Aspiring doctors go on their rounds

27th August 2010 at 01:00
A placement programme that allows prospective medics to work alongside the professionals is giving insights today to the specialists of tomorrow

It's the middle of the night and Iain Macdonald's heart is pounding as he runs towards the waiting helicopter. It may be a matter of life and death for his critically ill patient, who's being transferred from Dr Gray's Hospital in Elgin to an intensive care unit further south.

Journeys like this can be full of tension, especially when they have to be made in hazardous conditions across wintry dark skies. On nights like these, the 44-year-old doctor leaves the rest of the family asleep at home - his wife is a nurse and accustomed to emergencies. Family doctors used to give anaesthetics in small towns and Dr Macdonald's grandfather was one of the GP anaesthetists at Dr Gray's many years ago.

Dr Macdonald loves this job. Not just for these dramatic dashes when the team heads out into the snow on a life-saving mission. He even loves the routine days like today, when he's catching up on paperwork after a night on call.

This is his job, but it's also his vocation, and now he's passing on a sense of this to a 16-year-old schoolgirl who feels the same draw.

"I've loved it," he says. "Most people I work with in medicine really enjoy themselves and I can think of no better work to do."

The dark-haired girl beside him wants to be a doctor too, so this week Lauren Marshall, who has just finished fifth year, is on placement shadowing him. It's part of a week of work experience organised by NHS Grampian for prospective medical students from schools across the area.

"It's kind of bad, because I got into it when I was young, watching Casualty and stuff, and it's obviously not the real thing," says Lauren earnestly, as if confessing a terrible transgression.

"I've been in and out of hospitals with family and relatives and the whole environment is just fascinating. To be able to get into the profession and help people every day as your career, I think is just amazing and the best possible way to live your life," says Lauren, who is now going into S6 at Milne's High in Fochabers.

Lauren is one of 122 pupils to take part in Doctors at Work, a week's summer programme for senior pupils considering medical school. After a day's induction, they spend a day shadowing a consultant and a day-and-a- half with hospital porters, before meeting junior doctors to hear first- hand accounts of their early years in medicine.

The pupils are teamed up with a range of clinicians from NHS Grampian Teaching Hospitals - with four programmes at the Foresterhill site in Aberdeen and two at Dr Gray's in Moray. They'll shadow doctors at work in everything from neurosurgery to orthopaedics, including anaesthetists like Dr Macdonald. They'll visit theatres and clinics and accompany doctors on ward rounds, and they'll grasp the bigger picture, accompanying porters whose routine takes them throughout hospitals.

Some of these teenagers may never have set foot in a hospital before. "It's hoped that by encouraging pupils to see for themselves the role the doctor plays in patient care, by seeing this in the live environment, pupils will be better placed to make the right career choice," says Lynn Marsland, deputy director of strategic change at NHS Grampian.

"We hope that, by encouraging our local pupils to get to know the NHS, we will foster a workforce for Grampian for the future," says Ms Marsland, who initiated a similar scheme in NHS Highland.

She says shadowing porters is included in Grampian, after Highland pupils said it gave them a real insight into how hospitals work. They see the patients' experience as they are transported by porters round the hospital and it also highlights the teamwork in patient care.

Linda McKerron, learning and development manager with NHS Grampian, is a former nurse and part of the team delivering this new programme to 37 schools across Aberdeen, Aberdeenshire and Moray. "The only proviso is that school guidance staff are clear that these are pupils who have the academic ability to go on to apply for medicine," she says.

"We stress at the beginning, the pupils who then decide this isn't for them - that's absolutely fine, because it's better to find that out now."

Pupils interested in medicine have had work experience with consultants in previous years, but this is the first programme structured to offer this range of opportunities over the week. Work experience across the range of health service jobs is also offered to S4 pupils and to mature people considering a new career.

This week, the induction includes a session on infection control and hand- washing and another on patient confidentiality. Later in the week, there is an interactive session with a doctor from the laboratory services, which provide diagnostic testing for patients. Human resources staff explain issues such as pay and conditions and there's a separate talk on the Scottish Patient Safety Programme.

