A week in the life of a medical student

University of Birmingham

Friar Chris, First Year

Year of Study: 2010/2011

Each day of the week at Birmingham corresponds to a specific module, so Mondays in Trimester 1 were 'MTM' - 'Molecules to Man' (cell biology, molecular biology, genetics, embryology), Tuesdays were 'CEP' - 'Cell Communication, Endocrinology and Pharmacology', and so on. Other than this broad allocation, the timetable is not fixed; every day of the week of every week has its own unique timetable, so you're issued a booklet for an entire trimester of timetabling at once. Thursdays alternate between Integrated Problems - self-directed clinical problem solving (a sprinkling of PBL, perhaps) and placement in local GP clinics.

Monday: Wake up, briefly curse doing medicine as I shower, dress and pack bags. Fast-march to the 0900 lecture and arrive about 0858 with a sigh of relief. 50% chance of getting breakfast, depending on whether one can muster the willpower to get up and eat it, or chickens out and takes an extra 10/15 minutes of sleep.

On the average Mondays, Tuesdays and Fridays (the days dedicated to biological science lectures, tutorials, cadaveric anatomy et cetera), one can expect between 3 and 6 hours of scheduled activity, but sometimes as few as 2 and as much as 8 hours. Earliest start is 0900 (which means getting up 0730-0800ish depending on where you live), and latest finish is 1800 (though these can overrun). These scheduled blocks can and frequently are separated by single free hour blocks, leaving you not enough time to go home, but too much time to wait for the next lecture or tutorial, resulting in you either sitting with friends discussing yet more medicine in the common room, or sitting with friends doing yet more medicine work in the library. It's not unusual, however, to get three consequential 1-hour lectures in the same theatre with no chance for a break.

Mondays are a special case for first years, as everybody has to train and qualify to provide Basic Life Support, and bar some special lectures that are a part of this ('Emergency Medicine and Triage Procedure in Guerilla Warfare' was one of my personal favourites, hehe), all of the lectures and physical training and examinations for this take place outside normal hours (but still in the medical school). You'll only have this for 4 weeks - the year is split up into 4 week rotations so not everybody is doing it at once!) but during this time, you'll be in the medical school until around 2200 (10PM, just to reinforce the message :P), and unless you're lucky enough to finish at 1600 in the afternoon, it'll mean no going home between the last lecture and the 1830-1900 start of training! My advice - bring a board game (articulate is good), because after 2 hours of solid and repetitive 'Patient is unresponsive and not breathing, starting CPR' *chest compressions*, even your teachers will be bored.

Tuesday: Much like Monday, but hopefully not as groggy in the morning, and looking forward to Wednesday (all will become clear). Different subject, but essentially identical set-up as Monday. Often a Tuesday night involves getting well and truly plastered (lashed, Voldemorted, 'keen' et cetera), because it's MIS tomorrow, and no-one really ca- I mean, everyone loves MIS and is diligent and gets to all lectures on time *cough*.

Wednesday: Ah, MIS day. 'Medicine in Society' spans both of the teaching trimesters at Birmingham, and is made up from things as interesting as Medical Law, Ethics and the Hippocratic Oath to things as downright patronising and nonsensical as being told that we're all racist, sexist and homophobic, being presented with 'feminist views of medicine' and guest speakers explaining 'spiritual healing' to a lecture theatre of people who have better things to do such as trying to learn a bucket-load of endocrinology and biochemistry for an in-course assessment the next week.

It would be fair to say that quite a lot of MIS is... 'missed' by 'ill students'. Lectures are not attendance-monitored, but I tried to attend most things. Some really genuinely were a waste of time and I don't blame the skivers, others were important. If your timetable reads 'alternative therapies lecture' you'd probably be safe not going - or maybe even better off spending the time on other work you're struggling with. Not that you heard that from me, no sir.

