Most medical students begin full-time clinical placements in their third year. This will usually consist of a 1-2 month rotation revolving around various specialties. You will generally spend your days, 9am-5pm (some placements may start or end earlier, or involve evenings and nights), with a team of doctors as they look after patients within that speciality.
This can all sound very daunting. These tips have been written to help you get started with your first few placements and to help you make the most of your clinical years.
The First Day: Show up Early
Your medical school will inform you of the first team you will be shadowing, the name of the consultant who will be in charge of your learning and where you should meet the team on the first day.
Make sure you get there at least 15 minutes early and introduce yourself to the team. This will ensure you meet everybody on the team before the ward round starts and things get busy, and that everyone knows who you are. It will show that you take this placement seriously and in return they will be more willing to teach you.
In the Morning: The Ward Round
The mornings will often start with a ward round where your team will go around the hospital and review every patient who is under the consultant’s care. This can initially seem intimidating as there will be a big group of you walking around the hospital.
To avoid falling asleep, be useful! Ask for a list of the patients at the very start so you can orientate yourself along with the ward round. Teams will usually see all patients in one ward before going to another ward to see the ‘outliers.’
Here are some ways you can be useful:
● Grabbing the next patient’s notes and document Documenting on the ward round is a skill that should be learnt early. The junior doctors will help you at the start and with time it will feel like second nature. It will also ease the pressure off the rest of the team. An example of how to document can be found in the Appendix.
● Closing the curtains
● Grabbing the observations folder
● Filling in the request form for the x-ray the consultant ordered (which a junior doctor can then sign later)
These small things will help the ward round go that much quicker.
In the Afternoon: Help the Juniors
Once the ward round ends the juniors will often get together to get a coffee, have a break and go through the list of jobs that they have garnered from the ward round. This is an excellent opportunity to integrate with the team and perhaps get some of those pesky ‘supervised learning events/SLEs/whatever your medical school chooses to call them’ ticked off.
There will be many jobs you can help with, such as:
● Bloods & Cannulas (good practice for when you start working)
● Clinical examinations e.g. ‘Neuro exam for Bed 2 ? reduced left-sided weakness’ - use these as SLEs if you can
● Filling in request forms for imaging/investigations which a doctor can then sign for you
● Speaking to relatives (make sure you do not go outside of your comfort zone and always be prepared to say when you’re not sure of something).
In the Afternoon: Clinics
If it’s a particularly quiet day on the ward or if you just want a change, you could ask your consultant if there are any clinics you can join. Try and get an idea from the junior doctors beforehand about which consultants are good at teaching and which will just ignore you.
Clinics are a great way to learn because you have 1:1 time with a consultant in that speciality. You will see a variety of patients, be encouraged to examine them (in which case you will get to recognise pathology - and perhaps tick off another SLE) and learn about diseases and management all at the same time.
Throughout the Day: On-Call
All of the junior doctors on your team will have a day in the week (often multiple) when they will be on call. For some, this may mean spending the entire day in the Medical Assessment Unit or the Emergency Department clerking in new patients (clerking just means taking a history and examination and initiating appropriate investigations and management).
Once you’ve integrated with your team, ask one of the juniors when they will next be on-call and shadow them. You will get to clerk your own patients - someone who has not yet been seen by another doctor - and present them to your junior doctor. You will also be encouraged to think up your own differentials, what investigations you would request and how you would manage this patient - all within a safe environment. This is an excellent learning opportunity as you will be expected to do this yourself as an FY1 doctor (oh, and maybe get another SLE signed off...)!
In the Evening: Reading
Placements can be tiring, especially if you’re not used to a full working day. It’s perfectly natural to spend the first week of placement going home and lounging in front of Netflix to relax your brain. As time goes on and you get into the gist of things, try to make a habit of making a list of the conditions you saw that day and reading up around them. If you start this habit early, you will find yourself becoming more confident in recognising common conditions and knowing how to manage them - helpful both for exams and real life clinical practice.
One final piece of advice. You will no doubt come across a placement where you are just not wanted. This may be because of junior doctors who don’t want you on the ward or teams whom you just can’t seem to get on with. Don’t worry about this; it happens to everyone. You will not enjoy every placement.
Try to make the most of the rotation and use your time wisely. If you find yourself just standing around doing nothing, go to the library and read. Go to the Medical Assessment Unit and ask to clerk a patient. Find another FY1 who is more interested in teaching and ask to shadow them instead. And if you find yourself staring at a wall in the afternoon... just go home (if you can). Remember, clinical placements should be a learning experience and not a waste of your time.
Sample Structure for documenting on the Ward Round
[Date & Time]
Ward Round (Dr Cons Name)
Age of Patient
Reason for Admission
(Often found in the notes - or on your list of patients.)
Subjective - How is the patient feeling? ‘Patient feels well.’ ‘Patient complaining of pain in right leg.’
Objective - Observations of the Patient
‘Obs stable, apyrexial.’
‘Sats 98% on 2L of oxygen, tachycardic at 109bpm, apyrexial.’
Assessment - The Examination
‘Abdomen soft, non-tender’
‘Erythema over right lower limb up to calf, tender, warm to touch’
Impression - What is going on?
[If you’re unsure about this, check with the team - you will need to listen carefully to what the consultant says to the patient e.g. ‘I think you may have a chest infection’]
'Impression: ? CAP'
Plan - What needs to be done?
[Again, check with the team.]
Chase bloodsCXR - ? left-sided CAP’
[Initials of first name and surname]
[3rd/4th/5th Year Medical Student]
(As a medical student documenting in a patients’ notes, a doctor should also countersign).
By Dr Gunjan Sharma