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Clinical placements are the mainstay of medical school, as this is the only time for you to get patient contact, practice your clinical skills and get used to working in a range of real-life clinical settings. However, placement can be 'hit or miss' so I am going to share some of the things I have learned that have helped me extract the most value out of my placements.
Know where you're going and what may be expected of you on the day
Always know where you're going for your placement day and WHO you will be attached to. Then start to think about what may be expected of you on the day. I.e. If I'm supposed to be attending fracture clinic, it would be good for me to go over my knowledge of fractures! This can help you look prepared and professional when you turn up. If you're super keen and have your doctor's name, you can do a quick background check on their specialty and expertise. This is especially helpful if shadowing surgeons so you can prep the specifics prior to going in.
Introduce yourself to every person
I have slipped into meetings, handovers and ward rounds without introducing myself, trailing in the back before someone asks 'Oh sorry who are you?' Be polite and courteous and always introduce yourself to avoid that awkwardness. Let them know your name, your year and that you're placed on their ward / department today.
Create some goals (and prepare questions) for your placement day
Don’t go to placement with no goals in mind. I have done this many times and my days have always ended up feeling boring and wasteful. Always have at least 1 goal in mind. You should have an in-depth look at your portfolio before you go into placement so you have a clear idea of what clinical skills or tasks you can get signed off by a healthcare practitioner. Your portfolio will need to be completed to ensure you have a good level of clinical competency to progress to the next year of study. Your portfolio will include a few tasks such as:
Clinical skills
Reflective notes on a couple of cases you've seen
Supervised learning events or Case-based discussions: Taking histories from patients and presenting the information to a doctor, sometimes you will be expected to talk about your diagnosis and management too. May be expected to do clinical examinations under supervision etc.
The clinical skills section is particularly important to have a glance over BEFORE you go to placement - offer to take observations by asking the nurses or healthcare assistants (blood pressure, temperature, oxygen saturation, respiration rate, pulse), ask doctors if you can watch them undertake procedures like phlebotomy or catheterisation and take advantage of any peer-to-peer sessions (taking each other's blood glucose or blood pressures). These are some examples of the skills you will need to be ticking off as you go along.
Pro tip: You can do clinical skills at a higher level than is expected of you and the sign-off carries over onto the next year on Kaizen e-portfolio!
FOR KCL YEAR 4 AND 5 CLINICAL SKILLS LIST, DOWNLOAD A HELPFUL PDF WE GOT SENT BELOW. START WORKING ON FINAL YEAR SKILLS THIS YEAR:
Arrive at LEAST 15 mins early
I always recommend arriving to your clinical placement AT LEAST 15 mins early to actually figure out where you're supposed to be located and to put. your. things. away. Nothing is worse than a medical student turning up and faffing around during handover / multidisciplinary meetings trying to find somewhere to put their things.
If you're allocated a locker (like we are at King's), MAKE USE OF IT. Put the things you don't need away in your locker and take your necessities: stethoscope, notepad, ID card. The less the better.
Buy some necessities
Make sure you're well-equipped for what you may be thrown into during your clinical placement. Have a look at what the doctors usually go around with and mimic this. My key necessities are:
PHONE - this is where I keep my timetable/locations for placements, can contact anyone if I get lost and keep track of time.
Stethoscope and case - I keep my small notebook and phone in this case too. I got it from Amazon here
Small notebook - for taking histories, making a few notes on the cases you see (for those reflective notes later), teaching session notes
Surgical crocs (for scrubbing into surgeries) - Finding a UK Size 5 surgical croc is like trying to win the lottery. I decided to buy my own and it's saved me SO much hassle. We are now provided with our own sets of scrubs and I keep a spare set in my locker. Getting changed into my scrubs and my own crocs makes attending surgeries easier and quicker. I got my crocs from Amazon here
Eat before placement
Have a cereal bar, porridge, a banana or some berries before leaving for placement (or on the way if you're late). These are complex carbohydrates (that cheeky Nutrition & Metabolism revision) that are necessities for long days. You will probably feel nauseous or faint at some point because some of the things you see can be very distressing or just because the hospital is so warm! It is crucial that you have some glucose in your system to prevent this.
