a chest X ray that might be more worrying, can anyone think? Yeah, exactly. A tumor. So, this gentleman would be at high risk of a lung cancer because he's smoked for a really long time things we might see on the E CG. So strain on the heart. So, if he had something like, um, if he had something like a heart attack that was making him feel more breathless, then we might see that on an E CG. All right. So you've done this, you've done your investigations, you've taken your history and I've now ruled out a couple of other differential diagnoses. So we've done a chest X ray and we don't think he's got lung cancer. We can't see an obvious mass on there. We don't think he's got what's called a pleural effusion. So, don't worry too much about what that means, but essentially it means fluid on the lungs. So, if you were to see that on a chest X ray, you would see a clear line at the bottom where the, the fluid has settled at the bottom of the lungs because of gravity and it would look like a straight line across. So we don't think that that's going on cos we've done that in the chest X ray. And finally, we've also done a set of bloods. So we know that he's not anemic because his red blood cell level was normal. So hopefully you can start to see how you take your history and that starts to narrow things down. You might then do a few more investigations and again, you can then start narrowing things down more and more and thinking about which diagnoses might be slightly more likely. Ok. So you've gained another point well done. Does anyone know what imaging we might be able to use to rule out a pulmonary embolism? So a pe that's also another term for a clot on the lung or CO PD, which is chronic Obstructive Pulmonary Disorder, sorry, pulmonary disease. So that's a, a disease that's commonly associated with smoking and it's scarring on the lungs. Um Does anyone know what imaging we might use for that? Has anyone heard of any other types of scans? Exactly. So a CT scan is a 3D image of the lungs. So unlike the X ray where it's just one image, a CT scan can show us the structure of the lungs throughout. So for a, so a CT would be good for CO PD but for um for a pe we'd want want something that's called a CT pulmonary angiogram. So angiogram is essentially just an image of the blood vessels in the heart, sorry blood vessels. So that helps basically, we insert a dye into the body and that lights up the, the blood vessels and, and by doing that, we can then see if there's any blockages in them at all. So for example, like a clot, so a CT pulmonary angiogram would show us whether there's any clot in the arteries or the veins that are causing his breathlessness. Ok. So we've now ruled out quite a lot of things. Actually, we've ruled out anemia, we've ruled out lung cancer. A CT scan would also be a slightly more sensitive test for looking at lung cancer. So we know that chest X rays aren't perfect, but a CT scan is much more sensitive to picking up a lung cancer. So if you had a patient that you were really worried about, but the chest X ray was normal, but you still had worrying symptoms, you might refer them for a CT scan to get a slightly better image of the lungs. We've also ruled out CO PD, we've ruled out a clot on the lungs and we've ruled out kind of fluid on the lungs at the bottom. Ok. So you've established the most likely problem is related to the heart. So you gained another token. So there were three other diagnoses there. So the first one was angina. So for those of you that might not know, angina is basically chest pain that comes on when the patient is exerting themselves. And it's caused by a narrowing of the coronary arteries. So the coronary arteries are the, the blood vessels that supply the muscle of the heart and let the heart contract and they can become a bit narrowed if you get a build up of cholesterol and things like that. And when they become narrowed, it means the blood flow to the heart muscles isn't as good. And so when you're exerting yourself doing exercise and the heart is having to beat faster because the blood flow isn't as good with the arteries being narrower, you can get chest pain. The next thing is, is heart failure. So that's essentially the heart not beating as strongly as it did before that can happen for lots of different reasons. And then the final problem was problems to do with the valves in the heart. So, um like we were saying earlier, the mitral and the tricuspid valves or the semilunar valves in the aorta and the pulmonary, um my mind's just gone blank the pulmonary vein. That's right. Yes. Um Oh, sorry, didn't see that. Hopefully. So does anyone know what tests we might do to rule out? Firstly, what we might do to rule out angina. So think about what I said about the CT pulmonary angiogram and what an angiogram is, what test might we do to kind of rule out whether the patient has angina. Yeah, all of these things. So an ECG would be good because for example, a patient might have angina, but they also might have things that are precursors to heart attacks that might show up on an ECG. Um and a CT with contrast. Definitely. So, so we'd want to do what's called a coronary angiogram. So, coronary meaning the coronary arteries and angiogram, meaning images of the blood vessels. So that would help help us know whether there's any narrowing in those blood vessels that are causing his kind of strain on the heart and breathlessness. And then next, does anyone know what tests we might do for heart failure or problems with the valve? So how might we look at the structure of the heart when it's beating and understand whether it's still working properly? Yeah, exactly. So that's called an echocardiogram. Well done. OK. So these are the final tests that you need to do to try and get to the bottom