What to make of teaching on clinical rotations, and how to get taught
Part 2: Making the most of your clinical rotation
Students often feel that time spent on the ward is not “high-yield”, and in many ways that is true – particularly for university exams. The goal of medical school is to make you a safe, competent and compassionate doctor – without passing exams you don’t get to be a doctor at all, but without decent clinical exposure it’s hard to be any good. How to get the best of both?
1. Make yourself a useful part of the team
Turn up on time. Find the notes and charts, take turns writing the notes for the ward round (you can do this if one of the doctors reads and cosigns the entry). Talk a patient through a mini mental exam; phone the GP to track down a patient’s normal meds. Up-skill to be able to perform simple procedures like cannulas or taking bloods. If you are asking your seniors, “What can I do to make myself useful”, it is clear that you want to be an active part of the team. As such you’ll know your patients, you’ll learn more, and your seniors will feel more inclined to spend time teaching you.
2. Take relevant reading material
There is a lot of downtime on any rotation – particularly surgical rotations. Sometimes your downtime is even when the team is busy with tasks you can’t assist with, and don’t have time to teach. Having something relevant to read can allay frustration, help you get more out of the term, as well as prepare you for unexpected grillings.
3. Ask if you can sit in on rooms or clinic
This is a great opportunity to get an insight into what working in a given specialty actually entails, to see a host of pathology that never makes it to hospital, see how the consultants approach a problem, and to get some consultant teaching. It never hurts to ask, “Would it be possible to sit in on some sessions in your rooms?” – some consultants never take students, but most are more than happy to accommodate, particularly if you’re a visibly engaged student.
4. Ask questions
Relevant questions show you’re thinking and engaged, and often act as the trigger for a proper teaching session. As previously mentioned, you’re not the only person who benefits from teaching on the round. When a student asks questions, everyone on the round learns, and it creates an atmosphere for teaching within the team.
5. Ask to be supervised
There are plenty of procedures that you will be expected to be able to perform competently once you finish your degree. During your clinical years it is your responsibility to gain proficiency in these tasks – performing them in a safe and supervised setting until you are able to perform them autonomously. If you want experience, make it known and be proactive. If asked, “Can you insert a cannula?”, a response of, “Not yet” won’t get you far. Compare that to, “I’ve done them on models, but not on patients yet – it would be great if you could supervise me” – who’s going to say no if it is appropriate to teach?
6. You can always do a long case
Not much happening in the middle of the day? Team too busy for teaching? Doing a long-case and presenting to a senior is both useful for you and the team. Churning through long cases and getting feedback is always useful to you, and your team benefits when you discover relevant information that they haven’t elicited.
7. Ask for direction or to be excused if you aren’t learning
Exams in a fortnight? Make sure your seniors know. They get it – they were med students too. If you find that it is slow on the ward, ask a senior for direction – “can I make myself useful? – No? Would you mind if I ducked out to the library to get some study done?” – the answer to this will invariably be, “Sure”.
8. After hours counts double (with some caveats)
In general, when doctors see a medical student after 5pm, the response is, “Gosh, that’s keen – I’d better teach you then!” After hours is a great chance to learn, as long as you are attune to the fact that people are often more busy on after hours shifts and may not have time to teach – cut your losses and go home if this is the case.
Need to get competent on procedures? On an after-hours shift the doctor to patient ratio goes down, but the number of cannulas, NG tubes and catheters that need to be inserted is much the same. If you have developed a working relationship with one of the interns or residents, ask them if they think it would be a good idea to shadow them on one of these shifts. If it is not too busy, this can be a great opportunity to do some supervised simple procedures; if you are already competent with some procedures you can be a real asset to the JMO on that shift.
It is easy to feel like a third wheel as a medical student on the wards. As with any group, not all doctors are particularly good at or interested in teaching. By becoming an active member of the team, being proactive, and making your downtime productive you can get the most out of your clinical rotation and your teachers.