Tips for clinical years

Hello everyone!

I am really sorry if this has been asked before (if so, please link me)! I am heading into clinical years soon and I am feeling excited, but also slightly nervous.

My course is very traditional in its curriculum and has a very clear preclinical/clinical divide. I am so used to lecture - based learning and taking notes that I have no idea how best to tackle clinical years. How do I make notes? How much do I need to know? How do I know what I need to know? Is it better to stay in the hospital for as long as possible learning from patients, or, is it better to dedicate a lot of time to bookwork just like we did in preclinical years?

To those who are clinical year students/recently graduated: what is one thing you wish you had done earlier on which you only picked up later with experience?

Any suggestion would be really helpful.
Thank you :smile:

Reply 1

Beska

Original post by Cephalosporin

Clinical years are a very different beast to pre-clinical but don't get too hung up on the difference (and panic about "am I doing this right?" in typical medic style). You'll fall into a routine which suits you, just like you did in pre-clinical (when you likely had the "am I doing this right?" question in regard to the difference between A-Levels and university).

- Trust your medical school's curriculum - it's been well thought out (allegedly anyway!) and has served your senior colleagues well, so don't go rogue. Learn things in the order you're taught them and use your log-book (ack...) and learning outcomes to direct your learning. But then again, you're not likely to be able to cover everything within the time they give you in the detail you'd like - classic "how much do I need to know?"

- Make notes around your learning outcomes, or things that interest you, or patients you see (people really emphasise this point constantly, but sure if it works or not, but hypothetically it does). Use the OHCM as your bible (it's all you need to pass finals, ish) but if you're learning a condition from new consider Kumar and Clarke or your favourite equivalent. Use patient.co.uk and UpToDate, and always look at NICE guidance.

- You learn best from patients and being on the ward, but if you're not learning then there's no need to be there.

- Don't neglect your clinical skills for bookwork. Equally don't neglect your bookwork for clinical skills. Don't forget you're learning to be a doctor so don't ignore all the doctory stuff that the curriculum ignores (where are the drug cards kept, what's the phone number for pharmacy, what do you do if a patient's relative asks you a question?)

Reply 2

Beska

May be useful: http://www.thestudentroom.co.uk/showthread.php?t=2684711

Reply 3

*pitseleh*

Original post by Beska

Don't forget you're learning to be a doctor so don't ignore all the doctory stuff that the curriculum ignores (where are the drug cards kept, what's the phone number for pharmacy, what do you do if a patient's relative asks you a question?)

This, 100%. I feel like med school was good for teaching me how to pass finals; not so great at teaching me how to actually function as an F1. I realised this during final year and spent some time trying to learn 'how to be a doctor', but I wish I'd started doing that earlier. This isn't necessarily that important in the earlier clinical years, but definitely worth paying attention to in final year.

Other than that - make notes on things you've seen in clinical situations, preferably some time during the same week; medical facts stick in your mind easier when you can link them to a real human being that you've seen. Get your clinical skills signed off as early as you can; running around in final year trying to get someone to observe you inserting a catheter/doing a subcut injection when your time would be better spent revising is no fun at all. And don't stick around on the wards if nothing is happening - there's little that's more boring than just waiting around for something to do. If it's quiet, go home/to the library/somewhere else in the hospital where interesting things are happening; life is too short to just hover on a quiet ward! :smile:

Reply 4

Etomidate

Find a foundation doctor that enjoys teaching and stick with them. But at the same time, know when to ask questions and when to leave him/her to it for a little while. It's a busy job and medical students can slow you down to a halt (sorry!).

After the ward round, ask the juniors what's on the jobs list. Even better, create your own list as you go around and offer to split the jobs. However, remember that you're there to learn rather than be a blood monkey. Do bloods in return for teaching. If I have a medical student with me who is keen to help out, I'm more inclined to sit them down with an x-ray, ecg, bloods etc and talk through them, test them, offer advice etc.

If the ward is quiet, don't feel like you need to sit there twiddling your thumbs. Go home, study, sleep, go outside, go to the pub. Whatever. At the end of the day, you're a student and there is more to life than medicine.

If you're feeling particularly keen, pop your head into a different ward, ask one of the juniors if there are any good patients - go clerk them in retrospectively. Have a think about differentials and what investigations you would order and why, come up with a management plan. Then present it to the junior and you can compare your notes with the clerking notes. See if they match up and how the investigations panned out.

That's about it really.

(Also if you plan on coming to the mess in droves, eating all the bread and drinking all the tea - pay mess fees. It comes out of our wages. That said, a cheeky cup of tea here and there is all good).

(edited 7 years ago)

Reply 5

Ghotay

Original post by Etomidate

(Also if you plan on coming to the mess in droves, eating all the bread and drinking all the tea - pay mess fees. It comes out of our wages. That said, a cheeky cup of tea here and there is all good).

What?

I've never been in a hospital with a 'mess', so am genuinely curious about these mess fees, and provision of bread

Reply 6

Number 9

I second everything that's been said so far. In addition just make sure you're proactive in seeking out opportunities. Don't be afraid to ask if you can watch something or be involved in what's going on. And feel free to branch out beyond the team you're attached to if things are quiet on your ward.

In terms of ward work vs. book work, remember that there's plenty not on the curriculum that's important to know to function as a doctor but equally there's lots of must-knows for exams that nobody will mention to you on the ward. Keep both the immediacy of your exams and your future job as a doctor when you're deciding what to learn.

If you find it helpful (I definitely did this year!), share things you've seen and learned on the ward with friends attached to different teams and in different specialties. Everyone has unique experiences and learning opportunities during clinicals so talking about and sharing those experiences with each other really helps broaden your knowledge.

Reply 7

Helenia

Original post by Ghotay

What?

I've never been in a hospital with a 'mess', so am genuinely curious about these mess fees, and provision of bread

They are real! More likely to be found in non-London DGHs, in my experience. Well, all the London hospitals I worked in technically had one, which we paid £10-15 a month for, but were all so inconveniently located that I almost never actually went to one. The money usually goes towards tea/coffee/bread for those able to make the trek *cough*surgeons*cough* sometimes newspaper/Sky subs, plus a bar tab for any mess socials that get arranged. This last year has been the first when the mess has actually been located somewhere I could easily access in the daytime, and was regularly frequented by all grades of junior doctor.

When I was a student most of the East Anglian DGHs had messes of some sort, and most would allow students to share the facilities (it's a handy place for morning coffee pre-ward round or informal teaching) but they started to get pissed off with how much of the toast got eaten by students - which is understandable when there are 40+ of them not paying mess fees!

Reply 8

Cephalosporin

Thank you so much for all your help and tips. :smile:

I will definitely try to strike a good balance between passing exams and "learning to be a doctor", as well as book work and ward work.

Reply 9

junior.doctor

When you're learning examination techniques, the best way to be able to recognise when something is abnormal, is to know what normal sounds / feels / looks like. *Students are often (understandably) hunting for 'clinical signs', but also make sure that you take the time to examine lots and lots of normal chests, hearts, abdomens, ears… *You're going to listen to someone's murmur / look at their rash? *Do a full examination, or at least take the opportunity to examine another system or two as well. *

I also second the advice to get a good balance between ward work and book work. *On one hand, it is very obvious in OSCEs which students have spent the year in a library and have rarely examined an actual patient (especially in paediatrics!) - but at the same time, certain clinics / theatre sessions / ward time will be less useful, and being able to recognise these and do some book-learning instead, is valuable.