Wednesday does hold an added benefit though - it's a half-day off, even if you go to all your MIS (because we're all good, diligent students, yes?), there is nothing scheduled for the afternoon; lectures and tutorials tend to finish no later than 1300 and sometimes as early as 1100, leaving you free to do whatever (MIS will set you some self-directed reading to do, but it needn't be done that afternoon and it's usually only an hour's worth at most). There's plenty of time, so you can catch up on work, get that anatomy sheet done for Friday, file everything from the last few days, whatever. Don't overdo it with the work; some people stay for a few hours in the medical school or do a bit of work at home, but it's a rare chance for you to be out during daylight hours, instead of locked in the dark labs and lecture theatres of the medical school. The free time is situated perfectly mid-week, so let off some steam so you're motivated for the next two days; it's also a perfectly good opportunity to catch up with either other medical students who'll be celebrating their freedom in the light of day or non-medics who, as we know being slackers (jk ;) ) have the day off anyway.

Thursday: Thursdays alternate every week - one week you and your M-group will be doing 'integrated problems' from 0900, and the next you'll be on placement in a GP surgery (see 'Whilst on Placement'). Integrated problems is an interesting day; it's like a bit of PBL squeezed into our otherwise lecture/tutorial based course. We meet in a tutorial room at 0900 with our M-group and a 'facilitator' (what they call a tutor who doesn't really want to be in this morning) and are presented with a clinical case, which we split into themes, assign to 3-5 man groups and go away and research to prepare a presentation for 1400. The preparation is scheduled to be from 0900 to 1100, but in reality takes from 0900 to 0920. Which leaves your group with 4 hours and 40 minutes to prepare a 5-minute presentation which takes about 30 minutes to prepare. So, you group up with friends, get the work out of the way and chill in one of your flats with some tea and cake and have a good morning in, before popping into the medical school at 2 and getting all the presentations out of the way. Each group is meant to do a hideous load of bureaucracy, rating and providing critiques and coming up with questions for the presenting group, and documenting them. No-one bothers; the facilitator is usually playing on his iPhone because he/she is a junior doctor who realises the pointlessness of the activity as much as you all do, so you get it out of the way and usually have half an afternoon free. Good times.

Friday: It's Friday, Friday gotta get down on Friday.

Much like Monday or Tuesday, but with the promise of the end of the week and MedBar/a night out in sight, the day starts with friendly optimism, falls to a low of yawns and nodding heads by mid-afternoon but climbs back to a hive of frenzied happiness by the end of the day, as girls start the 5-hour process of deciding which colour underwear to choose for their night out and guys look forward to that nap before they spend 10 minutes getting ready to go out.

I keep mentioning all of these activities, but what do they entail? I'll give you a brief overview:

  • Lectures are pretty self-explanatory. They are almost all given to the entire year (bar some forums and first aid and BLS training lectures). These are not attendance-recorded at Birmingham, but that doesn't mean they're optional. I think we all know what lectures entail - some are more interactive than others - we have small digital voting pads issued to us at the beginning of the year (fit in your wallet; very small and light, and completely anonymous when you vote) that some lecturers use from everything to gleaning opinion to asking scientific or clinical questions - more often, however it's usually a lecturer putting in a series of pictures of scantily clad women and a vote option as to which is the most sexy (the irony when the year is 70% female. Can't say we're intolerant of lesbians, though). Lectures typically last an hour, but this doesn't mean they're short; it often may be that you have two or even three lectures without a break given by the same lecturer, on two different but related themes which perhaps elsewhere would just be labelled as one lecture.
  • (Small Group) Tutorials (SGTs) are done in your M-Group. I mentioned this earlier - this is a group of 15-20 people with whom you do all your tutorials, anatomy practicals, IPs et cetera. These are typically in-depth teaching as well as interactive work with an academic on something usually covered to some degree in a lecture already, but can rarely be group problem solving, and sometimes is just the in-depth work on your own - left as a group to manage yourselves. I'll just note that you'll spend a lot of time with your M-Group across the year - it's quite likely some of your best friends will be from this group, mine are, as is one of my housemates for next year. 
  • Anatomy Practicals (APs) are similar to SGTs (done in your M-Group) but take place in HTA-protected (phones off, no cameras, no food or drink, ethical standards apply extra) labs, with human specimens and videos demonstrating anatomy, histology and some cadaveric material that complements the specimens and models in the labs for you to use. These are lead by demonstrators who are usually junior doctors taking a year out or going into academia having just finished their SHO/FY2 year, and one is provided with a booklet of anatomy questions and instructions prior to the session which need to be completed if you really want to learn - these are detailed and doing all the work, drawings and answers for them can often take hours on a weekday night to do properly - it's a good idea to get them out of the way at the weekend, since they're typically made available to you on the webCT VLE weeks in advance. The content is quite exceptional - not only is there anatomy (not just pure, but functional) in great amounts, but it is also thoroughly integrated with clinical detail - the anatomy demonstrators themselves often being junior doctors can help a lot, and the set work always has large amounts of clinical correlation and research.
  • Cadaveric Anatomy (Prosect) is done through prosection. Yeah yeah, not as fun as dissection but if you've done your anatomy work you still learn loads - the specimens are amazingly well preserved and dissected, and you still get to stick your hands in and pull bits out and reveal the anatomy you're looking for; it's not just gazing at a nicely cut up body. The Prosectorium is state-of-the-art, and you visit in 2-hour sessions with one other M-Group and do rotations on each cadaver. Personally I find it really fun (I can be a bit morbid hehe). Others feel sick. Oh well.

