Approaching your first clinical year

In the first clinical year, students are excited that they are at last “proper” medical students, finally learning the skills of being a doctor in hospitals, rather than in lecture theatres. Although medical students who take integrated curriculums have had exposure to the hospital environment in the preclinical years, the clinical years have always been perceived as challenging and different. The uncertainties surrounding the hospital and the sudden change of learning environment can be daunting.

Preparing for hospital

Preclinical subjects, including pathology, anatomy, and basic clinical skills, may come in handy. After all, your preclinical studies are meant to prepare you for the clinical years. Most medical schools have induction programmes for the clinical years, which usually include lectures, clinical demonstrations, practical skills sessions, and tutorials. Besides equipping you with essential medical knowledge and skills, induction programmes introduce you to the hospital’s etiquette, environment, and staff. Take this opportunity to improve your practical skills, such as clinical examinations and venepunctures, and communication skills, by practising on manikins, actors, or friends.

Know the placement

Getting to know the firm of your attachment in advance helps you to prepare. Try to speak to your seniors and friends who have worked with the team or at the hospital before to find out the routines of that firm. Early familiarity with the hospital can make arranging accommodation and travel easier, especially if you are placed at a distant hospital. Find out the specialty and interest of your team so that you can read up on that subject beforehand. For example, if you are attached to a cardiology firm, it makes sense that you brush up on electrocardiography and heart murmurs.

Ask your seniors

All senior medical students have been through this stage and, therefore, are good people from whom to seek advice. For example, they know which doctors are keen to teach and so are worth shadowing. They can advise you on how to make full use of your first clinical year. They also know the structure of the assessments in your first clinical year, such as the objective structured clinical examinations (OSCEs), vivas, and presentations.

In the hospital

As a new member of a firm, you need to show your enthusiasm, team working spirit, and hunger for knowledge. Showing an air of confidence is vital but being humble when clueless is just as important.

The first week is usually challenging. You are either able to get a grip on how your firm or hospital works, or you waste the entire week standing clueless on the wards. For a productive first week you should get oriented with the hospital layout and key locations, such as your ward and the radiology department.

Find out how your hospital works. This includes the hospital computer system for checking test results, if you are allowed to use it; forms for requesting investigations; colour coding of blood bottles; and prescription charts. Also learn how the bleep system works, or you might spend most of your time not knowing where everybody is. Study your timetable closely so that you are on time for ward rounds and clinics.

Who will you spend time with?

Get to know your firm. It usually consists of consultants, specialist registrars, and foundation doctors (house officers). Don’t forget the nurses and other healthcare professionals. You are reliant on these key people to make your clinical attachment rewarding and enjoyable.

Consultants

Consultants are doctors who have completed their specialist training and are team leaders. They are generally the most experienced doctors in the team. They are directly responsible for your training and ultimately determine your grade at the end of the firm. Their instructions generally over-rule the rest of the team. For example, if they expect you to turn up for their clinics you should do just that, and not attend your registrar’s endoscopy list.

Specialist registrars

Specialist registrars are middle grade doctors who are training to be specialists. They are usually at least two years beyond graduation from medical school. They are fairly experienced and therefore you can learn a great deal from them.

Foundation year doctors

Generally you will shadow foundation year 1 and 2 doctors. These junior doctors are recent graduates who can give you the most up to date reports of life after medical school and about the structure of your course. Volunteer to help them in their entrusted but usually repetitive tasks, including taking routine blood, rewriting prescription charts, and checking blood results. These are important skills to learn as a medical student.

Nurses and other professionals

Making an effort to get to know the nurses and other healthcare professionals, such as the physiotherapists and pharmacists, is worthwhile. Once they are on your side you will be the first to find out about valuable learning opportunities, such as cannulations and unscheduled teaching. You should also shadow nurses, who have daily tasks such as making beds and preparing intravenous drugs. Other healthcare professionals, such as pharmacists and dieticians, are equally important for your education.

Other medical students

Having another student with you can make the hospital experience less daunting. Try to learn knowledge, experiences, and clinical skills from each other. And supporting each other psychologically—for example, by discussing experiences at the end of a day—can relieve stress.

Learning opportunities

Clerking and presenting

Clerking a patient is an important skill for any clinical student to learn. “Clerking” means taking a history, performing a clinical examination, and establishing the differential diagnoses and plan of management for a patient. Clerking is not easy to master, and doctors are heavily tested on this in the examinations for postgraduate membership of the royal colleges. Therefore, try to clerk as many patients as possible and present them to the doctors. Always make an effort to consolidate your knowledge by reading about your patient’s clinical problem. Learning, clerking, and presenting can also boost your confidence. Following up the progress of patients you have clerked is just as important. Focus on a few patients rather than every patient in your firm. And share your cases with other students in different teams so that your clinical experiences are not just limited to your team’s specialty.

Ward rounds

The structure and timing of ward rounds may vary depending on the team and who is leading it. Some ward rounds, especially teaching rounds, are very educational, and cases are discussed thoroughly with students and junior doctors. But some are brisk and seem to have no educational value, and medical students can easily feel ignored.

There are various ways to overcome this and look useful. Volunteer yourself for a specific task, such as being in charge of reading out blood results from the folder or recordings from the observation charts. That way you will be noticed, and more importantly you learn normal and abnormal clinical figures. You should also help the foundation doctors to update the list of patients. By doing this you will learn about the patients and not seem lost in ward rounds.

Outpatient department

The advantages of an outpatient department in terms of medical teaching are that you see a wide variety of cases, and occasionally you may be given your own room to clerk patients. But some clinics are too busy to teach or are so specialised that all the patients have similar medical problems. To overcome these disadvantages, write down one problem for each patient you see. At the end of the clinic persuade the doctor to pick one and go through the case in detail.

Theatres and day stays

Learn to scrub up correctly on your first day in theatre—it’s best from a scrub nurse. Then ask the lead surgeon for permission and scrub up as often as possible. Only by scrubbing up can you learn the skills of assisting and operating. You also get a closer look at the anatomy. You may be given the opportunity to do some suturing. You should also ask the anaesthetist for some teaching. You may be rewarded with a guided tour of anaesthetic equipment and even an invitation to attend the next inductions.

Finally

The hospital is full of learning opportunities. Don’t just limit your learning to within your firm. There is always something interesting happening in the radiology department (for example, angiography and percutaneous nephrostomy), endoscopy suite, emergency department, and physiotherapy gymnasium. All you have to do is ask.

We are asked to reflect on our learning all the time in medical school. At the end of the first preclinical year, you look back at your hospital experiences in delectation or disappointment, depending on how you have painted the picture. With an eager attitude, inquisitive nature, willingness to perfect skills, and humility to plead ignorance, you should find your hospital a fun place to learn.

Competing interests: None declared.

Provenance and peer review: Not commissioned; externally peer reviewed.

   

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