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Unless they're actually already in. Oh, I think now there. Hello and whoever's on the, whoever's on the session, would you be able to send a message? Just so we know if you're in, have you got the chat of the chat? Function? Bismuth? Oh, okay. Yeah, they're in. Yeah. Okay. That's Bill. Okay. Hi, everyone. Nice to see a lot of familiar names here. Hope you're doing well. Um, this is kind of the first session coming back since we run the mochi ski sessions. I hope you found them helpful and useful, um, to a couple of students that did kind of get, get back to us saying that they might have been missing some feedback. I am very sorry about that. We did try to get through to some of the examiners to give that feedback, but if you haven't gotten certain bits, I, I do apologize. Um, but I do hope at the very least that the, the feedback that was verbal, that's what we wanted to stress to the examiners, to be honest to give to you guys, to give you the most, uh, experience kind of in practice. So, I hope that was helpful the very least. Um, so today we're going to be doing a session on explaining medications. I know a lot of you have been asking for this session for a while now. Um, so I hope that is helpful if you have any questions, put them in the chat bar and Wisma can Eva you know, drop into the conversation as I'm going and ask them or at the end I can answer the questions were there and before I go any further, can everyone hear me? All right, and I am going to start share ing so just let me know if people can see the slides. Okay, right. Um Hold on share my screen. Okay. Just one second guys. Okay. I don't want giving you all a bit of a sneak peek for what's coming up in the future. Okay? Can everyone see that? Alright, Prisma just let me know kind of verbally whether people can or not I can see it. Yeah. Can everyone else? I presume everyone else come. Um guys just use the chat, chat function. Um If possible. Well, I'll just get started if you can see it was uh so today I'm going to be doing a talk on explaining medications um procedures to patient's um and also going into medication reviews as well. And basically the main format of the talk today is firstly how to format or going or go about explaining a medication to a patient. So how to follow a specific rubric and it can't really go wrong from that common medications that usually need requiring explanation in the ski stations. Now, in the Pharmacology station, that's where this sort of element can come up. I'm more convinced that you guys will get something like a history and there's going to be some kind of pharmacology element that you need to detect in the history. However, this is something to just be prepared for. I'll go through some of the medications that are very, are important that you're at least aware of how to kind of explain from that. I'll also go into medication reviews. This is checking all the medications, the patient's on a specific kind of format that you can follow for that and then to finish it off. Although I feel like this is an unlikely, um, uh station that can come up, it is a potential explaining procedures to patient's. So things like a bronchoscopy or an endoscopy and then explaining a disease to a patient. Now, this is something that is more likely to come up with them than, than, than the procedures. So explaining for instances, a new diabetes diagnosis or new M S diagnosis. Okay. So to start off explaining medications to a patient. So this is kind of the format that, that I like to follow and to be fair is quite a good way to, um, make sure that you don't miss anything when explaining medication. So to start off you want to take a brief initial history. So it's not like a history of presenting complaint past medical drug and all of that because that would take too long. It's more just to get an idea. Just the patient know why they're there. And do they even know that they're going to be starting this new medication quite often? The roof, the roof, uh, the remit of the station is they do know that they're starting this medication. And from there you want to try and understand what does the patient know about this medication. So, going through an ideas, concerns and expectations is quite a good way to approach it. And the concerns is the the key bit of this station really. So identify what are their initial concerns with starting it? They may be worried of potential side effects. They may have had a friend who was on it where something went seriously wrong and the best way to approach that is allow them to voice those concerns at the start and then state well, hopefully going forward for me explaining the medication how it works and a couple of other things and addressing these concerns that you have, hopefully, I can reassure you on those on those earned parts. And from there, it then sets out what you're sort of going to do so to break it down, you first want to explain the medication. So how does it work? Normal physiology? So what is the disease that they have or what is it treating? And then what does the medication do for it? So, for instance, a statin okay patient's who are put on it, they'll likely have hypercholesterolemia. So how you would explain that is in your case, you have quite high uh lipids or quite high cholesterol, which is fat in your blood. And this medication, the aim of it is to basically reduce. I'm sorry, I just need to know, sorry about that guys. I was just being asked for my parents for something. Um Okay. So uh going back to it, explain the medication, um the statin uh the aim of it would be to reduce the fat in your blood and hence reducing the cholesterol, put a new less at risk of certain medical conditions that you might have. Then you want to check for contraindications. This is usually specific to the different medications you're explaining some. Do you