 What is up guys, Karma Medic here and welcome back to another dose. If you're new to the channel, hi my name is Nasser and I'm now a fourth year medical student studying at King's College London and every single year that I progress in medical school I make one of these videos walking you through what a typical day or week looks like as a third year medical student, fourth year medical student and then next year hopefully a fifth year medical student as well. I honestly feel like it was just yesterday I started this journey through medical school. It feels like only a little bit ago that I stepped foot onto the hospital, started clinical placements, interacting with patients and performing clinical skills and exams, it's been a wild ride and I'm so happy to be here and I can't wait to see where this takes me and actually become a doctor in the future. So I guess first let's start with a bit of a general outline in your fourth and fifth year of medical school at King's College London. You can get placed pretty much anywhere around the country in England and so a lot of the times you might end up moving away from your friends who you were so close to in your first, second and third year. Which is quite a shame to be honest, I honestly wish that they kept us all together or we at least got to choose one or two people who we would like to be assigned to clinical placements with and that way we could have this sort of sense of community and continuation throughout medical school and depending on what hospital you're at, what district or trust you are a part of, you're going to get a vastly different experience even down to who your clinical supervisor is, who the rest of the team is with you, whether they're willing to teach you, whether they have time to teach you or whether they just want to stick to themselves. And so it's kind of crazy to think that as a medical student you could get a vastly different learning experience than your peers but I think the idea is that over the two years of fourth and fifth year everyone will have had sort of a similar experience after having been to so many different hospitals. So in fourth year of medical school here at King's College London we all rotate through the same four blocks. We have pediatrics, women's health or obstetrics and gynecology, emergency medicine and critical care and then a mental health block as well. So we have these four blocks spread out throughout the year and then in between each block we have consolidation weeks and also theme weeks. So theme weeks consist of a week of lectures focused around a specific theme. The most recent one that we had was surrounding palliative care and palliative prescribing and then consolidation weeks are weeks where we have absolutely nothing planned and those are always placed right before one of the progress tests that we have. So I've just completed my pediatrics rotation at a hospital here in London for the last eight weeks. It was a lot of fun. I got really hands-on and involved and I feel like I learned so much in terms of taking histories and also as far as clinical skills and exams go. And now I'm on my mental health block. I've actually been placed outside of London an hour and a half away in a nearby city, which is honestly a huge change and completely different to what I've been used to for the last eight weeks, but we'll get into that later on in the video. Something that I've really felt in fourth year is just the change in the responsibility that you're given by your seniors and also how much faith they have in you and how much they respect you to do things properly within the hospital. As a third year medical student, I always felt like I was observing. I rarely felt, well, I never felt like I was part of the team and I rarely felt like I was actually having a meaningful difference and helping out the other clinical staff that were there. Now, as a fourth year medical student, sometimes I'm the first person to see a patient when they come into A&E. And so that way, when I take the history and perform an initial examination, I'm directly helping other members of healthcare staff who now don't have to go and repeat that work. And so it's really, really cool to feel like you actually play a role. You actually help out and, you know, make somebody else's life easier. Also, of course, gaining tons of clinical experience yourself. We also get to write in the patient notes, which is obviously something very tedious for doctors who are very busy and have to see lots of patients. They sign off on those notes. Don't worry, we don't just type away whatever we want. And then it gets put in the system. They still have a read over them and make sure everything's OK. But the fact that we can write out this like one, two, three, four hundred word document for somebody else that they just have to glance over and approve is really, really great. Now, let me zoom in and focus on one of these four blocks that we have this year so I can explain to you what a typical week would look like for me. So since I just finished my pediatrics placement, I'm going to tell you guys about that. Generally, how I went is that we were in the hospital Mondays, Tuesdays, Thursdays and Fridays. So that was four days a week of actual clinical experience, talking to patients, interacting with them and learning all of these clinical skills that we need to do. And then Wednesdays were reserved for our quality improvement project, which is a day when you sort of do. It's not really scientific research, but it's sort of like a research study within a hospital, trying to improve something that could be done better within the hospital. Every Monday, Tuesday and Thursday, we had teaching from one to two PM, which involved going to a room and listening to an online lecture. On Mondays, we had teaching from two to four PM as well. So two to three PM was a series of cases that us students presented to the rest of the class and just talked about something interesting that we had seen over the last week. And then three to four PM was when a junior doctor came to talk to us about a specific patient and walk us through an entire case from presentation to discharge from the hospital. And then Friday from two to four PM, we had clinical skills sessions. So during this time, we would practice clinical skills that we're going to be doing on the wards. So for example, venue puncture, we also did urinary catheterization for both males and females. We did preparations for arterial blood gases, oxygen delivery, blood