"We have also prepared a reflective journal which has lots of questions for them to ask medics when they are with them, but it's also to note down their feelings while they are actually in the hospital environment," Linda McKerron explains over coffee in the hospital canteen.

"Then we pick this up with them again on the Friday before they finish. They may well use a lot of what they are writing here for their personal statement when they are applying for university.

"This lets them be in the environment, experience it and have an informed career choice, because a lot of their expectations are built around what they see on the telly," she continues.

Kathryn Greaves, associate dean of admissions for entry to medicine at Aberdeen University, was not involved in the organisation or delivery of the Doctor at Work placements, but has encouraged and applauded their development to help students decide whether medicine is the right career choice.

"The purpose of any work placement is to inform individuals about the realities of their intended career. The care and well-being of patients is central to a vocational career such as medicine," says Dr Greaves.

"Given that many individuals have had no experience whatsoever of people who are ill - or, indeed, of a caring or healing workplace - gaining first-hand experience of such an environment and being able to question and discuss the duties, implications and career opportunities with practising practitioners is an excellent way of informing individuals' decision to pursue such a career.

"Clearly, the more experience an applicant has gained in differing and varied medical and healthcare areas, the more realistic will be the career aspiration. In medicine, we seek to clarify that applicants have a realistic understanding and the commitment required for such a career, and assess suitability and aptitude for training."

For Lauren Marshall, this is the first time she has been inside an operating theatre and she's looking the part in green theatre scrubs with her hair scraped back in a cap as Dr Macdonald shows her round.

"A lot of the nights you are up a good part of the night - I wasn't up after midnight last night, which is unusual. But as a safety mechanism, we don't allow ourselves to anaesthetise patients the next day," says Dr Macdonald.

Student nurse Adele Imlach, 18, stands in as a patient so he can show how oxygen would be delivered before anaesthetic in a real-life scenario. "Before we do anything else, the patient is fully monitored. Once we set up the anaesthetic, we can measure everything that's going on with the patient," Dr Macdonald explains, as he talks Lauren through the equipment.

"There is a lot of practical involvement. In every patient contact, you are doing something physical - at the simplest, you are putting a drip in; at the most complex, you are putting tubes in airways, putting special drips in, putting in epidurals," he explains.

"So it's a hands-on thing, but it's also practical pharmacology. You are giving drugs and seeing an immediate effect in terms of unconsciousness, regaining consciousness of the patient. You are looking after pain relief and sorting out patients before and after operations.

"It's a practical job and you can see results immediately. So for someone who wants to see immediate results from what they are doing, it's quite rewarding. And, of course, you are very much working as part of a team."

So what qualities does he think make a good doctor? "Number one - and Lauren is very good at it - is communication," he says.

But what if the Casualty fans pass out in theatre, when they can't use the remote to make it all go away?

"Students or junior doctors coming into theatre for the first time regularly faint, as do the student nurses. But it just takes a day or two of exposure to these things and you become tolerant to it. You adapt to it very quickly," he says.

Lauren is calm and cool. "I quite like the sound of orthopaedics, that's to do with surgery on the bones. It can be hip replacements or anything like that," she explains.

Back in his office, Dr Macdonald says he sees the programme's benefits as a parent too - his 16-year-old twin daughters are among pupils on placements here. We track them down during the lunch break to find out how they are getting on.

Felicity is shadowing an orthopaedic surgeon and Virginia is with a consultant physician in the acute medical receiving unit. The girls have just finished S5 at Elgin Academy and have got scholarships to take A- levels at Gordonstoun after the summer.

"I am quite interested in forensic pathology," says Virginia.

"And that's nothing to do with CSI," her dad jokes.

"It's like figuring out how people died, if it's suspicious circumstances. But I haven't really decided yet," Virginia says. "Today I've been following a physician round the wards and he's been looking at all the patients. That's been good, because I've not really seen that before."

Having medical parents encouraged Felicity's interest. "Dad does work hard, but he always seems happy about his job," she says.

This afternoon, she's expecting to go into theatre and is not at all squeamish - those evenings watching Casualty and CSI have not been wasted.

Jean McLeish

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