have contraindications? Some dent, for instance, statins, the only one which really exist there is pregnancy or if a person has liver problems and then you want to go into uh well, firstly how the treatment works. I've kind of already explained that really. Um That's usually coming with the explain the medication. Um then you want to go into the treatment course. So this is how you're going to take the treatment. So what does it actually come as is it a tablet? Is it a liquid? Is even an injection? Is it going to be a once daily, um, medication or do you take it once weekly and then, um, how long are they actually going to be on it for? Is this a temporary thing or is this a bit more of a prolonged treatment? Um, in most cases, the explanation, once the medication usually is going to be lifelong or it's going to be a, a longstanding medication. But there are some exceptions from that point. I normally like to do a chunk and check. Now you can do the chunk and check at any point. You feel as sensible. This is where you're firstly giving the patient information as you've given them and then you want to check that, that knowledge or that understanding. Um I normally like to do it afterwards. I've explained kind of how the treatment works and how the treatment course is going to go before going any further. So they know how it works and what it's going to entail in terms of taking it and from there then going on to things like the monitoring required. Now, with every medication they have quite a long listed explanation of what certain blood tests or checks you need to do before starting and then more regularly, there's quite a smart way of getting about this either breaking it down. I mean, it's great if you can remember all the specific blood tests for each one, but that can be unrealistic. So instead going about it as there's a certain number of blood tests that we need to do before starting and then every couple of weeks or a couple of months go with your knowledge basis with how well you know it and then break it down into something which would sound sensible. So if you don't even know that there's blood tests, then admit that you don't know, say that your, your check, what monitoring is required and state there are some tests that we need to do before starting in every couple of weeks and usually that's sufficient. And then from there after you've explained the monitoring, then you go into the side effects and I used to like split this up into common and serious patient doesn't really want to be told every single side effect under the sun because then it's just going to scare them off. Neither does the patient want to get uh no information about the side effects at all just because you want to save save face and not tell them that this medication could cause some worrying things. So you have to find the right balance. I come up with a useful way to explain it. So I'll get onto that. Um But the common ones is I, I used to say about one in 10 people get these kind of symptoms, but normally these symptoms usually start resolving after a couple of weeks and if they don't, then you can come back and see us and we can come up with a plan moving forward. And the serious ones are the things that you have to mention to make sure that if they do get symptoms of that nature, they come straight. Uh they, they seek medical attention as quickly as possible. So, statins for instances, it would be the muscle pains causing things like grabbed a mile rhabdomyolysis. That's what you'd be worried about. At the end of that, you ask them if they have any questions, any concerns of what you've explained. And then from there at the end, I used to uh say that offering a patient leaflet or some information at the end is a very good way to end the consultation. It shows that you're ending it and it gives the patient to a way of checking over the information that you've gone over with them and any with the contact details that you can attach to this, it gives them a way to, to seek some advice if they are a bit unsure about something. So a way that you can phrase it is um okay. It's, it's been good that we've discussed these uh this medication and detail. I'm going to give you a leaflet before you go and also some contact details if you have any concerns or any issues with starting the medication, if you're happy to start it. And that's a nice way to conclude it. And as I say at the end. If you're unsure about something in the s came in terms of explaining something you're not expected to know everything. But the best way is to say that you're unsure, throw out a guess and a sensible guess and say, I think this is the case and then state that you would check it. So wherever the resources that you would check it is where you would go. So if it's a senior, you go to the senior. If it's something you can find in the B N F, you can say I'll check in our local drug dictionary, which is the B N F and get back to you on that. So these are some of the medications that you could be expected to explain. I've kind of broken it down into those specific kind of boxes that I did go through. So first one is methotrexate a good way to explain this medication. Is it suppresses the immune system? And as such, it reduces inflammation. So you use it and things like rheumatoid, um other conditions like IBD cases. Um And the main gist of it is if your immune system is being dampened, then inflammation will go down in turn contraindications that you want to check things like pregnancy if they have any liver impairment and any active infections going on the treatment course, it's usually a once weekly tablet and normally patient's take it with some folate kind of on an alternating day. You have to take it the same day each week. And that's important to mention and it's a long term medication that they'll be on it usually lifelong. Um And then in terms of the monitoring, you have