of your diagnosis. So an echo, an echocardiogram is a really great scan. It's a bit like an ultrasound. So it uses um you put the jelly on the patient like you would do on a pregnant, a pregnant lady's belly. Um You put AJ A jelly on the patient's chest and then um it uses ultrasound waves to look at how the heart is beating and what's so good about this test, unlike CT S or MRI S for example, or chest x rays is that it lets you look at the heart while it's moving. Whereas the other scans are just stationary images. So that's a really good test to know what the heart looks like when it's beating. Ok. So other a few bonus points people might not know cos these are slightly niche medi medical school things. But if John told you that he works as a roofer, does anyone know what that might make him slightly susceptible to? So, think about in the olden days, what chemicals they used to use in the insulation in the roof. Asbestos. Exactly. So, asbestos exposure, which, which we now know really sadly causes is even with a very small exposure can cause something, a damage on the lungs called mesothelioma, which is basically a really aggressive type of lung cancer. That even if you've had one exposure as a, as a young adult can cause problems later in life and, and there isn't really much of a cure for it. Does anyone know what it might be if he kept pigeons? Because he keeps pigeons. This is a bit of a random one. I can't say I've ever seen this. Don't worry, if not bird flu. Yeah, definitely think of that. Yeah. Um, bugs and things that birds can carry. So there's another thing called bird fanciers lung, which is a bit random but it's, but it's essentially an inflammatory process throughout the lung that's caused by, um, exposure to, I think it's kind of spores and things on the, on the outside of pigeons anyway. So those are slightly niche things that you definitely don't need to know about, but might just be a little bit more interesting. Ok. So you've done an angiogram for John? And this shows that he's got a narrowing in the left anterior descending coronary artery. So you don't need to know what that means. But essentially, it's the main artery um that supplies the left ventricle of the heart. So that's the main powerhouse of the heart that's pumping all the, the blood around the body. And I don't know if you can see here where the arrow is. So that's where the narrowing is. So they inject dye into the coronary arteries and then they light up and then you can see where there's areas that don't kind of inflate properly. So you can see that John has got substantial narrowing in one of his arteries. So that definitely could be causing his chest pain and his breathlessness. And then you do his echocardiogram and that shows that there is some thickening of the aortic valve and an ejection fraction of 38%. Now, that's a lot of medical terms, but the ejection fraction is essentially how much blood can, can the heart pump out during one cycle. So it's really important to know that because it essentially tells you how well, the heart is pumping and how strongly it's pumping. So I'll tell you that an ejection fraction of 38% is not very good. So that means that the heart isn't pumping quite as strong as it should be. And it, and there isn't enough blood getting around the body at each time it pumps. So we've now ruled a few things out actually. So the last three things we've got are heart failure, angina and aortic stenosis. So, actually, with this patient, it's lots of things that are causing his, his breathlessness. So, Angina, I'll just go back, we can see that. Actually, he's got significant narrowing in his coronary arteries. So every time he exerts himself, he's gonna get chest pain because the, the, the heart muscle isn't getting enough oxygen and that's what will be causing his chest pain. And if the heart muscle isn't getting enough oxygen, it's parts of that muscle might die. And that might mean that the heart has to pump harder and harder each time to get the same amount of blood round. Now, the other thing that we didn't talk about is the fact that he has thickening of the aortic valve. So, can anyone remember what the medical term is for? That? We've talked about it a little bit this week. So I'll give you a clue. It's aortic something then beginning with S aortic stenosis. Exactly. So we know that stenosis means thickening of the valve and essentially what happens if you picture valves as really flexible structures. If you get things, if you've got a bad diet or for genetic reasons, you might get a build up of calcium on those valves. So instead of them being soft tissue, they then get really brittle with coatings of calcium. And so every time the heart is trying to pump, the valve is really stiff when it opens like this. And so because it's not as easy for the blood to get out via that valve, the heart has to pump harder and harder in order to be able to get the same amount of blood out with and overcome that pressure. So over time, the heart is gonna become tired of doing that and that's when you might get something called heart failure. So then, so initially the heart will get stronger and we try and push against this aortic stenosis. But actually, then as the heart becomes tired, it might start to fail. And that's when you would see a reduced ejection fraction. So that was a little bit of a complicated one, but you finally got the last thing. So you've got the token for the medications. So now that you know what's going on with John, you can start to help him with different factors. So well done. Can anyone think just for a few bonus points, what we might do to help John's um diagnosis? So we know he's got angina. So what advice. Can we give John about helping manage his Angina? Think about what causes Angina. So