*Context: I wrote a thing for my medical school corporate blog. Here it is
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Hi 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. Take histories
Lots of them. If possible, take all of them. And then take some more. I used to dread history taking. I avoided it like MRSA. Nothing's worse than being stuck with a blank sheet and a blank look on your face trying to think of what comes after past surgical history while the patient sits there staring impatiently at you. That is, unless you then try and present that history to an irritable and overworked consultant. History taking is a vital skill which will either haunt you or serve you wonderfully throughout the rest of your medical career. It's important to get used to it early on as the ability to take a thorough and focussed history will be a major asset, if not essential, in virtually every single one of your future placements, as well as the OSLER exam at the end of the year which will test you specifically on this. The earlier you get comfortable with this skill the better. If you're one of those people who 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 improve is just by doing it over and over again 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 to doctors on the ward is great for highlighting things you may have forgotten to ask. The most important thing here is understanding the rationale behind each question. One of the biggest mistakes I made in CP1 was rattling off the questions mindlessly like a checklist, instead of purposefully asking questions 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 an irritable 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. 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 a 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.
3. A little introduction goes a long way
It's always daunting, your first day on the wards. You don't know where anything is or who does what or why everyone is ignoring you. Anxiety is like a bad smell - a natural deterrent to human interaction. The ultimate solution to this problem is to gain confidence by growing your knowledge, familiarising yourself with your surroundings and accruing small successes throughout your clinical experience, but this takes time to happen. Meanwhile, you can combat the rancid odour of your nervousness by being polite. 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 interaction 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. Obviously, be courteous when trying to get their attention. A simple 'excuse me' or 'hi' tends to do the trick. Alternatively, subtly manoeuvre your expectant gaze into their field of vision. If none of these things work, it's likely that he/she is wilfully ignoring you. In that case, try some other time or try somebody else. Remember to smile. Smiling helps a lot. 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 tend to be experts at tactful interruption. Eventually and with enough practice, this will come naturally to you as well.
4. You're expected not to know things
As a student, this is your golden opportunity to ask dumb questions, because you're almost expected to. Once you're out of medical school, dumb questions are far less forgiveable. So ask now. Ask with all you've got. Ask them till you've got none left. That being said, try to avoid questions that can be answered by an understanding of basic anatomy / physiology. Everything else as far as I'm concerned is par for the course. The worst that'll happen is you'll be told to read up on it at home. Also, don't be discouraged or take it personally when consultants make you feel dumb. They don't do it on purpose, it's just their nature. And don't just ask for the sake of asking. Doctors can tell and you look like a lemon. Learn to identify the junior doctors / nurses / registrars / consultants who are willing to teach (they will look friendly and not sigh as much when you talk to them). Make the most out of your time with them. Squeeze them dry and thank them profusely afterwards.
5. You're allowed to be there
When I first started clinicals, I believed that my presence on the wards or in the clinics was somehow encumbering its function. Some of the people I encountered during CP1 certainly made no effort to hide the fact that they shared this belief. You can't really blame them though. 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 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. He went on to tell me that hospitals and universities are paid enormous amounts of money to teach medical students how to be doctors, therefore apologising for being on the wards is as absurd as apologising for coming to lectures or attending a tutorial. Teaching is part of the job. It's even in the Hippocratic Oath. I came to realise that if I didn't make myself a nuisance now and learn what I needed to, I'd become an even bigger burden two years down the line when the workload and responsibility increase exponentially. I decided that I'd much rather cause a minor inconvenience now than be a major one when I qualify.
5.5 It's going to be alright
If I had a sixth thing to tell myself, it would be 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 may 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.
