Students often feel intimidated at the idea of coming to clinical areas for the first time. This might still be an issue for some students in senior years, when they are starting to consider applying for the Foundation Programme.
What can students do to make their transition from university to the clinical world and the world of work as smooth as possible?
I make no excuses when I say that this is a personal piece written from the point of view of a hospital specialist, although I think that much of what I say will apply equally in general practice.
I remember well-meaning and highly intelligent students trying to make themselves seen on teaching hospital ward rounds. They weren’t always the ones that stood out, or sometimes they stood out for the wrong reasons... With the benefit of hindsight, I would give them the following advice.
Patients are king
Whatever you do, you must try and put patients at ease. No matter how intimidated you are it is very likely that it is worse for the patients. For many of them this will be their first exposure to hospitals as well; you get to go home at night, whereas they may still be in-patients. You might be the only ‘doctor’ (even if you aren’t) they remember, so make the encounter memorable for a good reason.
Treat them with respect, no matter how difficult that might be. You can never tell what things have resulted in a patient behaving in a particular way; the obnoxious drunk might have just lost his partner. Keep your voice down when talking to other members of staff, and never make disparaging comments about a patient.
The granny test
This also relates to patients and how they should be treated. Think about how you would feel if you saw your granny being talked to or handled (during an examination) in a thoughtless or rough way.
We know that you are desperate to show that you can test plantar responses properly and know when to do it, but please ask the patient nicely and tell them what you are going to do before ‘tickling their feet’.
Doctors are always impressed when a student speaks to a patient, rather than just to their supervising doctor and refers to the patient by name. ‘She is the cat’s mother’, as my granny used to say!
Treat patients with respect, no matter how difficult that might be.
Do the work
If you are turning up on a General Medical take then there is a fair chance that some common conditions will be encountered. No one expects you to know everything, but you should be aware of the features of sepsis, acute coronary syndromes, cardiac failure, DVT, and so on.
Similarly, don’t turn up in a neurology clinic without knowing the difference between an upper motor neuron and lower motor neuron sign.
If you encounter an interesting patient or something you have never seen, go and read up on it that night. It will make it easier to recall what to do when faced with it in 18 months’ time in the middle of a busy night shift.
If you know what is going to be discussed at a tutorial then, again, do the reading. I cannot stress enough that the doctors who are teaching you have got plenty of other things to do, and they are usually unimpressed when teaching stalls as no one has bothered to look up a textbook.
Students who make an effort are always noticed.
Watch the juniors
You may want to be a consultant orthopaedic surgeon, but you only get to be one by being an excellent junior doctor. The work the junior doctors do – for instance, the foundation tier of trainees – is fundamental to the care of patients.
Students who make an effort are always noticed.
Learn how to take bloods, put in cannulae, catheterise and understand fluid prescriptions before you get too carried away with how to nail a fracture.
Consultants are always impressed when a student knows what is required of a junior team member and gets it done or helps to get it done efficiently.
The only stupid question is the one you don’t ask
I think this speaks for itself. We all want to appear clever, and some of you are genuinely super clever. However, no-one can know everything and it is always a good idea to ask ‘why?’ if you don’t understand something.
Try not to do this in front of patients, but afterwards in private or in group teaching – otherwise the answers to those questions might contain difficult words and concepts that the clinicians aren’t at the stage of discussing in detail with patients.
In the same way, when someone asks you a potential differential diagnosis and you know it might be a malignancy, try saying ‘neoplasia’ rather than ‘metastatic cancer’. The doctor may still need to sit down with the patient and discuss things, and you may not know what that patient wants to know about their condition.
Consultants are always impressed when a student knows what is required of a junior team member.
Ask to get involved
As long as your tutors don’t mind and you aren’t in the way, come to the ward out of hours and see how it works; ask to get involved in an audit or two; ask if you can go to theatre.
On the last point, a word to the wise – operations are often life-changing and you see patients at their most vulnerable. Bear this in mind when assessing what to go to. Make an effort to introduce yourself to the patient at a convenient time before surgery and ask if they would mind you observing. It is always impressive when a student has gone to that effort, and even more so when they have read up on the procedure at hand.
Try not to argue
You are all very intelligent and have time to learn about the things that excite you in detail. Sometimes your teachers will say the wrong thing or make an error. They are only human, and I would recommend that you are forgiving of their frailties.
That isn’t to say that you shouldn’t speak up when things seem wrong. You are learning to be professionals, and when things seem wrong they probably are.
Listen to the nursing staff
The ward, clinic and practice nurses may have years of experience. Watch who your consultants turn to when they have questions or concerns; I suspect that much of the time it will be a senior nurse.
If a nurse says there is a problem, there almost certainly is and you should at the very least listen. Even if you feel a nurse is wrong, you should listen respectfully and address their concerns.
If a nurse says there is a problem, there almost certainly is.
You don't have to be an extrovert to succeed
Medicine is a broad church and there is a role for almost everyone who can pass through medical school. Don’t feel you have to change into a particular type of person to succeed; there are introverts and extroverts in all fields.
That being said, if people are telling you there is an issue, it is incumbent on you as a future professional to listen and reflect. It’s how we all grow, and all your mentors want is to see that you are listening and changing in a positive way.
As regards choosing your jobs, if you want to be a clinical academic it is probably best to spend as much time with them as possible. However, there is more to life and learning in medicine than academic foundation jobs or jobs in academic units.
There are lots of good jobs out there and, for some, a district general hospital or a few months in general practice seeing how the vast majority of medicine is practised, is just the sort of environment that is required to grow professionally. Both are likely to offer more learning experiences than clerking in another liver resection in a teaching hospital.
All that glistens is not gold, and the fundamental skills of being a good doctor are equally, if not more, likely to be learned in a more general environment where responsibility is likely to come earlier. It takes different strokes for different folks.
However, I firmly believe that if you make patients your main concern and are respectful of the contributions of the whole team, then you will gain the respect of the team and get that dream job.
Mr Jerard Ross
Jerard graduated from the University of Aberdeen in 1994. He then moved into surgical training in Edinburgh before completing his MD at the University of Manchester. Before joining the MDU he was a consultant in adult and paediatric neurosurgery in Edinburgh where he was the surgeon to the Scottish National Paediatric Epilepsy Programme.
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