Trainee Case Study - South West Peninsula Deanery

South West Peninsula Deanery
Career Planning Service
Stroke Medicine – South West Peninsula Trainee Case Study
Dr Paul Mudd – Specialty Trainee
Your background prior to studying medicine
I went to medical school aged 18, straight after A-levels.
The reason for choosing Stroke Medicine
I felt many of the hospital specialties had become rather narrow, but Geriatricians still
enjoyed the fusion of acute general medicine with complex, long term diseases and
rehabilitation. I did all the medical specialties as an SHO and found Geriatrics to be best
suited to an ‘all-rounder’. Although Stroke medicine is a specialty largely within Geriatrics
and treats a similar group of patients with a similar ethos, a smaller number of young
patients are treated too.
A stroke is often a life-changing event for a patient and their family and the decisions you
make will be important to them. It’s a rapidly developing and expanding field with recent
extra funding from central government. The doctor is part of a large, multidisciplinary team,
so there are other interesting professionals to interact with. It’s a friendly specialty with a
healthy mix of people, the doctors being usually from a geriatric or neurology background.
You also need to know about surgical techniques, radiology, psychology and general
cardiovascular medicine too. There are good opportunities for research and travel.
The reality of working in Stroke Medicine as a trainee doctor
Many other conditions can mimic a stroke, so it’s important to keep an open mind and have
knowledge of alternative diagnoses. Most stroke patients have additional illnesses that limit
or delay their recovery and you need to know how to manage these. Patience and
explanation are needed. Many are left with disability and helping them to cope is a challenge
which can still feel rewarding. This will take all your communication and teamwork skills.
Some patients die from their stroke and you’ll need to be able to cope with all aspects of
palliative care.
Out-patient clinics involve seeing new strokes (or their mimics) and aim to prevent further
strokes and heart disease. You’ll need to keep up to date with all aspects of cardiovascular
medicine and basic neuroscience.
Daily activities and responsibilities
Seeing acute strokes in A&E and other wards and assisting with thrombolysis.
Ward rounds with the junior doctors and case conferences to plan rehabilitation with
the relevant therapists.
Out-patient stroke clinics allow us to see people with potential strokes quickly and
there are now good services to provide same-day scans and treatment.
We follow patients through to their community hospital as they undergo rehabilitation
and get ready to go home.
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I spend time teaching students and staff and communicating with GPs and families,
performing audit and research, time for self-study and visiting other departments.
Attending local and national meetings to learn and interact with colleagues.
Suggestions for personal development and managing change
Firstly, gain a sound knowledge and experience of general medicine. Most stroke doctors
will still do on-calls for the acute medical ‘take’, having passed the Royal College of
Physicians exam. Develop good teamwork and communication skills. You’ll need to cope
with diverse patterns of work, some patients being very sick and some relatively well. The
hours can be long and physically demanding, but are improving and there are opportunities
to work part-time.
Ways to achieve a successful work-life balance
Doctors have more leisure time than before, so keep in contact with all your non-medical
friends and make the most of your holidays. Keep fit by any means possible and have a few
hobbies. Develop an enquiring mind and enjoy your study leave and meetings.
Snapshot of your career path to date
I did six years of hospital medicine, experiencing all the major specialties and on-calls and
sitting the MRCP exams. I felt I’d gained a broad education at the ‘sharp end’ after this. Then
I spent a year as a stroke research associate and a year in New Zealand as a medical
registrar.
After choosing Geriatrics I was accepted as a registrar with additional training and on-calls in
general medicine. I’m now doing a year of Stroke Medicine as part of a Department of Health
initiative to formalise stroke training and gain a new Certificate of Specialist Training in
Stroke (CCT).
Career goals for the future
I’m aiming to pass the certificate of training in Stroke, publish a further research article and
become a Consultant in a few years
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