Tips for the Wards

I’m hoping to provide some honest and practical tips to help you make the most of your clinical placements / work experience attachments. Even if you aren’t starting clinicals any time soon, you might find it useful. The important thing is to stick with it — do your best, don’t give up, and for goodness’ sake iron your shirts.

JonHi there, my name’s Jon and I’m a fourth-year medic doing Specials at Mansfield at the moment. Equipped with six months and two weeks worth of hindsight, I’m hoping to provide some honest and practical tips to help you make the most of your clinical placements / work experience attachments. Even if you aren’t starting clinicals any time soon, you might as well scroll through. This catalogue of previous shortcomings and avowed ineptitudes will at best inform and at worst serve to amuse.

1. Talk to patients

Take histories. Lots of them. If possible, take all of them. History taking is asking a patient questions to formulate a diagnosis and management plan, and I used to dread it. Nothing’s worse than being stuck with a blank sheet and a blank expression, trying to think of what to ask while the patient sits there staring impatiently at you.

History taking is a vital skill which will either haunt you or serve you wonderfully throughout the rest of your medical career. The ability to take a thorough and focussed history will be a major asset, if not essential, in all of your future placements, as well as exams. If you naturally know which questions to ask and have the Calgary-Cambridge framework entrenched within the essence of your soul, good for you. But if not, you’ll have to work at it, and the best way to get better at it is just by practising and learning from your mistakes.

Once you’ve taken your history, go over which questions you have missed out – what you should have asked – and remember to ask them next time. Presenting your history and discussing it with doctors on the ward is great for highlighting aspects you may have forgotten to ask. The most important point here is understanding the rationale behind each question you are asking to help exclude or support a particular diagnosis. Once you reach that stage, it’s less like going through a checklist and more like solving a puzzle. That’s when it gets challenging, and that’s when it gets fun. Of course, this presupposes some knowledge of common diseases and their presentations, which normally gets covered during tutorials and in weekly lectures, but you’d be surprised by how much clinical knowledge one gains just from being chewed out by a consultant on the wards.

The sooner the process of history taking starts to become an automatism, the sooner you can focus on thinking about possible diagnoses while speaking to the patient. This will then determine which questions you should ask and also help you with presenting your findings later in a clear and structured manner. It took me longer than I’d care to admit before I finally realised this.

2. A little introduction goes a long way

Remember when you were taught to always introduce yourself to patients as a matter of basic courtesy? This applies to doctors and nurses too. It makes a lot of difference, saying good morning and initiating interactions instead of shuffling around uncomfortably in the background waiting to be asked who you are. Staff are more likely to help if you have made the effort to make yourself known, plus being civil just generally improves the working atmosphere. Give consultants an opportunity to acknowledge your existence by introducing yourself and asking if you can join their ward round/theatre/clinic. I used to think it was an unforgivable sin to interrupt a healthcare professional in the midst of doing something. It turns out, they don’t mind too much if you have a good reason for interrupting them. Nurses and doctors appreciate enthusiasm and are more likely to involve you if you actively show it. If you’re still struggling to get the hang of engaging with strangers, observe the foundation year and core trainee doctors. They are experts at tactful interruption. Eventually and with enough practice, this will come naturally to you as well.

3. Learn the surgical sieve

This. Consultants have a habit of asking medical students what the causes of things are. My go-to move when that happens is to physically and mentally freeze up, look around me in a panic as if the answer is lurking somewhere in the periphery of the room, say ‘umm’ a few times, and then offer up some dumb sounding suggestion in a tiny, apologetic voice. I mean – that was before I learnt the surgical sieve. Essentially, what it is is just categories of diseases – the main ones being Vascular, Inflammatory / Infective, Trauma, Autoimmune, Metabolic, Iatrogenic, Neoplastic, Congenital, Degenerative, Endocrine and Functional. The mnemonic I use is ‘VITAMIN CDEF’. Trust me, it’s a lifesaver – definitely one worth learning. Now at least my answers have some structure before they get shot down.

 

4. You’re allowed to be there

When I first started clinicals, I felt that my presence on the wards or in the clinics was somehow encumbering its function. Having a medical student around does slow things down. We take ages to clerk, make mistakes, plus having to teach means having less time to treat. However, about halfway through Clinical Phase 1 (CP1), a clinical teaching fellow in Lincoln told me something I’ll never forget. He said that no matter how much of a nuisance I believed myself to be, I had a right to be there and make a nuisance of myself, so long as I was learning something in the process. Effectively, he was saying not to let my fear of getting in the way get in the way of my learning. It’s natural to feel slightly out of place at the beginning, but since getting into the swing of it, being on wards and in clinics has become one of the most rewarding and interesting parts of medical school. Don’t worry if it’s taking some time to get there. Everyone has to start somewhere.

 

5. It’s going to be alright

My fifth and final note to my CP1 self is this: Medical school is tough, and it keeps getting tougher. There will be days where you feel like giving up and just quitting med school to work on your comedy, but don’t do it. You might think you aren’t intelligent or hardworking or determined enough, but that’s not true. Trust me, I’m from the future. You are going to make it. The important thing is to stick with it — do your best, don’t give up, and for goodness’ sake iron your shirts.