Pre-elective thoughts...

So, welcome to my blog about my upcoming medical elective to Scotland! In this first post I want to quickly give some background about me, what I'm into and the events that have lead up to me doing my elective in Scotland. Most of the stuff below was adapted from our 'elective portfolio', a piece of work we had to do for King's to make us think about our electives - and even though at the time is was derided as being ridiculous (some bits of it still are ridiculous), alot of it provided lots of food for thought...

From when I first arrived at medical school I heard stories of how medical students travelled far and wide on their electives, visiting some of the most deprived areas in the world, with most involving horrific tales of poverty and inequality in a country in Africa and how the students were humbled by their experiences. When I started to think about my elective around Christmas time last year I came to consider my own motivations for the elective, and began to realise that I did not necessarily have to conform to the semi-accurate stereotype of 'nearly-a-doctor-but-not-really going to poor country to rescue locals'.

I always saw the elective as an opportunity to explore an area of medicine that I might be interested in pursuing as a career. I grew up in the Lake District spending lots of time outdoors, and I started rock climbing during secondary school. Once at King’s I joined the KCL Mountaineering Club and over 4 years worked my way up the committee before finally becoming President in 2011-12. As I was then getting into the later years of the medical course I decided to bring together these two interests, the outdoors and medicine, by getting involved with KCL Wilderness Medicine Society, and last year became President after a year on their committee. During the breaks in med school I spent a long time logging 'quality mountain days' to help me qualify as a Summer Mountain Leader in 2012. Also I completed the Far from Help: Part 2 course run by Wilderness Medical Training in Oxford during a weekend in November,  at the same time as taking the first Wilderness Medicine 'student selected component' at King’s. So I wanted an elective plan that could pull together most, if not all, of these different interests.

On a separate note, my clinical partner Andy has been key in shaping my ideas, although I don't think I've admitted as much to him! Andy studied Global Health as an intercalated BSc, and as such has a deeper insight into developing world issues than most. He's heavily involved in KCL Medsin, an organisation that raises awareness about developing world issues (sorry, issues of the 'global south') and many times following KCL Medsin events I’ve had (alcohol fuelled) discussions with him regarding the ethics of electives in developing countries. These helped me realise that I did not want to be a burden on an already struggling health care system, be that by requiring an in-country member of staff as an interpreter or by simply diverting valuable teaching time and clinical cases away from in-country medical students. With English as my only fluent language I was conscious of the potential ethical dilemmas of being involved in the care of patients with whom I could not consent to my involvement. Also, I understood that as a 4^th year medical student I would not be competent to carry out many medical tasks, and thus the issue of who would benefit most from a placement in a developing country was at the front of my mind.

After thinking about all of this I decided to do my elective in an English speaking developed country. With all of my interests in the outdoors the obvious choice was right on my doorstep – Scotland. With some of the most remote mountainous terrain in Europe, an elective in Scotland ticked all the boxes, allowing me to pursue my medical interests in an English speaking country, in a healthcare system I knew with the knowledge that I would be presented with numerous opportunities to combine my medicine with the outdoors.

Having decided on a country I then began exploring the placement opportunities. From two previous trips to the Orkney Islands I had been blown away by the dramatic Scottish islands and coastline, and was massively excited at the prospect of being immersed in their wildness. A quick search on King's' 'Elective Abstract Records System' (a database of all electives taken by King's students) revealed that Lewis, the most northerly of the Outer Hebrides on Scotland’s wild Atlantic west coast, did in fact have a hospital serving the population of 18,500 islanders, and that a student from King’s completed a placement there only the previous summer. Following a short email exchange with Rhoda from the Western Isles Hospital I had my 4 week placement confirmed; one down, one to go.