Throughout the day, make sure you have some lunch (save money and sacrifice your sleep by waking up earlier to prepare some), bring a disposable coffee cup to fill up your coffee (FOR FREE on some of the wards) and take toilet and water breaks when you need to (politely let the doctor you are shadowing know before you leave).
Read the room
It's important to understand where it may or may not be appropriate for you to be in a clinical environment. My rule of thumb is to keep out of the way in high-pressure, fast-paced situations where you can not actively help, unless called upon. If you also feel like you aren't getting the most out of your particular placement, find somewhere else to go. The worst thing to do is waste time hassling a doctor who does not have the capacity to teach you that day - these things happen and it isn't the best feeling but you can make the most out of your placement elsewhere. Make sure to introduce yourself and state why you're there. I.e. I was assigned to labour ward one morning and there was nothing much for me to see or do as none of the women were in labour yet. I made my way down to the orthopaedic fracture clinic and asked to sit in with one of the doctors. I learnt so much!
Talk TO patients
Talk TO patients not AROUND them (i.e. it’s not good practice to ask doctors or nurses if you can do procedures instead of asking the actual patient right in front of you). This is especially important if you are sent to take a history, observations or do an examination. A key part of patient contact is building a genuine rapport with patients. You do not always have to follow a perfect history - sometimes just have a chat with them! You'll be surprised at how much you learn and they'll be a more likely to cooperate with you when carrying out your clinical tasks. Most patients are more than happy to help with your education if you treat them like people and not a means to an end.
Ask questions
When you're on placement, try to engage with what is being discussed or carried out. Not sure why the doctor is ordering a certain test for a patient? ASK! Not sure what you're looking at on an X-ray or CT scan? ASK! It's a good way for doctors to remind themselves why they are doing things and keeps them on their toes whilst helping you with your clinical decision-making and diagnostic skills.
"Think horses not zebras"
This was a really good quote that I was told on placement. You will inevitably be quizzed by your seniors on placements and this is a great chance to test your knowledge and consolidate your learning. It may be humiliating (you will never know everything) but most of the time they are asking you difficult questions to get you thinking. Use the simple knowledge that you ALREADY have and talk this out loud with the doctor.
A real scenario that happened to me was the other day when I was asked: 'Why do you think a 22 year old would get gallstones?'
- I knew that gallstones were produced from bile (~20% cases) or cholesterol (~80% cases) build-up
- So I told the consultant that either one of these substances could be high in this patient causing their gallstones.
He asked 'What types of conditions would make these levels high?'
- They could have a condition that affects the flow of bile (such as cirrhosis, primary sclerosing cholangitis, or obstetric cholestasis), however this would be rare in a 22 year old
- They could have a condition that affects their cholesterol levels such as hypercholesterolemia
This patient was investigated for familial hypercholesterolemia
The doctors can prompt you with follow-up questions and this can aid with your understanding of disease, diagnosis and management. It's also important to have a good understanding of common conditions that patients may not even present with but most will have in their past medical history. These include (but are not limited to):
Diabetes
Hypertension
Heart failure - and all the things that can precipitate this such as an MI, cardiomyopathies or chronic hypertension
Stroke
Arrhythmias
Arthritis (Rheumatoid and Osteoarthritis)
Obesity
UTIs
Having a general overview of some of these conditions can help you work out next steps with your doctor when on the wards. If you don't know, don't be afraid to say this! But the doctors will expect you to at least try. Sometimes clutching at any random piece of information floating in your head is the best way to learn and forcibly recall knowledge you didn't know you had. You know more than you think you do!
Complete your portfolio by the end of the same week
Make sure you write down your reflective notes and sign off your clinical skills by the end of the week so that for the next week's placements, you can enter with a fresh mind. Writing your reflective notes as soon as possible keeps them as accurate and organic as possible.
I hope this helps you get a bit more organised for clinical placements. Comment some other tips you've learnt from placement along the way!
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