Whilst On Placement: Whilst in GP placement, do as the GPs do. Usually great fun, bar one problem - the medical school set a bull**** list of things that they'd like you to do (usually involving lots of pointless common sense activities and bureaucracy) and want you to find out about patients' 'socio-economic background'. Errm, no. Luckily for you, most GPs are down-to-earth people, not academics sat behind desks at the university trying to fulfil diversity and tolerance criteria, and mine, for example, read through the entire day's worth of school-prescribed nonsense in about 10-30 minutes each week, made fun of it, then put us in appointments and do it the old-fashioned way; questions and letting you poke and prod patients. As I wrote in my reflections of a first year entry, the medical school will also probably tell you not to do anything fun - no blood taking, giving people their vaccinations, examinations et cetera. Whilst I certainly wouldn't suggest anything unprofessional or illegal, I would.. ahem... encourage anyone on their placement to... make the most of the 'opportunities' offered by the doctors that you're working with, who are normally more than eager to give you the chance to do this clinical work!

Dress smart, and do it with flair. Patients respect you as some sort of mini-doctor - always make sure they know your position, this is a legal and ethical standard, and never abuse this trust. They trust you, in some cases, as much as their doctors, and are willing to tell you personal details and spill emotions that they otherwise would not. I found that some patients even treated me with reverence; correct any who insist on calling you 'doctor', make sure they understand you're not yet even if they're going to keep saying it. It helps if you behave and act respectably - just doing enough to avoid being indecent and getting into trouble with F2P is one thing, but it's beneficial both to your own behaviour (tidy appearance, tidy mind) and the patients' perception of you if you dress smart. Suits are your friend, but feel free to do it with your own quirky flair too - babies and toddlers love bow ties, I might add! (I wear one now, yes, they're cool).

University of East Anglia

xXxBaby-BooxXx, First Year

Year of Study: 2010/2011

During Lecture Weeks:

Friday: I had to rearrange the days slightly, as at UEA, the week technically starts on a Friday. At 9am on a Friday morning I meet up with my PBL group, with the intention of getting two things done over the space of 3 hours. Firstly, we all present our previous week's PBL topic. This can be in the form of a presentation, a game, a wordsearch - anything you like, as long as it covers the topic.

After that, we look over the two PBL scenarios for the following week. We brainstorm (on average) 10 outcomes a week. The lecture and seminar titles can also give some clues as to what the outcomes are, and we have a facilitator to guide us towards the correct outcomes. We then randomly select an outcome each, and we also assign seminars to individuals for them to write up, as they run simultaneously, so it's impossible to go to them all.

Friday afternoon we have a one hour Clinical Relevance session - an interactive lecture based around a made up PBL type scenario, where we are quizzed about the answers to the previous week's outcomes.

