Challenging aspects

Now that you have been on a few placements you may have been faced with a few more challenging aspects. We asked our students to share some of their experiences, and offer useful suggestions.

Anna

I think in "Obs' and 'Gynae" there were not many patients, so as there were probably only ten patients, I could only talk to a few people.

Suggestions

• Obs & Gynae tends to have a quick turn-around time, so, even if it seems there are few patients now, there will soon be more.

• This is quite subjective. Actually, ten patients per student seem like quite a lot! When you are new to placements, clerking patients takes quite a long time... You won't necessarily get through all of them. Just make a start and see how far you get.

Wuji

Sometimes I find it quite hard to arrange my timetable because every day was packed.  By the time 'Respiratory' was over, or all the teaching was over, there are a few things that I feel I missed out on. For example, until today I hadn't got the chance to be in the Respiratory Clinic, as when I was in Cardiology there was already another group of students in Respiratory and then it was not very easy to ask them to change with you, because that's probably their only chance. 

Suggestions

• Time management! We all struggle with this. Doctors also.

• It is quite normal, you can't do everything at once and not all students can come in and observe at the same time.

Akma

I'm a bit nervous when a doctor asks about anything. For example, when he asks about the symptoms of a disease I can't really think about that disease at the time. I am quite slow, so, I have to take my time and think about it first and then I can talk about it.

However, for some cases [university to hospital practices] it's totally different, because patients come with different conditions, different diseases, so we don't really expect that it's from the text books; you have to have a broad spectrum. 

Suggestions

• There is always a tension between the ‘bread and butter' conditions and the ‘weird and wonderful'. As a student who is new to placements - it is vital that you cover the basics. Curiosities won't help you to pass exams.
• Red flag symptoms are the key. What you really need to know is what makes you safe!

Carole

When we went on the ward in the afternoon there was no one there, no consultant.  We just arrived, and the junior doctor was really busy, he had like two death certificates to fill in and certify and other things to do, and all he said was "Oh go sit in that room."  So we literally sat in the room for four hours and did like nothing.

Suggestions

• Either clerk patients or read up on things. Don't sit around doing nothing. Make sure you are prepared and bring a suitable book for each placement.  

Lionel

I don't feel I've got the balance quite right between placement and book work.  In a way you want to do a good job for your team and you want to be seen to be keen, as that leads to more opportunities. If they've seen you around and seen that you're keen they're more likely to give you a better experience for your placement. Equally, though if you don't do any writing up, it's limited how much you will remember of it.

Suggestions

• You could go to the library and write up some of your notes. Just make sure to tell someone that this is where you are going.

Abigail

I'm going to be starting medicine here in a few weeks time, and I know that I am going back to a ward lifestyle again, but it's going to be so different. I feel like I'm going to be starting again.

Suggestions

• Every time you move to a new placement, day one is always the worst! But day two is bound to be better.
• In the meantime, make sure you make the most of your current placement - the opportunities you have now will soon be gone.

Aina

I think difficult aspects for me would be sometimes to motivate myself to come into some attachments, when there's no structure, or there's no one to keep an eye on you, and I feel that I'm expected to just be there and not know what I'm meant to be doing.  It just feels as if sometimes I'm wasting my time when I haven't got someone telling me what to do, or know what I'm meant to learn. I think this year there is a lot more responsibility for your own learning, not lectures any more, and I was so used to that and preferred it. So I think that's what I'm struggling to adjust to.

Suggestions

• Ultimately, you learn with patients. It is particular cases that make the disease come alive - a real patient will help you remember in the end. Much more so than stuff that you learn only from books.
• For each placement, make sure you come up with a list of diseases that you need to know. Then go and find a patient who has this!

• If you can't find a patient, you can also make use of videos and other resources to cover that list.

Wuji

There was a consultant who I found quite demoralising every time I saw him, because every time I saw him, he would ask me a question.  Then he would ask another, and I would answer, and then he would go in deeper.  Then sometimes he would say, "Oh no, even my five year old can answer that."

Suggestions

• Yes, it is true. Some clinical teachers are like that! They haven't been in our shoes for a while...
• To some extent, you need to expect this / prepare yourself for it. But there are really good ones too!
• Sometimes, you start out like that with someone, but as you get to know each other better, the relationship might change. 

Rose

When I came across a patient with primary brain tumour, it had a profound effect on me, because it is someone your age, and I can really relate to that. I found myself thinking, "My God, what if that was me in that situation?"  We had a chat about that.

Suggestions

• That's great - it is really important to talk about this stuff - if you can, with your clinical teacher, but otherwise, with friends - or both.

• In that situation, it might be a good idea to ask for 5 minutes outside so that you have a moment.

Aina

You know that you can't let your emotions get the better of you.  It's not very professional and you need to build yourself up - because you are going to be seeing so many patients in the future. I just need to learn how to take it.  I can't break down and cry every time I have to break bad news to someone.

Suggestions

• The clinical teachers sometimes lose sight of the fact that us students are probably new to this... It is ok to feel upset!
• There is a really good symposium being run on these issues as part of the palliative care attachment! There are different levels of dealing with it.

Rose

I think that the registrars and the team are in the dark as much as we are.  They've got their job to do (and the consultants), especially in surgery, so they are far too busy.

Suggestions

• If everybody is busy, make sure you do some appropriate reading. And if they are still busy, then offer to help, e.g. doing bloods.

Wuji

I know that I am still a student learning and do not have the courage to do a lot of things that the 'FY' really does.  Even taking blood, I would be like hesitating as to whether I should do it on this patient, because he looks very sick.  I found myself thinking "What if I have to go a few attempts, will it give him more pain? ..."  then I would stand back, "Oh I think he is really in pain, so why not just do it?"  Some of the FYs say "Just go and give it a try," but I think the confidence is not there sometimes.  I know that's the reason why I am a medical student. But of course it depends on the patient; sometimes they just look so tired, so sick, that even blood taking you don't feel like doing on them.

Suggestions

• At first, taking blood is terrifying! This is a very common emotion.
• You have to try and separate out the different aspects: Perhaps, this patient is really suffering and you are not the best person - given your inexperience. But make sure that you come up with a solution. You can ask for help and offer to take blood from the next patient instead.
• Ultimately, you need to step outside your comfort zone. Obviously, it is always easier to just walk away, but eventually, you will have to get used to it. So, at some point, you simply have to bite the bullet.
• Make sure that you get ready to give it a go. Get all the stuff ready and try. If it doesn't work, it is not the end of the world. You try twice and if you can't manage, you then go and get help.

• If you are unsure of your basic technique - go and get help, for example from clinical skills. Student nurses might also be able to help.

Rose

I know you can't argue with your superiors, as you're told not to. But sometimes you almost feel like you're doing things, or not doing things because you're not supposed to, and you know you're only a student. So I've refrained from doing something, because I don't want to step on registrars' or consultants' toes. I feel like I'm being rude at times, and that's really hard to deal with, because I wouldn't normally be like that and I don't want to be like that, I can't be like that.

Suggestions

• No, you can't argue. But you can ask questions! For example, you might say "I read somewhere...". Try and find a polite way of asking questions.
• Sometimes, you just pretend that you are interested. And then you get them to talk some more...