the FBC LFT and U N E S that are taken and this is before starting it, then they're done every two weeks and then it gets onto every 2 to 3 months. And this is why I say that sometimes it's important to realize the limitations of how much knowledge you can retain in your head. So if you want to break it down, how I used to go about, it was show that you at least know how it works throughout a contra indication just to check. So do you, are you pregnant at the moment? Make sure that you explain the treatment course and then for monitoring aspects saying that there's some blood tests that we need to do before you start and every couple of weeks and then onto a couple of months that's usually sufficient. And then side effects common ones, it usually causes gi disturbances. So things like abdominal pain, it can cause nausea. Um and that those kind of issues and then in terms of serious ones that you kind of want to watch out for, for methotrexate, uh they're kind of grouped together as blood disc racist, but that basically incomes is any kind of uh bone marrow kind of disorder as such. So, leukopenia, uh a granular cytosis anemia and thrombocytopenia. So you're not going to obviously mention those things to the patient because they won't know what leukopenia means. So how you would phrase these instead is symptoms that I just want you to look out for is if you're feeling very, very tired all of a sudden if you start going down with kind of infection like symptoms, um or if you start getting any kind of bleeding, So any blood in your stool or any blood in your urine, I want you to come see your GP straight away just so we can make sure that things are all right. And that's usually a good way to go about it. Next medication. Certainly. So I'm, I'm going to explain the first couple and then I will give you guys the slides so you can actually go away and like look at these because I could go fall of them. But that's not as useful for your learning as this is kind of rope learning stuff as such. So, sertraline, it uh it's mainly used for cases of depression. So, in depression, how you'd explain that is depression is normally brought about by an imbalance of certain chemicals in your brain. And the search line is a medication that helps us rebalance those. So it can start improving your mood and your ability to function in, in the day, giving you more energy for doing certain things. In terms of contraindications, there are a none really that, that I could find. And, and no of, um, in terms of treatment course, it's a once daily tablet. Sometimes it can be twice daily, but normally you say it's sort of once daily for most of these medications and then once you improve. So this is how you explain it. Once we start seeing that there's some visible changes and that things are looking like they're getting better, well, preferably continue it for a minimum of six months before maybe considering stopping it or if it is working well and we're happy with it and you're not get any serious side effects, we might continue it longer. In terms of the monitoring. There's nothing really that you need to do searching before you start it. And in terms of side effects, common ones, it can cause a bit of gi upset and as well as that it can also cause headaches. But again, these are ones that usually fizzle out after a week or two. And then a serious one that you always want to mention is when you first start it, it can, it can make your mood and your depression slightly worse. As such. We insist that if you do start guessing thoughts of suicide or self harm, then you come straight back to see us moving on from that. So this will be the last one that I kind of go through. But lithium, normally we use it things like bipolar disorder So how you'd explain bipolar disorder is related to the pay the symptoms that the patient might have stated. So I understand that with the symptoms that you've been getting, you've been getting a bit of a low mood sometimes and then your mood has been kind of very elevated, but that can come with certain other negative effects. Hence, it means that kind of your functioning and everyday life can be affected as such. So, lithium, what it is is we class it as a drug called a mood stabilizer. And how this medication works is normally bipolar disorder. It affects the chemicals in your brain and can sometimes make them high and then can sometimes make them slightly low. And the balance of that is a bitter scheme. So some chemicals might be higher when you're feeling really good and jovial and then when you've been guessing those episodes where you've been feeling really low, those chemicals can be coming down. So what we decide to do is the lithium will basically rebalance those chemicals. So it can meet a nice normal level for you. So it can mean that you can still function during the day and you're not getting any of those low episodes, but it might mean that you might not get so many kind of hae episodes, but it sort of neutralizes that in terms of contraindications, wants to think of a pregnancy. Uh it's contraindicated, things like heart failure and renal impairment and usually the contraindications once they're normally linked to the blood test that you do. So that's usually a good way to kind of prompt yourself if you're, you're struggling um to remember certain blood tests or something in terms of the treatment course, it's a once daily tablet and it's usually taken long term in cases of things like bipolar disorder in terms of the monitoring. So before you start, you normally have these blood tests. So FBC you any TFTs. So one complication that I didn't mention, but it's a side effect of it is it can cause things like thyroid problems. Hence why we do a thyroid check a beat HCG. So to check over there pregnant and N E C G as well, so make sure that the heart's working away and then you actually, and then you specifically want to