Monday: Monday is a day of lectures relevant to that week's topic. The day usually starts at 11am and ends at 4pm, with an hour for lunch. The first lecture is usually a Research Methods lecture. If you do anatomy SSS (i.e. you are one of the three responsible in your PBL group for preparing the cadavers and presenting the anatomy to the rest of us) then the day begins at 8:30am, and then it's straight into lectures as outlined above. Most of the lectures are relevant to the outcomes, there are some that are supplementary that you may need to know for exams.

Tuesday: Tuesday begins at 9am with 3x1 hour seminar blocks. The amount of seminars in each block varies each week, and generally first year is where you have the most overlapping. On average, there are 3 seminars running at one time, although this drops down in later years I am led to believe. After that we have a one hour lunchbreak, and then we have two further lectures. That is the end of the timetabling on a Tuesday.

Wednesday: Wednesday is usually a day off, unless you have IPL teaching (inter-professional learning) or you do anatomy, where again you can be preparing the cadavers. Every other week is presentation of anatomy, where everybody goes to the dissection room for a couple of hours or so.

Thursday: This is GP placement day. Most Thursdays (apart from a couple where you have consultation skills training) are spent at GP practices, where you practise history taking, examination skills, and the GP tutor can give what you've learnt a more clinical grounding. Ideally, the patients you see on Thursday should have conditions relevant to the week you're studying for.

Of course, at certain points of the year you also have other assessments to prepare for in your spare time. Analytical Reviews are 2000 word essays where you critically appraise a selected research paper, by answering 12 or so questions outlined by the Research Methods team. SSSs are 10 minute powerpoint presentations based around a selected medical domain (e.g. biochemistry, law, physiology, pharmacology, ethics, sociology etc) researching a specific topic in depth using (hopefully) recent research papers. A portfolio essay is written once a year, which involves reflecting on your experiences based around a certain GMC guideline.

While On Placement: I won't do a day by day breakdown for this, as it's very variable. Basically, secondary care placements consist of structured patient teaching (where a patient with a specific condition comes in and the consultant talks you through the common signs etc), radiology teaching, surgery, sitting in on clinics, clerking patients on wards and also clinical skills training (so for first year this mainly consisted of cementing joint examinations in our heads and learning to administer IM and SC injections).

University of Manchester

UnicornSparkle13, First Year

Year of Study: 2015-2016

During Lecture Weeks:

Monday: Ah, PBL case open! I got really lucky and didn't have to start until 10:30am, but half of our year will start at 9. Every Monday, around 10 of us will sit in a room, armed with whiteboard pens and our PBL books, and we'll open a case. This entails reading through the case aloud, line by line, then picking out cues, such as "hypertension" or "rashes on skin", or even psychosocial cues, such as "felt nervous at the GP surgery". We put these all up on the whiteboard, and link 'em together. We then use these linked cues to come up with some questions that we'll have to answer over the course of the week, so we can discuss them on Friday. The entire process takes about 90 minutes. Every person has to look up all the questions, there's no sharing/ "You do questions 1 & 3, I'll do 2 & 4!" It's not too bad though. At some point during your first semester you'll have a couple of microbiology sessions on Monday afternoons. You'll either have anatomy today, or Friday. How fun!

Tuesday: Tuesdays will either be great, or terrible, depending on your timetable. We have three lectures, from 2-5pm every Tuesday. I didn't have anything in the mornings, so I got some PBL done. You might have EBM (Evidence-Based Medicine; basically stats) which lasts for an hour, Communications Skills, (2 hours) or in your second semester, Physiology & Pharmacology (2 hours) EBM's a bit naff, but the other two are great fun, are compulsory to attend, and although it sucks getting up early, it's worth it. Bring snacks to your lectures. You'll need them.

Wednesday: Three lectures in the morning, 9-12. Nothing special. That's it. Now go be a good little medical student and get dru-*cough* I mean, do some PBL :)

Thursday: If you didn't have EBM/Comms/Physpharm on Tuesday, you'll probably have it today. Some people have nothing at all. That's all for now, folks!

