This anecdote happened many years ago when I was a brand new (read: inexperienced) physician doing my stint in the Colonial Health Service of the former Belgian Congo. I was assigned to a small hospital in the interior of the Maniema province.
Soft tissue infections and abscesses were rather common in this tropical climate, but at one time there seemed to be virtual epidemic of abscesses on the buttocks or upper arms. It seemed that patients with these abscesses were all coming from one area of the territory. That seemed rather odd and we started investigating. By way of background let me say that the hospital was also serving several outlying clinics or dispensaries in the territory. Health aides were assigned to a specific dispensary on a periodic basis. Patients would know his schedule and come to the dispensary for their treatments. Now this was the era of “penicillin.”
The natives were convinced that this wonder drug would cure all their ailments, from malaria and dysentery, to headaches, infertility, and impotence. You name it and penicillin was thought to be the cure-all. No wonder they would like to get an injection of penicillin for whatever their ailment was.
As our investigation demonstrated, the particular health aide assigned to the dispensary from where most of the abscesses came, would swipe a vial of penicillin and a bottle of saline from the hospital’s pharmacy on his way out to his assigned dispensary. When he arrived at his dispensary there was usually already a long line of patients waiting with various ailments. He would get out his vial of the “magic” penicillin, show the label to the crowd and pour it in the liter bottle of saline; shake it up and then proceed to give anyone, who paid five Belgian Francs (at that time equivalent to .10 US $), which he pocketed, an injection of the penicillin, now much diluted in the large bottle of physiologic solution. To make matters worse, he used only one syringe and one needle. No wonder there were so many abscesses in the area of injection. Of course we quickly put a stop to that.
Anyone interested in reading more about my experience in Africa and many other areas can download a free e book via Smashwords at: http://www.smashwords.com/books/view/161522 . The title of the book is "Crosscultural Doctoring. On and Off the Beaten Path"
It is understandable why resume writing is daunting for most students – they haven’t achieved many significant things at such young age and they have difficulties to present usual things as something extraordinary. However, you shouldn’t give up on your efforts, because you will be surprised by all things your potential employers consider valuable. All you have to do is find the right way to demonstrate your achievements and relate them to the job you are applying for.
The following tips will help you write a great resume that will represent you as an ideal candidate for every employer.
1. Start the process by listing your experiences. You cannot tackle the challenge right where it gets most difficult, so you should gradually work your way towards the precise professional language. Start with brainstorming and create a list of all experiences you consider significant. You can draw experiences from all life aspects, such as school, academic activities, internships, prior employments, community service, sports, and whatever else you consider important. Look at that list and distinguish the most motivating experiences that led you to the point where you currently are.
2. Target the resume towards the job. Sending the same generic resume to all potential employers is a common mistake students do. You should tailor a custom-written resume for each job application, representing experiences and skills that will be relevant for the position you’re applying for.
3. Present yourself as a dynamic person. Find the most active components of your experiences and present them in the resume. Focus on action verbs, because they are attention-grabbing and make powerful statements (trained, evaluated, taught, researched, organized, led, oriented, calculated, interviewed, wrote, and so on).
4. Mark the most notable elements of your experiences and use them to start your descriptions. An employer couldn’t care less about the mundane aspects of college or internships, so feel free to leave them out and highlight your persona as a professional who would be a great choice for an employee.
5. Show what you can do for the organization. Employers are only looking for candidates who can contribute towards the growth of their companies, so make sure to portray yourself as someone who can accomplish great things in the role you are applying for. You can do this by reviewing your experiences and highlighting any success you achieved, no matter how small it is.
6. Don’t forget that your most important job at the moment is being a student. While you’re a student, that’s the most important aspect of your life and you should forget to mention that you are an engaged learner in your resume. Include the high GPA and the achievements in your major as important information in your resume.
7. Describe the most important academic projects. At this stage of life, you don’t have many professional experiences to brag about, but your academic projects can also be included in your resume because they show your collaborative, critical thinking, research, writing, and presentation skills.
8. Present yourself as a leader. If you were ever engaged as a leader in a project, make sure to include the information about recruiting and organizing your peers, as well as training, leading, and motivating them.
9. Include information about community service. If all students knew that employers appreciate community service as an activity that shows that the person has matured and cares for the society, they wouldn’t underestimate it so much. Make sure to include information about your activities as a volunteer – your potential employers will definitely appreciate it.
10. Review before you submit! Your resume will require some serious reviewing before you can send it safely to employers. This isn’t the place where you can allow spelling and grammatical errors to slip through. The best advice would be to hire a professional editor to bring this important document to perfection.
One of the most important things to remember is that writing a great resume requires a lot of time and devotion. Make sure to follow the above-listed steps, and you will make the entire process less daunting.
Worst experience ever? - this is pretty difficult as I've worked in some of the poorest countries in the world and seen some things that should never happen like children dying of dehydration and malaria. But this recent experience was definitely the worst.
It was midnight and I was trying to get my 16 month old to sleep having woken up after vomiting in his cot. Despite paracetamol, ibuprofen, stripping to nappy, damp sponging and having the window open he went rigid and started fitting. It only lasted a minute or two yet felt like an eternity as he was unable to breathe and became progressively blue as my mind raced ahead to brain damage or some other horrible sequalae.