check the lithium level. So lithiums are a narrow therapeutic index drugs. So the lithium level being checked is, is for that reason. Um And again, it's very specific after five years, you want to do this every week, but simplify it, say that we'll be doing it every couple of weeks and then less sporadically from then and that's usually sufficient. Oh Sorry. Uh And then in terms of side effects, common ones, you normally get, you get gi upset, you can sometimes get like this metallic taste in their mouth. And quite commonly they can get at these fine tremors and then serious ones is. So your symptoms of toxicity that normally comes with the tremor and a couple of these other ones like neurological symptoms, cardiac symptoms and renal symptoms. So the best way to kind of explain this to, to them is if you start feeling generally under the weather, if you start getting kind of problems with your, your bladder or feeling like your heart's kind of becoming a bit irregular. So you get like palpitations. um or if you start getting like this very specific kind of tremor, of course, tremor, um then come straight back to see us. And even with the fine tremor, it's difficult to distinguish the two. So normally you would advise them to come, come to seek medical attention if they have a tremor anyway, as it's not a very nice side effect to have anyway. So you might want to modify the dose in that instance. So other medications that I'll just quickly mention are useful to know about. So warfarin statins. So that, that I kind of went through earlier, Metformin atypical antipsychotics and the big one that they like to sometimes test you on is close up in because that one normally has a specific side effect or adverse effect that, that they can test in like a history sort of station, which is the a granular cytosis. So they come in with a sepsis and all sorts. And you have to recognize that the cloZAPine could be linked bisphosphonates and these ones are quite a good one for them to test you on because there's a specific kind of explanation terms of how to take the medication. So that could definitely come up. Um, the I, I kind of go through it in the treatment course, but basically you want, what you want to state to them is you don't eat anything with this medication. You want to take it 30 minutes minutes at least before you eat and you have to stay upright for 30 minutes minimum after you've taken the medication. And then they also have some specific side effects that you definitely want to mention. So, osteonecrosis of the jaw is the big one. So if they get any kind of like receding of their jaw or any pain in their jaw, that's definitely something to get to be seen for um, any kind of like swallowing difficulties or any pain on the swallowing and upper gi believe symptoms as well. So I know that the list team seems exhaustive, but this is where I say that you just can't voepel in every single one, but I would be aware of the most common ones. Hence why I've kind of boxed them up for you. And I've also kind of red, red highlighted the ones that I think are less likely that's still important to know about. I would also say that the Yassky Stop book that I've kind of recommended to you guys that has a list and that's why I kind of gleaned a lot of my knowledge from Bible also added to. Um, but the best way I would say about going about learning these is learn about, learn, you know, as many as you kind of, these ones that I've gone through anyway as best you can. And then looking at these lists basically just have a general idea. Okay. If I had to explain that medication, how would I explain how it works? Do I know kind of how it's sort of going to be taken? And do I know any side effects that I could mention as well? And normally in these medications, there usually is monitoring, you can't rope rope, let them all so state to them the best you can what you know, and go from there and say that you can, you can check beforehand and get back to them. Um And yeah, the most, the most important thing actually about this kind of station, if it was to come up is usually going to be in the addressing concerns. But so any person can explain a medication flawlessly. But if you know the medication off my art, but if you can't address a concern or explain the medication in a way that they'd understand it, then you know, that station can fall flat on its head. So that's why I say it's important to just know that specific thing of how would I explain that medication to a patient in layman's terms. So these are kind of my top tips from it. So at the end of uh, an explanation, if it's been long winded, check, a patient's understanding, do it where you feel? It's right. But I kind of told you where I think the chunkin checks are good to put in when explaining the side effect. This was kind of my rough statement of why I used to like to stay. So state most medications, if not every medication has side effects, usually the common ones resolve in a week or two. And if they don't, they can come back to see, you can come back to see us. It's important that I do go through these side effects. So you are aware that they could possibly happen. And with the more serious ones that I will go through very few people actually get these, but it is important that you're aware of them. So if you do start getting early symptoms, we can treat you early before things get to a stage where it, it might, might not be so good. And that's a good way to lay out the kind of fundamental explanation of side effects that doesn't make them start panicking or thinking that you're doom and gloom ing it. As I stated, if you know the blood test, you can read that as kind of what we talked about. And this is the kind of same statement that was saying before with multiple tests, try and simplify it down. So with the antipsychotic, if you kind of saw what I put in the box, there's a massive