To write this as a final year student is a surreal experience. I can still vividly remember my first day on placement. I remember the smell of freshly ironed scrubs as I hung them up the day before. I remember the bus route that I would take a hundred times over the next three years. I remember all my classmates crowding around the reception, trying to bleep their respective teams, only to have the overworked intern respond with a heavy sigh. I remember the weight of my stethoscope around my neck as I walked the hospital wards for the first time. I can still recall the name and face of every patient I talked to and every staff member who gave me a second glance. Most of all, I remember the absolutely terrifying feeling of transitioning from lectures and MCQs to hospital wards and OSCEs. I know many of you are starting placements soon, and for the majority of you, this will be your first clinical experience in your medical journey. Here are some things I wish I had known before my first placement.
- It’s terrifying–get used to it!
If you are an anxious-type A person, the idea of going from lecture halls to a morning meeting filled with nurses, SHOs and consultants may feel terrifying. I am here to tell you that it is! I am not trying to scare you, but the sooner you accept that you are going to feel uncomfortable and out of place sometimes, the sooner you can work through those feelings and find your footing. Being the most junior part of the team can be daunting, but it also gives you a unique strength of being able to make as many mistakes as you can (and learn from them!)
- Do your future self a favour and keep good attendance.
I know, I know – you’ve read the word’ attendance’ and have probably rolled your eyes, let out a huge sigh, and had a whole body shudder. I did the same. Here’s a fact: good habits go a long way. If you start your first placement with questionable attendance, the truth is you might carry that habit throughout the rest of the years. It becomes increasingly difficult for you to attend if you become used to attending only one day a week. This is particularly true in your senior cycle, where attendance is closely monitored for a good reason. This brings me to my next point:
- Medicine is learnt on the wards.
No amount of books, lectures, anki decks, YouTube videos, or practicing on your poor unsuspecting roommate will equate to the knowledge you get from being on the wards. There is always something to do and always something to learn. From morning rounds, OPD, theatre, grand rounds, departmental teaching – there is so much to do! The information you get from being in the hospital, from interacting with patients and staff members, is the type of information you’ll never forget again. A common phrase clinical tutors like to say is ‘you can get as much out of this placement as you want’. This is SUCH an important statement. The truth is, you get to control how much exposure you get out of this placement, and a huge part of this is how you interact with your team.
- My team refuses to acknowledge me!
Imagine this: you’re on your first day of placement. You’ve gotten up at the crack of dawn to catch the bus. You could barely sleep the night before from the anxiety. You go into the ward, equipped with your stethoscope, hammer and Oxford Handbook. You find your team huddle, sneak in the back, and remain quiet. Your team finishes the huddle, and everyone disappears. Nobody gave you a second glance. You walk around the ward, confused and dejected, for the next 2 hours before taking the same dreaded bus back to the library.
Here is the reality: you are a SHO on a busy ward. It’s Monday, which means you’ve got an influx of new patients over the weekend. The weekend team does the handover. You’ve barely slept, you’ve not had your coffee yet, and you’re pretty sure you’re wearing two different pairs of shoes. You vaguely remember an email about medical students coming this week? You can’t tell, because 20 people are surrounding you, some familiar and some not, and you don’t have the time to ask everyone individually. The meeting finishes, and you brush past the student glued to the wall without another glance.
Interacting with your team is such an essential part of your placement that I could write a whole separate article on it. Here are the key points :
- Introduce yourself: This sounds obvious, but you would be surprised at how often you would forget to introduce yourself when you’re nervous– it applies to everyone on your team. The doctors, the nurses, the patients!! Saying “Hi, my name is X, I’m a 3rd year medical student, and I’m placed on your team for the next two weeks” goes such a long way.
- Ask for the team schedule: Every team has a schedule. Whether medical or surgical, all teams will have different times for clinics, rounds, teaching, and so on. Take a moment to ask the intern or SHO for the schedule for the week. Clarify what time they start, which wards they are on, and where to meet in the morning. However, remember that these timings are often not rigid. Ask a member of the team for their phone number and do not be afraid of contacting them!
- Nurses know best: No one knows a patient like the nurse taking care of them does! Nurses are in constant contact with patients. They know their families, their neighbours. They’ve heard about their grandchildren’s First Communion and learnt the names of all their pets. One thing I would never do is visit a patient without first informing the nurse in charge. Some patients are not suitable for examination. Hearing difficulties, cognitive impairment, and patients who have had a rough time in the hospital are things you will frequently stumble upon. Introduce yourself to the nurse, and ask who on the patient list is suitable for a history/examination. If you’ve seen a patient previously on rounds and they seemed appropriate, I would still ask the nurse for confirmation. The patient may have received bad news, be feeling unwell, or be in pain. Asking beforehand will save you from being in an awkward or uncomfortable position.
- Not everyone is friendly: There is an assumption that since medicine is a caring profession, everyone who practices medicine is caring. Unfortunately, that is not true. The truth is, the majority of hospitals are understaffed. Staff are overworked and underpaid. You might come across people who have had a bad day or those who might not be interested in teaching or helping you. While that is rare, it can happen. My advice: DON’T TAKE IT PERSONALLY! It is easy to become insecure and withdraw from the team. I can honestly say that 99% of the time, it is not intentional.
5) How to be an active member of the team:
In my first placement, I fell into the trap of being a passive member of the team. I attended every dreadful 8 a.m. morning round, the five-hour clinics, and the confusing departmental teaching sessions. But other than standing there being silent, I did nothing. It was frustrating because I knew I wasn’t participating, but I didn’t know what to do about it. I also felt like a burden to my team! Looking back, there are many simple things that I could have done to make my integration into the team easier and more useful.
- Ask for the patient list: Having a list of the patients on your team is essential to help you remember patients and their conditions. Asking for a patient list each morning will demonstrate to the team that you are interested and not just a passive participant.
- Offer to grab the patient charts and Kardex: Check the patient list and grab each patient chart and Kardex before the morning rounds. This small gesture can make the team aware and appreciative of your efforts. Also, don’t forget to put everything back in its place! A chart or kardex out of place will cause a lot of groaning and grumpy staff in the ward.
- Offer to write notes: If you are working with the intern, you can offer to write down the notes for the rounds. Interns are usually assigned stable patients with minimal comorbidities; therefore, their notes should be simple and direct. Ask the intern whether you can practice note-taking!
- Find out where the forms are: If a patient needs to have blood taken, physiotherapy request, dietician input, etc, you will see your team grab the appropriate request forms. Learning where they are kept, offering to bring them, and even offering to fill them out can make you feel more confident and comfortable in your position on the team.
- Close and open the curtains: This is probably the simplest thing you can do! You would be surprised by just how much a team appreciates a small gesture like that. Whenever you are rounding with a patient, make it your task to close the curtains around the bed to ensure patient privacy. Once the team has finished their discussion with the patient, ask the patient whether they would prefer the curtains to be pulled back or left in place.
6) Go easy on yourself!
It is very easy to get overwhelmed and lost in the chaos of the hospitals. The healthier you are, physically and mentally, the more you will be able to achieve. So, enjoy your time! Don’t compare yourself to others! Allow yourself sick days! Don’t stop practicing your hobbies!! You have only just begun, and medicine is a marathon, not a sprint. You don’t need to know every examination from the first day. You don’t need to have taken 15 histories, three sets of bloods, and have somewhat performed lifesaving cardiac surgery in the parking lot within the first week. Pace yourself. It is a long way, but the finish line is nearer than you think..