Friday: PBL case closed! You go in, waffle on about something you vaguely remember from your research, whilst staring down at the two pieces of A4 you're allowed to take in with you, and then that's it. You don't have to consider this case again until revision time! Hurrah! In the afternoon, you'll have either Anatomy (dissections) or Communications, or Physpharm. You get a nice break in the middle of the day though.

While On Placement: This varies. in first year it's gonna be around 8:30-12pm, and you'll have to make your own way there, unless you have a hospital visit in Preston - you get a coach. You'll have to dress smartly, and you'll pretty much go just to chat to patients.

Make sure you take notes! You'll need to keep a log of patients you've seen/met for your portfolio, as well as elaborating and reflecting on significant conversations with patients.

University of Nottingham

Fission_Mailed, First Year

Year of Study: 2010/2011

Monday: Shake off the Sunday night bar-crawl hangover and make it in by 9am. Monday is a solid lecture day, normally 6 hour long lectures (but often slightly fewer) with an hour's gap at 1 for lunch. The first semester modules are Molecular Basis of Medicine (abbreviated to MBM, biochem), Intro to Excitable Tissues (EXT, phys/pharm), Human Tissue Development and Differentiation (HDT, histology and embryology), Public Health (PH1), Behavioural Sciences (BHS), Early Clinical and Professional Development (ECPD or PD1) and Clinical Communication Skills (CS1). There are lectures for PD1 and CS1, but they aren't very numerous. The bulk of your time in LT1, the main lecture theatre, will be for MBM, HDT, PH1, BHS and EXT (which is a shared module with the pharmacists).

Mondays tend to drag massively, you'll often be expected to sit in LT1 for 4 hours on the trot. PH1 and BHS lecture attendance will drop fairly markedly after a few weeks but the other modules will still get a full house because they are pretty damned difficult and you'll want a much teaching as you can get.

The second semester is very much like the first, apart from the fact that the modules are different. From January onwards, you will be doing Cardiology, Respiratory and Haematology (CRH, phys/pharm again and still with the pharmacists), Clinical Laboratory Sciences (CLS, it covers genetics, pathology and immunology) and Human Development, Structure and Function (SF1, this is anatomy, brought to you by the sadists who run HDT). There are less modules, but the workload does kick up a notch, the three components of CRH are basically modules in and of themselves, and anatomy is terrifyingly big. Mondays and Tuesdays are mainly CRH and CLS, with very occasional SF1 lectures to introduce a new limb.

Monday night is Oceana or Mirage. It's sticky and horrible but I know medics who went to one of the two every single Monday for the entire year.

Tuesday: Like Monday, but sometimes you'll have 7 hours of lectures. Tuesdays tend to be broken up with workshops and microscope practicals. The workshops are for EXT and MBM; there is a series of ridiculously hard questions for each one in the module handbooks. You're supposed to attempt the problems in your own time, then you spend an hour or so with a group of about 25 and a lecturer/academic going through your answers and workings. It is at this stage you will realise that the questions were in fact very easy and you completely overthought all of them. Make sure you do the work beforehand. People chance it, but somebody always gets picked on to write their answers with their method on the whiteboard. The microscope labs each hold about 120 people, so the cohort is split into two for these. You sit down, set up your microscope and look at a bunch of pink things on slides, while a lecturer with a microscope hooked up to a TV and a microphone explains what it is you are meant to be seeing. There is space in the handbook to draw what you see and note down key observations; nobody does this. With hindsight, we probably should have, because the HDT exam was rock solid. There is also a "Microscope Driving Test" which everyone must pass before they can complete the module. All you have to do is correctly focus a microscope without any help or written notes; it is spectacularly easy yet people still fail it.

Tuesday mornings tend to be horrible due to the aforementioned Monday night, and the tendency of the EXT lecturer at 9am to turn the lights down too low. People sleep in public health for entirely different reasons. There isn't really a big club night on Tuesday, but a few societies have their weekly social.