long list if you can't simplify it into layman's terms for patient. So pulse patient's will no BP, patient will know and wait a patient one. No, but a patient might not know what an E C G is, although definitely not know what HBA one C test is and lipids and prolactin. So the best way to explain those is we'll also do an E C G which is to check your heart rhythm and it's these little leaves that we put on your chest and we'll also do a series of blood tests as well to check things over. And that's usually good that that normally is like, yeah, four marks. That's perfect. That's why I want to hit and this oh sorry, did something I was going to say no, sorry. You can tell you uh hoping that you wouldn't say oh yeah. Now they can hear you or something that would have been quite bad as I've just been rambling on. Okay. So uh last tip in terms of memory treatment, course, this is literally what I kind of just learnt as how best to approach it most if not all the drugs that I've actually put down basically once daily tablets. The only ones that kind of the exceptions is your atypical antipsychotics. Those ones you can give in a uh I do need to remember this. I think a depo injection or maybe that's the levodopa someone correct me on that. But the three which I always remembered was slightly different was eight of Clan Psychotics leave a doper and insulin. So if you can't remember those, go through it. I'm having a mind blank. So I'm sorry about that. But yeah, I have put them down for you guys. Um I was gonna say marginal tip would be um right in the act. If you can literally just say for more information, I will give you a leaflet. You basically, you would have covered everything because everything could be on the leaflet if you don't know what to say. Um As I said, it's so important at the end to just quickly drop in, here's a leaflet, but I'll give you a leaflet before you go, which will kind of go through everything we've discussed and maybe address any questions that you may have. If there's anything that comes up, which you kind of comes to mind that you weren't able to ask today, I'll have some contact details on that, that you can contact to address those concerns. Um Also, I was going to say with medication explanation. Um I don't know if you guys knew about regard if um I think the years before our year, um they had like a proper 11 minutes stations for these um where they actually had to explain the whole medication, but we don't have that anymore and it's only seven minutes. So, um, there's like lesser chances of things coming where they literally just ask you to explain. But if they do then you don't have to go into too much people. Yeah. I mean, to be honest, even as I've, I've shown before, if you break down a medication, I mean, some, a bit longer than others, if you're asked to explain that form, and I've not got a lot better because there's not a lot to explain for it. And, you know, you might not be able to remember everything in these specific boxes. Hence why it's important to go through the giving the leaflet trying to explain it in sort of layman's terms that still show that, you know, sort of what to do, but kind of also show the limitations of what you can remember on the day. Um But yeah, if you have seven minutes, you can only cover so much. And that's why I say probably the main crux of those stations is going to be, can you address the patients' concerns? And usually those are directed where you'll know what to say or you'll know how to address that concern. So, Metformin for instances, they may think that it causes hypos and they'll be expecting you to know Metformin doesn't cause hypos you might be thinking of a different thing or, but identifying wildly concerned about that. Oh, I had a friend who was on Gliclazide, which is a, like a diabetic drug and they had a hypo and they were really unwell. So it's gleaning, what do you think might be the real concern as such and addressing that? So, yeah. Um, okay. So moving on if there's no questions, but you can ask them at the end if you want medication reviews. So this is slightly different, less likely to come up because I think it's quite a mean thing if they want you to gain this information about every single medication, especially with the time constraint that you have. But this is how you do want anyway, normally it's a quick intro. So checking patient details, see why they're there. Do they know why they're there? And then you won't quickly establish what medications they want. So these are all like, you know, tablets, liquids, suppositories, inhalers over the counter medicine supplements, they're not going to be on one of every single thing. So I don't think you're gonna have to do this for seven different drugs or something. They might be on like two or one if this is going to be a station that they give you. So be prepared for them to tell you and then go through it in this manner. So for each drug, what you want to establish is what condition it's for. So do they know what condition is for? So that's step one, when did they start it? So it could have been a year ago, two years ago and could have been recently. Do they know, uh, the dose route frequency? Sometimes they might, sometimes they don't, I mean, half the time I've been on medications and I don't know what dose it is. I do know the recent frequency, at least. So at least that can tell you a bit about their understanding about how to take the medication. Yeah, how they take it. So this can tell you quite a bit about, okay. Do they know the specific technique for taking their medication? So if they told you I'm, I'm on Alendronate, the first thing popping into mind. Mind is, oh, that's a bisphosphonate. Okay. So what I normally ask them walking through how you take that medication and that shows the examiner that you, you kind of know what you're asking but you want to put the patient in the