The fitting stopped and my mind turned to whether I was going to have to start CPR. I lay him on the floor and put my ear to his chest and was glad to hear a strong heartbeat but he was floppy with a compromised airway so I quickly got him in the recovery position. The ambulance arrived in 8 minutes and after some oxygen and some observations he was strapped in and ready to go. He had been unconscious for about 15 minutes but was starting to come round, much to my relief.
The ambulance crew were great and their quick response made all the difference but then they took nearly half an hour to get to A&E in the middle of the night because they took the most awkward route imaginable. I don't know if it was a deliberate delaying tactic or just a lack of local knowledge but even without a blue light I could have done it in half the time! Why do ambulances not have GPS - ideally with local traffic info built in?
We arrived in A&E and were ushered to a miserable receptionist who took our details and told us to have a seat. I noticed above her head that the wait time was 3.5 hours, though we did see a junior nurse who took his observations again. Not long after the screen changed to a 5 hour wait and a bit later to a 6 hour wait! I am glad to say that by about 3 hours my little man was back to his usual self (as evidenced by his attempts at destroying the department) and so after getting the nurse to repeat his obs (all normal) we decided to take him home, knowing we had a few more hours to wait for the doctor, and that the doctor was now unlikely to do anything as he was now well.
I tell the story in such detail in part for catharsis, in part to share my brief insight into being on the other side of the consultation, but also because it illustrated a number of system failures. It was a horrible experience but made a lot worse by those system failures. And I couldn't help but feel even more sorry for those around me who didn't have the medical experience that I had to contextualise it all. Sickness, in ourselves or our loved ones, is bad enough without the system making it worse.
I had 3 hours of walking around the department with my son in my arms which gave me plenty of time to observe what was going on around me and consider whether it could be improved. I did of course not have access to all areas and so couldn't see what was happening behind the scenes so things may have been busier than I was aware of. Also it was only one evening so not necessarily representative.
There were about 15 children in the department and for the 3 hours we were there only a handful of new patients that arrived so no obvious reason for the increasing delay. As I walked around it was clear to me that at least half of the children didn't need to be there. Some were fast asleep on the benches, arguably suggesting they didn't need emergency treatment. One lad had a minor head injury that just needed a clean and some advice. Whilst I didn't ask anyone what was wrong with people talk and so you hear what some of the problems were. Some were definately far more appropriate for general practice.
So how could things have been improved and could technology have helped as well?
One thing that struck me is that the 'triage' nurse would have been much better as a senior doctor. Not necessarily a consultant but certainly someone with the experience to make decisions. Had this been the case I think a good number could have been sent home very quickly, maybe with some basic treatment or maybe just with advice. Even if it was more complex it may have been that an urgent outpatient in a few days time would have been a much more satisfactory way of dealing with the problem. Even in our case where immediate discharge wouldn't have been appropriate a senior doctor could have made a quick assessment and said "let's observe him for a couple of hours and then repeat is obs - if he is well, the obs are normal and you are happy then you can go home". This would have made the world of difference to us.
So where does the technology come in? I've already mentioned Sat Nav for the ambulance but there are a number of other points where technology could have played a part in improving patient experience. Starting with the ambulance if they had access to real time data on hospital A&E waiting times they may have been able to divert us to a hospital with a much shorter time. This is even more important for adult hospitals were the turnover of patients is much higher. Such information could help staff and patients make more informed decisions.
The ambulance took us to hospital which was probably appropriate for us but not for everyone. Unfortunately many of the other services like GP out of hours are not always prepared to accept such patients and again the ambulance crews need to know where is available and what access and waiting times they have. Walk-in patients are often also totally inappropriate and an easy method of redirection would be beneficial for all concerned. But this requires change and may even require such radical ideas as paying for transport to take patients to alternative locations if they are more appropraite.
The reasons patient's choose A&E when other services would be far more appropriate are many and complex. It can be about transport and convenience and past experiences and many other things. It is likely that at least some of it is that patients often struggle to get an appointment to see their own GP within a reasonable time frame or just that their impression is that it will be difficult to get an appointment so they don't even try. But imagine a system where the waiting times for appointments for all GPs and out of hours services were readily available to hospitals, ambulances, NHS direct etc. Even better imagine that authorised people could book appointments directly, even when the practice was closed. How many patients would be happy to avoid a long wait in A&E if they had the reassurance of a GP appointment the next day? And the technology already exists to do some of this and it wouldn't be that hard to adapt current technology to provide this functionality. Yet it still doesn't happen. I have my theories as to why but this is enough for one post.
In case you were wondering my son appears to have made a full recovery with no obvious ongoing problems. I think I have recovered and then he makes the same breathing noises he made just before the fit and I am transported back to that fateful night. I think it will take time for the feelings to fade.
Thanks to those who read my last post. I was encouraged to hear from my colleagues at Med school that the post sounded very positive and hopefully. A few of them queried whether I had actually written it because there was a noticeable lack of sarcasm or criticism.
