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The transition from second to third year can be a daunting one. Whilst the traditional pre-clinical/clinical split is no longer as popular as perhaps it once was amongst medical schools, there is still an obvious change in learning style and environment. Patient interaction no longer becomes a token part of your learning, but is absolutely central to your progression.
You can expect to be speaking to more patients, compiling a portfolio of your experiences (with some helpful direction from your medical school), attending clinics, assisting in theatre and, hopefully, becoming part of the team. You will also find that the more clinical knowledge you acquire, the less confident you feel and the more you realise you don’t know. That is all normal. It is a feeling that remains, I’ve been told, for the rest of your professional career as a doctor. Simply put, you cannot and you will not know everything. Learn the basics that your medical school asks of you (find a curriculum/ buy or loan the Oxford Handbook of Clinical Medicine) and explore, in more depth, the areas that interest you.
Each medical school prescribes a different basket of learning experiences for medical students in their first clinical year. It’s important that you follow what your medical school says. However, here I offer you some advice, having made that transition and continued through clinical medicine, relatively unscathed.
In the first week, learn your histories and examinations. It may seem, at first, that a didactic approach to learning the art of speaking to patients is somewhat artificial. It isn’t. I won’t bore you with the percentage of diagnoses that can be made from histories alone (because this will be drilled into you) but it requires practice and manipulation of the basics to get it right. Therefore, it is vital that the basics are second nature. Learn what a presenting complaint is and understand the histories for the most common presentations in each general medical and surgical specialty. Know two or three questions that you can reel off when asking about past medical history, drug history, family history and social history. Understand in a bit more depth, what is required when you are undertaking the ‘review of systems’. I found this to be useful when I had forgotten to ask about relevant symptoms in the history of presenting complaint.
Once you have taken a history, learn basic examinations. Some medical schools assess you in long cases and so will want a smooth and confident integrated examination style which incorporates cardiovascular, respiratory, abdominal and neurological (cranial nerves and peripheral nervous system). Others may assess you in OSCEs and short cases and so will want isolated examinations. Know what is expected of you and learn from patients. Practice not getting your words muddled up when explaining to patients what you’re going to do. Learn techniques to ensure that you’re not always moving the patient and thus causing them any unnecessary discomfort. If you’re feeling brave, ask them how they thought you did (the overwhelming majority enjoy participating in the learning of future doctors and will only want to encourage you). Most importantly, try and find a willing junior doctor to present your findings to (they were at your stage once!). They will be able to tie together the clinical picture, perhaps offer their own insights into the patient and complement what you have already learnt.
In terms of other clinical experiences, clinics can be a useful learning environment if you make them so. A Registrar or Consultant won’t mind you asking if you could take histories and examine some patients (as you become a bit more proficient over time). If they’re pressed for time, the answer may be, not today, but asking will get you everywhere. Show enthusiasm and interest. Question them about what they’ve just seen. Comment on what you know or something which you didn’t understand. A wasted clinic experience is one where you don’t take an active role. If an active role isn’t possible, then write down each of the cases and use them as a hook upon which you can learn from later.
You will feel less supported as a clinical medical student. But you will feel empowered. It is important that when you have tutorials that you attend because that brings everything together. Often you get the impression that you’re slightly isolated. Don’t worry about that. I would encourage you, when you become more confident, to go off on your own and find experiences yourselves. Look for opportunities and get to know a team or a junior, well. Ask them for teaching. You can offer them feedback which helps them progress and they can impart real jobbing doctor knowledge, which will make you look slick and improve your performance. If you can, create your own timetable. Whilst it’s important that you see the common conditions spend some time exploring other areas of medicine. Don’t avoid the specialties that you don’t enjoy. Actively seek out opportunities in them. This will help when you find it a struggle to pick up that specialty’s textbook during revision periods. Finally, learn the art of reflection. You will constantly reflect as a clinical student (no doubt it is a requirement) and it is obligatory in the Foundation Programme. Learn how to do it properly by finding a structure.
Above all, enjoy it. Every single day, a new person will let you into their lives and share things with you that perhaps they haven’t shared with their nearest and dearest. Treasure their stories and recognise how privileged you are to be exposed to the widest range of human experience. Remember, as well, that with that knowledge comes responsibility. A responsibility to protect your patients’ confidentiality. On that note, if you fancy some useful bedtime reading, have a look at the GMC’s Tomorrow’s Doctors and Good Medical Practice Guides.
Good luck and have fun!
Harrison Carter is co-chair of the medical students committee
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