cultures, suturing. We did a whole bunch of things just to get that practice in so that we can learn to be more comfortable doing it on the actual wards. So my pediatrics rotation was eight weeks long. And for each one of those weeks, we were assigned to a different ward or a different part of the hospital and got to experience something completely different. My first week was in the outpatients clinic where I sat in on allergy clinics. I had a rapid access clinic, ophthalmology clinic, orthoptics clinic as well. I think is what it was called epilepsy clinic, learning disabilities. So all kinds of different presentations and patients. Generally with clinics, you know, you sit in one room, you see one patient after another. And I found that it got a little bit monotonous, especially for orthoptics and the optometry clinics that we were doing. I didn't really enjoy those at all. But when I was in the rapid access clinic, my clinical supervisor, who happened to be the consultant that I was sitting in with, he gave me full control over the situation. I sat in the doctor's chair and I asked all the questions I even wrote to the patient notes myself in the folder. And then of course, at the end of my consultation, the doctor stepped in and asked anything he felt needed to be asked and he did all the management and treatment, but it was amazing to be given that much responsibility to sit in the doctor's chair and act as if I was the doctor. So for that day, when I sat in the clinic, I think I took the patient histories from eight different patients. I really was exposed to quite a lot of different scenarios and I got to practice my clinical skills quite a lot. But then for something like the allergy clinic, honestly, I was mostly just watching and mostly just shadowing. So I didn't get as much out of that experience. And even though I always put myself out there and offered to take patient histories, offered to do clinical examinations and offered to help as much as I can, if your senior just says no or there isn't really anything for you to do, then you're kind of just stuck. And at that point, probably what I should have done, honestly, is just left that clinic and gone to pediatric A&E or another ward and just done something that might have been more useful with my time. But, I don't know, I just signed those clinics and I wanted to gain the experience from that specific field of medicine. But anyways, you live and you learn. Then my second week in pediatrics, I was on the neonatal intensive care unit. That was a pretty interesting week as well. I've never seen so many tiny, tiny babies in my life. As far as a medical student experience, I felt like I didn't get that much hands-on clinical activities as I would have liked. Obviously, these babies are quite fragile and they require higher levels of care. And it's okay that I didn't get to handle them all that much. I did get to listen to a couple of cardiac murmurs and there were some interesting cases here and there. What was interesting that week is that I got to perform a newborn baby exam or a Nipi and the baby peed all over me during that examination. I talk about that in a little bit more detail in one of my other vlogs. I'll leave a link to it somewhere up over here or over here. I honestly never know, somewhere here. During that week, I also got to watch a category one C section, which was honestly like an out-of-body experience. It was so crazy to see. So, you know, there was still something good in that week. Then the next two weeks, I spent in the pediatric emergency department and honestly, that was incredible. I've never talked to more patients, examined more patients in my life. It was just two weeks of intense, intense, intense clinical activities and clinical experience. I feel like I learned and I gained so much. On top of that, all the staff that was there, honestly, every single one wanted to teach me, they wanted to show me things, they wanted to let me do the history taking, they wanted me to examine and I honestly can't be more thankful for being surrounded by those types of seniors that who want you to learn and who push you to learn. I really felt like I was part of the medical team and it was an amazing feeling. So, hopefully that gives you a little bit of an idea of what my days were like, what my different weeks were like in my pediatrics placement. It really does vary so much down to which hospital you're in, what ward you're on, who you're surrounded by and what patients come in and what you get to see. But that's part of what's amazing about medicine is that it's so incredibly varied and you almost never know what's walking through the door. Obviously, on a pediatrics ward, we know that children under the age of 16 are gonna be coming through, but you really don't know what they're gonna be presenting with, especially in A&E. So, on Mondays, Tuesdays, Thursdays and Fridays, we have clinical placement and then Wednesdays are dedicated to the quality improvement project. So, this project is where we go to the hospital and we identify a problem and then we propose a solution for that problem, implement that solution, and then collect data before, during and after in order to see if our implemented solution did anything. This is actually a decently time-consuming project. I know it's only supposed to take one day a week on a Wednesday, but I know from my previous research project in third year that it always ends up taking longer than that. This year, we've been off to a slow start. We haven't really gotten anything started just yet. We're supposed to do our first set of data collection next Wednesday, I think. But yeah, I definitely anticipate this taking quite a bit of time in the future. We're gonna try to get as much of it done as we can in the coming weeks so that we don't have to worry about it closer to exams. Speaking of exams, this brings me over very nicely to the next topic of this video, which is talking about assessments. So, this year, because of COVID, honestly, assessments have changed quite a lot. We used to have three progress tests that we wrote in person throughout the year and then, of course, the practical hands-on exams called the OSCIs that we also had once a year. So, the first two progress tests this year are online, one of which I actually wrote about a week ago and then the third progress test, the one that actually counts towards sort of our final grade when we graduate from medical school is going to be written in person. Now, these two online tests that