So... the following posts may be a bit different. A little warning - some of what I post may be me playing "Devil's advocate" because I believe that everything should be questioned and sparking debate is a good way of making us all evaluate what we truly think on a subject.
With no further a do, let's get on to the subject of today's post ....
An Introduction to Clinical Medicine
The previous year was my first as a clinical med student. Before we started I naively thought that we would be placed in helpful, encouraging environments that would support us in our learning, so that we were able to maximize our clinical experience. My hope was that there would be lots of enthusiastic doctors willing to teach, a well organised teaching schedule and admin staff that would be able to help us with any difficulties. I hoped these would all be in place so that WE medical students could be turned from a bunch of confused, under-grad science students into the best junior doctors we could possibly be.
It seems that medical school and the NHS have a very different opinion of what clinical medical teaching should be like. What they seem to want us to do is 1) listen to the same old health and safety lecture at least twice a term, 2) re-learn how to wash our hands every 4 weeks, 3) Practicing signing our name on a register - even when this is completely pointless because there are no staff at the hospital anyway because the roads are shut with 10 inches of snow most of the time, 4) Master the art of filling in forms that no one will ever look at or use in anyway that is productive, 5) STAY OUT OF THE WAY OF THE BUSY STAFF because we are useless nuisances who spread MRSA and C.Dif where ever we go! How we all learn medicine and pass our exams is any ones guess!
Undergraduate Co-Ordinators - Why won't you make life easier for us?
While at my last placement I was elected as the 3rd year student representative for that hospital. While I was fulfilling that role it got me wondering what it is that Under-grad Co-Ordinators actually do? I thought this may be an interesting topic of debate.
1) Who are they and how qualified are they?
2) what is their job description and what are they supposed to be doing?
3) Are they a universal phenomena? or have they just evolved within the West Midlands?
4) Does anyone know an under-grad Co-Ordinator (UC - not ulcerative colitis) who has actually been more benefit than nuisance?
1) UC's as a species are generally female, middle aged, motherly types who like to colonize obscure offices in far flung corners of NHS training hospitals. They can normally be found in packs or as they are locally known "A Confusion of co-ordinators". How are they qualified? I have absolutely no idea, but I am guessing not degrees in Human Resource Development.
2)I am fairly certain what their job should involve: 1) be a friendly supportive face for the poor medical students; 2) organise a series of lectures; 3) organise the medical students into teaching firms with enthusiastic consultants who are happy to give them regular teaching; 4) ensure the students are taught clinical skills so that they can progress to being competent juniors; 5) be a point of contact for when any students are experiencing difficulties in their hospital and hopefully help them to rectify those problems to aid their learning.
What do they actually do? It seems to be a mystery. I quite regularly receive emails that say that I wasn't in hospital on a certain day, when I was in fact at another hospital that they specifically sent me to on that day. I often receive emails saying that my lectures are cancelled just as I have driven for over an hour through rush hour traffic to attend. I sometimes receive emails saying that I, specifically, am the cause of the whole hospitals MRSA infection because I once wore a tie.
I never receive emails saying that such and such a doctor is happy to teach me. I never receive emails with lecture slides attached to them so that I can revise said lectures in time for an exam. I NEVER receive any emails with anything useful in them that has been sent by a UC!
Questions 3 and 4, I have no idea what the answers are but would be genuinely pleased to hear people's responses.
The reason I have written this blog is that, these people have frustrated my colleagues and I all year. I am sure they are integral to our learning in some way and I am sure that they could be very useful to us, but at the moment I just cannot say that they are as useful as they should be.
To any NHS manager/ medical educator out their I make this plea
I am more than happy to give up 2 weeks of my life to shadow some UC to see what it is they do. In essence I want to audit what it is they do on a day to day basis and work out if they are a cost-effective use of the NHS budget? I want to investigate what it is they spend their time on and how many students they help during a day? I would like someone with a fresh pair of eyes to go into those obscure offices and see if they can find any way of improving the systems so that future generations of medical students do not have to relive the inefficiencies that we have lived through. I want the system to be improved for everyone's sake.
OR if you won't let a medical student audit the process, could you manager's at least send your UC's to learn from other hospitals where things are done better! If we (potential future) doctors have to live by the rule of EVIDENCED BASED MEDICINE, why shouldn't the admin staff live by a similar rule of EVIDENCED BASED ADMINISTRATION? Share good ideas, learn from the best, always look for improvements rather than keep the same old inefficient, pointless systems year after year.
My final point on the subject - at the end of every term we have to fill in long feedback forms on what we thought of the hospital and the teaching. I know for a fact that most of those forms contain huge amounts of criticism - a lot of which was written exactly the same the year before! So, they are collecting all of this feedback and yet nothing seems to change in some hospitals. It all just seems such a pointless waste.
Take away thought for the day.
By auditing and improving the efficiency, of the admin side of an undergraduate medical education, I would hope the system as a whole would be improved and hence better, more knowledgeable, less cynical, less bitter, less stressed junior doctors would be produced as a result. Surely, that is something that everyone involved in medical education should be aiming for.
Who is watching (and assessing) the watchers!