Wednesday: Wednesdays are half days, so whatever you get up to it should be done by 1pm at the latest. Lots of stuff gets done on Wednesday mornings, mostly PD1. This comprises two GP visits and two hospital visits per semester. Everyone is assigned to a GP somewhere in the city, and once you've made your way there in time for the start of their working day (getting to mine involved waking up at 6:15 and catching two buses) you spend the morning sitting in on their consultations. During each visit you are expected to record the details of each consultation you see into your ECPD logbook. These consultations will go on to become your ECPD coursework, which is worth 50% of the module, the other 50% being the OSCE in June. As you progress through the year, your involvement with the consultations will increase. By your second placement, you should be taking histories from certain patients before they see the GP and then presenting them at the start of the consultation proper. You also have to record yourself interviewing a patient, transcribe it, and analyse your communication skills for the coursework which makes up 100% of CS1.

In practice, what each student gets out of a GP visit depends entirely on how they approach it and how willing the GP is to play along. I got lots of opportunity to practice clinical skills, e.g. my GP tutor taught me how to take blood pressure before we were taught how to officially, some people will get to make house calls, some will be given lots and lots of opportunities to talk to patients alone and present them, whereas some, like me, will barely speak to any patients without the GP present. Following each GP visit, there will be a PD1 seminar where you discuss the learning objectives from that visit. It is here that you are taught how to take a history, and stuff like mental health & capacity and the doctor patient relationship is brought up here.

Clinical skills teaching for the OSCE also takes place on Wednesdays in the Clinical Skills Centre, a mocked up hospital ward with all of the gubbins that a medical student could possibly want.

Hospital visits occur across several sites (QMC, Nottingham City, Kings Meadow and Derby off the top of my head) and are an opportunity to put recently aquired clinical skills into practice, so a couple of weeks after learning how to perform a respiratory and take a history, you will be dumped onto a resp ward and told to get on with it. Aquiring clinical skills at this stage may not be all that important, but it is jolly good fun and the post-visit debriefs with the registrar I was attached to are some of the highlights of my year.

Wednesday afternoons at uni are sport, and the big Wednesday night out is Cr-isis in Rock City. Marginally less sticky than Oceana, and closer to town than Mirage, it is normally a good night because you will see plenty of people you know. In the second semester, Wednesday afternoons take on a new significance as you find yourself doing all of your dissection prep work. Turning up to a DR session without having read the relevant chapter and made notes is suicide, you haven't been chewed out until you've been chewed out by a retired surgeon who now spends two mornings a week being mean to medical students.

Thursday: Thursday is a bit of a mish-mash. There are lectures, lab practicals for EXT, more workshops, more microscopes and occasionally PBL sessions for BHS. There only tends to be ~4 hours of actual contact time, but this can be spread through the day; sometimes we have a hectic morning and are done by lunch, but normally you have a few sessions in the morning, then a 2 or 3 hour gap before your final couple of lectures/practicals. I tend to go the library and read the papers, or just go back to my room for a kip.

In the second semester, half of the year dissect on Thursday, and half dissect on Friday. DR sessions are 3 hours long and break down as follows- half an hour of initial teaching in a side room as one of the dems explains what you need to do (you should already know this, quite a few of them will undertake impromtu testing at this stage). Then half of the 10 people in your group will head out to the cadaver and work on it for an hour. The other half will carry out the tasks in the module handbook, looking at radiographs, examining bones, labelling diagrammes, etc. A bell rings and you swap place, then an hour later each group of 10 will gather around the table for an oral assessment, both of the quality of the dissection and of theoretical knowledge. *******ings at this stage are not rare, so be prepared!

We leave the DR smelling of formaldehyde and needing a bacon sandwich more than anything in the world.

Friday: Normally a pretty light day. Clinical skills and labs. It isn't uncommon to only have an hour in the medical school, and you'll get a fair few Fridays off completely.

Friday night is Ocean, it is the stickiest and most horrible place in the entire world, but some of my very best nights at university have been here because absolutely everyone you know, from every year, will be here. Guaranteed.

While On Placement: See "Wednesday" for information.


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