we've had, the university has told us that we are able to use any external resources that we wish as long as we don't ask the opinions of other people. And so, this includes Googling things, looking up things in your notes, having a textbook next to you, whatever. Which at first, I honestly thought was kind of weird and would just inflate everybody's scores by quite a lot. But the university said that in their testing with previous years when they did this, the average score of students only went up by about 3% and it went up pretty evenly across the board. So, I guess it's not gonna have that much of a difference compared to writing something in person. But from a personal perspective, I want to sort of emulate the most similar situation to progress test three, which is actually going to count. And obviously, I'm not gonna be able to Google anything in that exam. And so, for progress test two, I want to take it completely blind just as if I was writing it in person. No Googling, no textbooks, no notes, no nothing. For this first progress test that we did, progress test one, I did use Google, I did have my notes next to me and I actually recorded myself taking that exam. I'll leave a link to it as well somewhere up over here. You guys can click that and watch it if you want to. Now, Oscis, the actual hands-on practical exam. This is what has changed the most this year. So, usually what we would have is 14 stations. Each one lasts six minutes. Each one has a patient inside of it. And we would talk to that patient, take a history from them and then also examine them or do one or the other. And so now with COVID, obviously that's not really possible. It's not feasible to put these patients at such a high risk of talking to like hundreds of medical students. And so things have had to change. So don't quote me on this because I'm not 100%. But I think what's going to happen is that we're only gonna have four to seven stations on one day this year. And then we're gonna have one, what's being called a longitudinal clinical work experience or something like that. I'll leave the correct thing, whatever it's called somewhere down here. But basically we're gonna have half as many of those six minute stations that we usually do. And now we're gonna have this prolonged single 45 minute station. Now this 45 minute oski station is going to involve being taken to a real patient inside a real hospital, asked to take a history from them and then think about what sort of investigations you would want to do, request those investigations, wait till those results come back, interpret those results and then think of a management and treatment plan. Now as you might be able to appreciate that honestly sounds a lot more stressful than a single six minute station. In a six minute station, even if you do something completely wrong, even if you completely fail that station, you can just throw it behind your back, move on and go to the next station. But with a 45 minute station like this, if you don't extract all the necessary information that you need in that history in the first 10, 15 minutes, then you might not exactly know what investigations management and treatment plans to do moving on forward. So I know this is gonna be quite stressful for medical students. I know that the 50 years are freaking out about this and I'm sure I will be too once we get closer to that. But hopefully by then we have a little bit more information, we've had a little bit more practice about it and things go okay. The plus side to this 45 minute station is that this is kind of exactly what you will be doing as a doctor. You're gonna go to a patient, take a history from them, think about what investigations you need and then when they come back, interpret them with the history, come up with a management and treatment plan. And so in that sense, it is very good practice for the future. But as far as acing these exams, getting really high scores and just using medical school, I don't know if it's the best thing. I know that this type of Oski station is quite common in the United States. I have a friend who's studying there and she's told me that this is exactly what their Oski's are like. And so I was kind of surprised when I heard that we were implementing that too. But yeah, I guess we'll just see how it goes. I don't really know how to feel about it right now. Other than that guys, I mean, medical school is very, very similar. We still have a lot of face-to-face contact. We still go into the hospital almost every single day and we spend a lot of time talking and interacting with patients. Even though COVID is happening and I know that there's so many restrictions going on, I think it's still really important that us medical students get to go in and we get to practice and gain that experience that we're going to need as doctors in the future. Of course, at the same time, we have increased levels of precautions. Personally, we all have increased personal protective equipment. We can't go see a patient unless we're wearing gloves, a face mask, a visor or some kind of eye protection and also a full body apron. And then if you're doing any aerosol generating procedures, there's even more PPE that's involved. On top of that, as soon as we get to the hospital, we have to change into scrubs and then before we leave, we have to remove those scrubs and change back into our normal clothes. So there is a lot of extra precautions that are being taken. So I do feel like the medical school and the hospitals are doing a good job of doing as much protection as we can. And at the same time, I feel that medical students do really need this experience. And so I think there's a balance there, but I think the university is striking that quite well. So this year in my fourth year of medical school, I feel like my commute times are just not great at all. In my first block, I was about an hour and 10, an hour and 15 minutes away from my clinical placement. In my second block, I'm now an hour and a half outside of London. And so I need to move there. I can't commute from this house from this beautiful, beautiful place with all these lights and my massive desk and this orange dog over here. And then in my fourth block, I'm moving to an entirely different city, also an hour and a half outside of London. Thankfully, my third block is at a very, very close hospital, really close by. Thank you, Lord. But generally speaking, my commute times have gone up. My time spent on buses and trains has gone up, which I'm really, really sad