if I give you a clue and say that Angina is caused by what we've got. Oh, yeah, we've got. Exactly. So how are we gonna reduce his cholesterol intake? Yeah, all of these things. So we can encourage John to have a healthier diet. We can encourage John to try and go and do some exercise. We could also give John a medication called a statin which will help reduce the cholesterol in his um his arteries and prevent that damage getting worse. Yeah, all of these things well done. And then, so the next thing is what would we need to do? Given that John's aortic valve is really stiff and it's causing strain on the heart. What do you think we might need to do with that valve? Yeah, GTN is also correct. So GTN spray is a spray that patients put under their tongue and it helps dilate the arteries and make them wider and that increases the blood flow to the muscle. And so they, they um improves their chest pain. So what do we need to do to the aortic valve? Do we think? So? Not quite a stent. So a stent is usually something that goes inside a tube. So for example, a stent might go inside the coronary arteries to try and widen them. But yeah, exactly. We, we need to do a valve replacement. So that can be done in lots of different ways. But essentially, if this, if the stenosis of the valve is causing significant damage, then that valve either needs to be repaired. So take away some of the kind of calcium and, and try and improve the function or ultimately, it might need to be replaced completely. Um, a bypass is a slightly different procedure. But definitely if John's Angina was getting worse and those coronary arteries were becoming more blocked, then later down the line, if we weren't able to modify his risk with lifestyle changes and statins, then we also might need to do a bypass procedure to put an alternative vessel to go around the blockage on his coronary arteries. So all of those things are really, really great answers. Well done, everyone so sorry to keep you a little bit late. I hope that was helpful. Um But that, that's a little bit of an insight into the type of learning that you might do at medical school. So you'll be given a patient who comes in with a problem and then you'll start to take a history and learn about the different diseases that might come under breathlessness, for example. Um And that's one of the ways that definitely I was taught at Bristol in my later years. Um And as a way of kind of incorporating that scientific knowledge with a patient that comes to see you with a problem. So I hope that was helpful, really well done on all of your responses tonight. They were, they were brilliant. I can tell that you've all been listening this week and if, and even if you didn't know the answers to things, all of the things that you suggested were really, really sensible guesses. So, so well done. Um, and I think we'll just wrap up for the evening. Ian, was there anything else you wanted to add? No, not at all. That was really good, Kirsty. Uh Can, can you guys hear me? Ok. Yeah. No, yeah. Ok, great. Um Yeah, that was a really amazing Christy, I think. Uh this is exactly the sort of thing that you guys are gonna learn at medical school. So it was a nice insider. I'm sure useful uh for everybody. But yeah, um thank you so much for attending. I hope the sessions this week have been useful for you and it's been a pleasure uh helping to organize. It was mostly these guys, but, you know, it was amazing. I have been a part of this as well. So thank you. Um Just I guess a few closing remarks from us. Thank you so much for, for joining this week. It has been really lovely to see all of your suggestions in the chat. You're all so enthusiastic and I think, you know, if if we can help with anything in the future, please get in touch with us. Um equally in the short term. All of the things that I mentioned at the start. So recordings will go up on metal should automatically send you some feedback. Please take a couple of minutes to complete it if you can and you'll then get a certificate for, for attending these weeks. Um I know there was a question earlier about how, how can you use this week to stand out at medical school uh to stand out in interviews. So this is another example of something that you've done in your spare time to show that you're interested in medicine. You've all, you know, really engaged with this this week and think about how this experience has kind of give you a better insight into what doctors might do and the training pathway and the different team members that you might meet. You know, we've, we've talked about lots of different members of the team that might be involved and, and it's a really good, it's really good to have an understanding of the different people that will be um working with you in the hospital and show that you understand the teamwork. Um And then also this is something that you can reflect on. It might not be a face to face work experience, but it hasn't given you more of an insight into one of the specialties that you can do in medicine. And so reflect on what, what the things you've learned this week, what other things you might want to go away and learn because we've talked about in this week is there's something that's really interested in you. And so you've gone away and done a bit more learning about it. And, and also how might this event make you a better doctor in the future? So, for example, do you think teaching other medical students or teaching other people might be something you're interested in? Um and all of those things. So hopefully this week has been helpful in more ways than one. But please get in touch with us if, if we can help with anything else, even if it's just admin bits in the, in the short term. Enjoy the rest of your evening, everyone. Thanks.