position of okay, how would I approach it? So if they say, oh, I take it with a meal every single day or something, I'm thinking okay. That's not good. Yeah, then you want to establish, are they actually taking it and you have to ask it directly but in a sensitive manner? So, okay. Have you been all right taking that medication? Have you been taking it consistently or there's some days that you might forget to take it or something so posed in a way that you're not being judgmental, just kind of phrase it an extent of every one sometimes misses a dose and then asking about side effects. So, have they been getting any side effects while they've been on the medication? Sometimes that could actually establish that they've been getting a serious one and they haven't realized it's a serious one. In which case, that would be quite a red flag thing that you need to pick up in that kind of medication review. And then the most important question really is you want to make sure that it's actually helping the patient if it's a medication that can, you can measure that. So if someone's on a statin, I'm not really going to ask, is it helping because they can't monitor their blood cholesterol by themselves? But if I uh for instance, was asking them about an NSAID that they were taking, so, I don't know, actually I'll say morphine and it's for some chronic pain. I want to make sure that it's actually managing their pain and they're not getting breakthrough pain, they're not getting, they're not having to take it more frequently on, not like they're prescribed, being prescribed it or told to take it. And that can usually tell you quite a bit. And then if you've kind of got to the end of that, a good way to sort of bring it full circle is, or that you can more do this in this part here, I would want to make sure that they have not started any new medication or had any recent hospital admission? Why is that important? Well, if this is a station where they might be assessing a couple of red flag things, which they normally are assessing if someone starts a new medication, that can be very telling that that might be a culprit for some kind of side effect that they're getting or some new symptom that they're getting the same thing with a new hospital admission, that hospital admission could be very related to why medication might not be working. Their kidneys might have, um, kind of had an issue during the admission and as such a medication they're taking now is not being excreted as well. So certain things can definitely be linked. Okay. Any questions on medications, explaining them and all of that, because I've, I've covered quite a bit so far. So I can understand there might be some questions, but if not, I'll move one, if not, I will move on. Okay. So last two bits, I've only got two more slides now. So almost at the end. So explaining a procedure to a patient, it's kind of the same format for the medication at the start. So I've kind of kept it the same, but I used to like doing that because it sort of meant that I knew where I was standing and the bit in between I might be altering. Okay. So first brief initial history, what brings them in today? Do they know what procedure they're going to need. What's the patient's understanding and same thing, ideas concerns expectations and they'll be a short part. Then you want to go into the actual, once they've told you, I think it's this procedure, I think. And then you establish, okay. Do you know anything about it or that, then you actually go into your, this is what it is? Ok. So, explain what the procedure is. So if it's a bronchoscopy, put it in layman's terms. So we need to see more of the lungs and we kind of need to see the tubing that goes into the lungs. Okay. So the anatomy, how it works is you have achieved that kind of comes from your mouth and it's connected and it goes down into your chest and then kind of branches out into these much smaller tubes. And that's kind of where your lungs start kind of exchanging all the oxygen and stuff. So, what we need to do is the bronchoscopy is going to allow us to, we're going to basically put a camera down through the mouth into the throat and then we'll put it down into that tube, your windpipe and it will, and we'll feed it down. So we have a better look at the different structures inside the lung and to make sure there's nothing that, that we can pick up while we're doing that. And the camera will allow us to see anything. And then you want to reassure because that sounds like a very grim procedure. So, however, with this procedure, I will reassure you that we do actually give you some, uh, an aesthetic. So a local anesthetic spray to numb the area. I will also give you a sedative as well. That actually makes you a bit drowsy. So you actually won't remember the procedure being done. So if you're slightly concerned that I don't want to be kind of awake while this procedure is happening, you won't even be aware that it is happening. Then you want to go in to explain the reason for the procedure. So if you've explained kind of what you're doing, you obviously need to explain why it is. So the thing that kind of was coming to mind, which I probably would have fed into explain the procedure is if you're worried that there might be a cancer, then I wouldn't say that you're looking for a cancer. But you do want to say we want to see whether there's anything in the tubes of the lung. So ever there's any possible mass, any possible infection going on and you're kind of adding different things in cause you never know there might be an infection, there might be an abscess, there might be some signs of uh tumor, you know anything. So you kind of pat it out around other stuff, what will happen and then you kind of want to break down into the steps of the procedure. So before the procedure, what happens and normally there's two things you need to sort of explaining