about. Honestly, there's really few things that make me angry in this world that make me upset and annoyed. But feeling like my time is not being used properly is at the top of that list. It just makes my blood boil. And sitting on a train or sitting on a bus is a perfect example of not using my time well. So yeah, I absolutely hate commuting. It's like the bane of my existence, the bane of a lot of other people's existences, I'm sure. And so I try to do the absolute most that I can during these commutes. I always have my iPad on me with this magic, I forgot what it's called, magic floating keyboard case, whatever it is. And I write out scripts for YouTube videos just like this or work on looking at clinical exams and stuff like that that I need to do for medical school or other things like filling out engagement logs for my online portfolio, writing up case-based discussions or mini clinical exercises that we do, whatever it is that I can do something useful, something productive instead of just staring out the window or listening to my music. If I really don't feel like working, then I'm usually listening to an audio book. I'm currently listening to what is it called, deep water horizon or fire on the horizon. It's called fire on the horizons. And it is the story of the huge oil rig that went up in flames. I think it was the one that was attached to BP. I'm actually not sure, but it was called the deep water horizon oil rig. Very, very interesting book. I'm really enjoying it. But anyways, the point is that I try to listen to books. I try to do something that's like useful instead of just listening to music and staring out the window. As far as exercise, hobbies and extracurriculars go. Exercise, unfortunately this year we have played, I think only two or three games of basketball, which is so, so sad. It's something that I used to do every single week, something that I absolutely need in my week in order to relieve stress and socialize with other people. I'm very sad that we can't do that, but obviously I understand given everything that's going on. Instead, I'm doing a lot more running, but now where I'm placed for my mental health block, it's in absolutely the middle of nowhere. It is like pitch black around me unless I'm running on the main roads. And even the main roads, at some point I run out of main road and there's just no more street lamps. So yeah, I'm not really sure what I'm gonna do about running there. As you guys have seen, this YouTube channel is still going strong. I'm very, very happy to see knock wood as always. I'm still making videos every single week. I'm still enjoying this hobby so, so, so much. And you guys are watching the videos, you're liking them, interacting with them, and that just makes me really happy. I feel so privileged to be able to do this as a hobby, something that I actually enjoy and something that other people find value in and also find useful. So I'm just really happy with this whole YouTube situation. With the increased amount of clinical time that we have this year and with my longer commute times, I am feeling a bit more stressed in terms of doing these YouTube videos every single week. I'm still able to do it. I'm still managing my time, but I feel like it's definitely becoming harder and harder. So yeah, I try to squeeze in as much YouTube time when I can, when I'm commuting on the train or I'm in the bus or like I find five, 10 minutes of downtime here in the house. I try and do as much as I can whenever I can. As far as social life goes, I feel like it's as good as it can possibly be given the situation that we're in. Depending on whether London is in lockdown, what the current rules and regulations are, I either can or can't see my friends in different types of environments. So we just try and do as much as we can within the restrictions that we have. I'm so, so, so lucky and so thankful that I live at home with my sister. If I lived at home by myself, I honestly don't know what I would do. We are still able to socialize at lunch, cooking at dinner, and you know, at odd times of the day and on the weekends and things like that. So I'm really, really happy to have her. And now, of course, that I've moved somewhere else to a different accommodation for my mental health block. There's a whole community of students there where we all live together. We all see each other every single day. And so I'm sort of building like a second social circle, a second friend group over there, which has also been great. So yeah, guys, I don't know. I think that's it. I think I've blabbered on for 35 minutes now. So that should be enough to give you guys a good insight into what fourth year of medical school is like here at King's College London. It kind of feels like more of the same, but we have this increased responsibility. We do have an increased workload as well. Things are just getting more real. Things are getting more serious. And you know, we're getting closer and closer to actually graduating as final year medical students. I'm very happy that I still feel excited about going to the hospital. I still feel excited about talking to patients, even though it can be nerve-wracking at times. And yeah, every year when I make one of these videos, I say that I hope I feel this way the next year. So I'm here and happy to confirm that I do feel the same way that I did last year when I made one of these videos. I've been vlogging a lot of my experience as a fourth year medical student and you guys can find those videos here on the channel. I'll also leave links and screen cards to them somewhere up over here. I'm still happy with this career path that I've chosen and I think it's the right decision for me. And I would highly encourage anyone else to do it. If you feel like you're interested in medicine, if you have an inkling about medicine, get some work experience, go to a hospital, see what it's really like. I'm in my fourth year and I'm still very happy with all the choices that I've made. I need to touch wood after saying that. That is a big, big statement. All right guys, I think that's pretty much it for me. I hope that you found this video useful. If you did, please don't forget to leave a like on it and also subscribe to my channel to see more content from me in the future. And I'll catch you in the next one. Peace. So on Mondays, Tuesday, oh, sorry. On Mondays, Tuesdays, Thursdays and Fridays. And so I think this is gonna be quite stressful for a lot of medical students. I know that the fifth years are freaking, bless you.