After confirming an island placement I thought that a placement on the mainland would compliment my experience on the isles and present me with a more rounded experience of what Scotland had to offer. I knew of a hospital in Fort William, the outdoor capital of the UK situated right underneath Ben Nevis, having spent time in the surrounding hills logging days for my mountain leader qualification. Following an internet search in early January I emailed the Belford hospital, and received a quick response informing me to apply through the University of Edinburgh. Following a trip to the Academic Centre at Guy’s to acquire a transcript of grades along with a few other bits of paperwork, I sent off my application. The following month I received the confirmation that my application had been successful, meaning my elective was sorted!

I know I was fortunate to have arranged my placements with such ease. When hearing the difficulties that friends were having organising their placements I felt relieved that mine had come together in such a short space of time, with the additional satisfaction of knowing the placements would perfectly fit my interests. I was excited by the prospect of actually increasing my skill base during my elective, as opposed to passively observing the provision of health care in a foreign system, language and culture. I was set for 2 months in Scotland!

At the same time as arranging the placement I had to think about what areas of medicine I wanted to pursue during the placements. Through the course at King's we've had the chance to do SSC's, which allow us to focus in on an area of medicine that we're particularly interested in. In my first year I took an SSC looking at the role of free radicals in acute mountain sickness, and this was followed in second year by an SSC looking in more depth into current and future methods of imaging hypoxia. Both have strong connections to mountain medicine and high altitude physiology and research. After this I intercalated in Physiology, during which I took an extreme physiology module looking at human adaptation to extreme environments such as outer space, high altitude, scuba diving and deserts. During this time I began to consider anaesthetics as a potential career, as I found the physiology fascinating and it was suggested by colleagues that anaesthetics would fulfil such an interest. As a result I completed an SSC in day surgery anaesthesia in third year, which helped consolidate anaesthetics as an early front runner. I found the combination of advanced practical procedures with the application of physiological knowledge really exciting and stimulating, and enjoyed the instant physiological results of interventions. During the wilderness medicine SSC earlier this year I had the chance to explore pre hospital medicine, which complimented my involvements with the Mountaineering Club and Wilderness Medicine Society. 

As I said above, anaesthetics is high on my list of specialities at the moment. Also having done A&E during 4th year I really enjoyed the unpredictable nature this, with the need for quick decisions and immediate actions. Combining all these aspects of the speciality with the need for effective communication and competent team work I think leaves a very attractive speciality. I find playing a leading role in a team immensely satisfying too, and I've developed this outside of my studies during my qualification as a Summer Mountain Leader and my current forays into Duke of Edinburgh supervisor and assessor roles. Also during third year I found the manual tasks, such as airway procedures and intravenous cannulation, very rewarding. My most recent clinical attachment to Worthing hospital opened my mind to the possibility of surgery as a career, as I found myself presented for the first time with the opportunities to perform simple surgical procedures. I surprised myself with how much I enjoyed surgery, and how satisfying I found it. And so at the moment anaesthetics, emergency medicine and surgery are the three areas of medicine that I think I'm most interested in.

Finally, my thoughts on potential specialities heavily influenced where to do my elective, whilst conversely the location of my elective influenced which specialities to undertake. In order to experience emergency medicine I needed to be able to communicate easily with patients and integrate meaningfully into an existing team, factors which logically led to an English speaking country. Likewise anaesthesia requires good team communication, but furthermore I felt that in order to maximise my learning from such a placement I needed to operate in an environment similar to that in which I may eventually work, and so carrying out an elective within the NHS seemed ideal. Also such a system would be well set up in terms of training, supervision and support - areas vital to gaining skills both effectively and safely. The Outer Hebrides would provide the perfect location for my interest in pre-hospital care, whilst Fort William, with its busy A&E department, would enable me to explore the careers of emergency medicine and anaesthetics.

So that concludes my pretty long first post on motivations for elective! Apologies if some of that was a bit formal, as I said at the start I nabbed most of it from my elective portfolio which was written a bit more formally than I intend this blog to be! I leave for Fort William tomorrow, around midday, although the time could get pushed back depending on how packing goes in the morning! That's one of the good things about doing the elective in the UK with a car - I don't have to worry too much about packing :) ~250 miles, ~5 hours according to the omniscient Google. I'll let you know how the journey goes...