that. So all intake, can they eat anything before? Usually not? And then can you drink anything after that? It's usually your pre op measures. So, um, this is things like the, uh, sorry, no, before the procedure, the pre op measures is usually the stuff that you're going to kind of give them if you need to kind of supplement the procedure you're doing. So I was trying to think of an example for it. But if you want to do a colonoscopy, you're going to give them things like laxatives to clear out any feces before you actually do the colonoscopy. So that's the kind of pre op measures. I'm meaning and I'd think about before the procedure is in like anything like the day before hand and then during the procedure is kind of the day of. So that's going to be your, you know, general anesthetic that you'll give them or the local anesthetic that you'll give them any sedatives to kind of make them a bit drowsy and not remember bits of the procedure. And that can be, and it may sound scary to them. So you kind of have to pad it around an explanation that reassures them. But the best way to explain it is it's more to ensure that you don't panic or worry that the procedure is taking place at the time. So it kind of makes you feel relaxed. And then from there, there's other procedures to facilitate sometimes during the procedure. So if you're doing things like colonoscopy sometimes before and they might do a pr exam. Um so it depends on the procedure you're explaining. And then after the procedure, the things that you need to explain is firstly, I would actually explain what's going to happen when they wake up. So it can be a bit scared if a patient wakes up in a completely different part of the ward or something. So state into them, you'll wake up on our recovery ward. There'll be a member of staff there when you wake up to make sure that you're okay. So it will usually be an an East test, but it might be one of the nurses and they'll be there to kind of re orientate you and make sure that you're okay. Then from there, you then want to establish certain elements of, well, what's going to happen during that day. So, are they going to go home afterwards or are they going to stay overnight? Are they allowed to eat and drink? Driving is very important. And you know, if, if they work a job with heavy machinery, you know, you want to establish that and then if there's going to be any follow ups that, that need to be involved, this is quite specific. And that's why I think explain a procedure, you know, it's, I feel it's very unlikely to come up, but this is how you kind of go about doing one if you are put on the spot and if it was explaining procedure it'll probably be something that you guys do regularly that they would expect you to know of and it might not be as thorough as this. Um, so that's just something for you guys to kind of guys just keep in mind that whatever they're testing, testing you on your risky, that's actually what you're expected to do as an F one. And if there are procedures that you won't be doing as an F one, you won't be asked to do asked, you won't be asked to explain it. I really hope I don't have to do a bronchoscopy as an F one that's for sure. Um Yeah, so, so firstly, I think this is a little bit unlikely that they will ask you to explain procedures, but even if they do it would be very simple stuff. I mean, I've mainly put this in for you guys because a lot of you have asked for a particular session on explained procedures. I don't think it's necessary, but I've kind of put this in as sort of a brief description of this is how you would approach it. So, you know, you can glance over this if you want have a rough idea. Okay. This is sort of how I do it and be happy with that focus main, more on the medication aspect. If you're gonna spend any of your time anywhere anyway, after the procedure, you do eat chunk and check and then you kind of finish it off with risks, the procedure and you sort of go about it, the medication thing, every operation has a risk, you know, all of that. And if you really are kind of in a rut, the best kind of fall back for every procedure is risk of bleeding, risk of damage to any local structure. So, bronchoscopy damage to the lung damage to any of the uh bronch I or trachea, you know, your windpipe, that kind of stuff and risk of infection and then you kind of combat that with what do we actually do to mitigate those risks and that's kind of the reassurance bit. So risk of bleeding, we do expect there might be a bit of blood, uh a bit of bleeding. But the surgeon, you know, is very um experienced and we also have a niece to stay who's monitoring things like your BP and heart rate to make sure that this bleeding, you know, is controlled and that that we're keeping on top of it to make sure nothing bad happens. So that kind of stuff and then same thing again, any questions the patient has offer a patient leaflet and contact details. And then this is kind of the last slide of the day, but explain disease to a patient same starting off brief initial history. What's the patient's understanding of the disease? And then ideas concerns expectations and reassure. And then this is where it kind of deviates again for what you do specifically for this case. So first you want to explain what's normal, so make things simple. I used to think about nerves as explaining them as kind of wires and conduction. So a good case where they might ask you to explain particular diseases like M S. So how you'd explain M S is you have a lot of wires. So your nerves are like kind of the wires of your body and they tell you to do certain things and they stretch all the way over the body. They tell you kind of to move your hands, they tell you how to move your feet. And all of that with M S, the insulation of these wires starts to be lost. And so the conduction of these wires isn't as good. So sometimes you may find that