Developing a Survival Guide
Have you ever gone to bed feeling annoyed at yourself for not having a productive day? Well it's not like that when you're a Trainee ACP, because you don't have enough time to not be productive! Every day is a mental checklist of what needs to be completed before the next round of lectures; before the Year 1 deadlines; before the next work project deadline.
From about week 4 to week 8 the pace was exciting - thrilling - and then this high speed journey would hit a moment, a moment that stalled me in my tracks, where the uncertain novelty of learning a new clinical skill seemed to still me. A moment, in the midst of a lecture, where I would look up to find myself wading through a deep pool of knowledge with the shore far off in the distance. The depth of theory is fantastic to learn but as it added it up I asked myself, "Will I retain all of this?" In my evenings, I balanced the time I needed to study with the time I needed to complete a piece of work that should be written now because there won't be time later. Added to my own work and research deadlines that filled my week.
This bustle of productivity was combined with performing new clinical skills; hands on assessment skills that go beyond assessing body composition or physical signs of malnutrition - and these came with their own challenges. When checking manual blood pressures I struggled to hear anything above my own shuffling, when counting respiration rate I missed inspiration when my eyes fluttered to the clock (or I would forget what number I had counted for heart rate!), when doing physical examination I was worried I would hurt people if I pressed too hard so I went through the motions rather than learning what I was looking for. These physical examinations were teaching me to assess for signs of pathology I was now expected to know the physiology to, but I didn't (not completely anyway). So it was another item to add to my mental checklist.
But there was no time to linger when I felt a moment that stilled me. More needed to be learned. My lectures moved onto the next system of the body and my deadlines for completion of tasks drew ever closer. So I needed to say, "Okay, that didn't work well that time. I'll just need to make sure it does next time... Right, what's next." And the daily progress of productivity moved forward.
My eureka moment
Then I attempted venepuncture.. And that was the game changer. Now I would be lying if I said I expertly recalled all the steps of ANTT, drew blood and changed bottles with dextrous ease.. But the very fact that I was doing this at all changed my mental approach to clinical skills. It felt very clinical to prepare a tray for taking bloods. I no longer felt like an imposter when entering the treatment area of the ward; I had a very clinical purpose for being there (I wasn't just looking for someone or trying to find alcohol wipes).
Maybe it was the culmination of practice over the last few weeks, but suddenly I felt more relaxed when undertaking clinical examination or procedures. And relaxation was key. When performing manual blood pressure the pulse was so loud I wondered how I ever missed it, when counting HR or RR I had more confidence so my eyes took in more and my brain readily processed and retained the information. When learning clinical examination skills, it felt more comfortable and it was easier to layer the practical over the theory.
Building for longevity
There are nights that I fall into bed exhausted. But if I haven't struck the right balance of exhausting both my mind and my body, my mind steals from this additional reserve to recall and recite all new information learnt that day or talk through future plans and scenarios. All while I lay awake for hours. Learning point: no matter how late it is I save myself time (and gain sleep) by taking time to exercise. Healthy body, healthy mind... And an exhausted Maria.
Which takes me to my next key point, sleep and nutrition support my body. Sure, I am preaching to the choir here, I know. But bad habits have a way of wriggling in and sticking - even if you are a qualified Dietitian. Sometimes I decide I am too busy to eat. Sometimes I decide I am too tired to prepare a nourishing meal. It's all excuses of course. I feel better when I eat better and there's the mental reward of knowing I have eaten well ("well done me, yay").
The next big item on my checklist is performing an assessed clinical examination of a patient. A daunting task but I have no time to hesitate. I am now 8 weeks into my training and there is a lot left to learn with a long way to go… but I feel like it is starting to come together. And… at least I never go to bed feeling annoyed that I haven't been productive.