these nerve that these nerves and these wires aren't firing as well or sometimes they might have just lost the conduction completely that they can't fire. And that's how it explained nurse and you kind of do have to be a bit, you know, good with your explanation that you explain it, but also kind of reassure them in a way. So M S, you know, it is a chronic condition, it is progressive in nature, but we have excellent treatments for it. We can mitigate the effect that the condition has. And it's not an instantaneous condition in that these symptoms happen all that want. So you might notice small changes over time, but it is important that you're aware that this condition does progress. And then how I used to explain blood vessels was usually things like tubing and stuff. So your heart is like a pump and the blood vessels like the cheese carrying the blood all over the body to where it needs to go. So once you've explained normal anatomy, whatever the diseases, you then want to explain what is the disease doing. So as I said with M S, you explain it kind of as the wires losing their conduction with a heart attack, how you'd explain that is your heart is a pump and it has its own blood supply tubes that transport the blood to it. So it can work fine with a heart attack. One of these two is basically gets blocked and stops blood flow to a particular heart of the pump, uh particular part of the heart or the pump and that part of the heart, which is the pump, stops working a bit. So it doesn't pump as well. And that's kind of how you can sort of explain it. And if you need to use some kind of diagram or something, you know, if they got some piece of paper there in a pen on the side, they probably want you to actually use it. So definitely use an aid if you need to, to help your explanation because diagrams and stuff can be very good and it actually shows that your very good um candidates and using what's around you to aid your descriptions. And then with this, once you've explained normal and disease, you kind of want to check understanding from there. So they know what this disease is and what it entails. And then from there, you kind of explain what's expected moving forward. So disease, the symptoms and the complications symptoms is kind of what uh you know, you're likely to get in terms of, you know, effects of the condition. But complications is what they need to look out for as things that you might be worried about, that they need to seek medical attention for management, what you can do. So, you know, you're conservative medical surgical and I'd approach it in that format. So M S you know, you're conservative, talk about things that your physio, you'll talk about kind of groups that people with M S can join, which sort of, you know, help in terms of speaking to others with the same condition, medical, we have medications that help and all that. And then from there, you kind of finish off with an understanding, what's the understanding, any questions and finish off with off relief and contact details. So you see that every all these ones still have the same kind of format. They just got different bits in the middle, but the bits at the end and at the beginning kind of stay as they are and it's a good way to kind of approach these stations. So that's, it's thank you all for listening. Um And if you have any questions, then please feel free to put them in the chat or you can even say them to, to us or happily answer them. Um, I was gonna say, uh, with, with Pharmacology stations. Um, yeah, so these are the things that could come up or otherwise. Um, I think most of you have done democracy, Bena. So, um, it would be something similar to that where you'll have a patient presenting with the problem and then you need to explore kind of like taking a history. But my main tip with any Pharmacology station is make sure you explore the drug history section a bit more than any other section. And I, I haven't take box for like four things to ask, which is like normal medications, like as they are they on any regular regular medications, are they on any specific or the counter medications? And then herbal medications, you have to ask that because most people don't say, uh, and, uh, finally you also need to ask about any recent medications and they've started and you have to ask, ask those specifically because patient's may not say it Um, yeah, that's pretty much the only thing I would add in a Pharmacology station. Um, if you guys, uh, think that you need more sessions in Pharmacology, just add it to your feedback form as well. Um, but if not, we'll move on to extra interpretation. Next week, one might be need to, might need to be broken up into two sessions. It's quite, it's quite an extensive topic to teach maybe because, you know, there's a wrist x rays, lumber was fine hit, you know, I could go on. So I, I will do a proper teaching thing and to be fair, I would recommend that you guys come to it. Um, but yeah, I'll probably split it up into maybe two parts dependent on and yeah, we'll probably do it next Wednesday. So this time the any questions? So he's, this, uh, this uh presentation will also be uploaded online. So if you guys want to be watch it, then feel free and I will upload the powerpoint slides as well. So I know that you guys actually want me to normally send you in advance. I'm very sorry. I should have done that before. But yeah, I'll do that in future. Yeah. If you don't have any questions, that's it. Uh, dangerous. Yes. No problem. Glad you found it helpful. Mhm. I wonder whether if I stopped broadcasting, that means it'll kick everyone or whether it will just stop it being live. Yeah. Mm. It's fine. I'll stop it whenever I'll stop it when everyone was left. Mhm. No problem Brendan. I don't think anyone has any questions. I think you can stop. Okay. Yeah, that's fine. I'll stop it now. Thank you. All right, thanks guys.