Difficulty of Going Backwards.

So I've had a week of lectures...which to be fair weren't too intense. They weren't 9-5 lectures so I can't really complain. Ever since January, I feel like I have made leaps and bounds in terms of progression in clinical experience. In paediatrics, I hardly did any clinical skills and was in a small group for my placement. I had a partner with me for all clinics and was never really on my own. Didn't really even see patients on my own either. Then we get to Obs and Gynae...slowly venturing out a bit and being a bit more independent. Still in a small group on my placement, BUT I didn't have a partner to go with to clinic/theatre. I was actually scared to be on my own as I have never really been to clinic on my own and you get all these thoughts of: "Ahh no one to bail me out when the consultant asks me a question." I actually really enjoyed going to clinics on my own as you get to chat with the consultant more and it isn't as daunting for patients to have two students watching/sitting in. I definitely started becoming more independent on placements and started being more proactive in guiding my learning.

Then my last placement in orthopaedics. It was the first time I ever attended a placement on my own. I have always been in a small group. Funny enough my first concern was: "Who the heck is going to eat lunch with me?!" I am definitely not a fan of eating on my own as it is painfully boring. I like to talk during my lunch as I eat quite quickly so talking helps me slow down. I can easily scoff down lunch in 5-10 minutes and I end up taking extremely short lunch breaks. Luckily, due to my half-days I was able to go home to eat so I didn't have to sit in a cafeteria eating on my own and staring off into space. When I did have to eat lunch at the hospital I was usually with my consultant/registrar so we all ate together. But yeah my independence was really tested in this placement as everything I did was all "me". No one to fall back on. No one to rely on. No one to catch your mistakes...other than the consultant. Went to see new patients on my own and do full examinations on my own..then presented to my supervisor. If you had asked me to do that in my paeds placement...I wouldn't be confident enough to do it. I guess that's one thing with being dropped in the deep end. Got to learn quick and deal with it quickly. To be honest it did help that my supervisor is probably one of the nicest people I have ever met so I knew if I made a mistake I wouldn't get a full blown telling off/humiliation. It was also nice that I actually got to do things during my placement such as see patients, do examinations, assist in surgery, etc.


Now...sitting in lectures on a very hard plastic seat (even the clinic chairs are more comfy) in a small tutorial room...painful. I was talking to my friends and they kept saying it was nice to have a relaxed week of just sitting around and doing nothing but listen. I actually struggled this week. I may not be the hardest working medical student...but I hate sitting around. Especially with my last 2 placements where I was actually being productive and learning loads on placement...I am actually a bit sick of sitting in lectures and listening to one person talk about the same subject for 2-3 hours. Also got my induction pack for my next placement (GP) and the first thing I read: "Patients should not be seen by medical students who are on their own. Medical students will be supervised at ALL times." I'm totally looking forward to GP now...so excited that I'm bouncing off the walls (sarcasm). I really really hope that the package is a bit outdated and my GP will let me go see patients on my own and do some examinations. It's weird getting so much independence and responsibilities...and suddenly being stripped from all of it and back to holding hands. If this is the case...wow this is going to be a shock to the system.

The Key is to be Proactive

Have been in placements for about 10 weeks now and I have had many ups and downs as you have read in my previous posts. After looking back at my placements, I've realized that my best experiences had been when I am being proactive. Being active in learning and stepping out from my consultant's shadow. In my first placement in the summer, I put a lot of effort into taking patient histories and doing loads of physical examinations (cardio, resp, and abdo). 2nd placement...did a lot of ward rounds - definitely seen a lot. For comparison sake - first placement I took about 10 patient histories and have done 4 cardiac exams, 3 respiratory exams, and 3 abdo exams. 2nd placement: 1 patient history, 1 shortened peripheral nerve exam. Poor showing in the 2nd placement. Yesterday, I did a group revision session on cardiac, resp, and abdo examinations. I knew how to do those examinations quite well and knew what I was looking for and can easily explain positive findings. The minute we got into neuro and musculoskeletal (MSK) exams...I died a little inside. I didn't know what was going on. Okay well MSK was easy to follow as I'm quite familiar with joints and those tests...but neuro was painful. I obviously didn't know how to do these exams as well as the cardio, resp, and abdo exams and it just felt horrible how lopsided my learning has been. Thinking back - it was because I was really proactive in my first placement. I had put a lot of effort into seeing patients and doing examinations. These last 2 placements - I've been...how should we put it...lazy.

You might ask: why suddenly the realization? Yesterday I was in clinic in the afternoon and my consultant told me to go take patient histories of the new patients in clinic and to come back and present the histories to him. While presenting, my consultant would ask questions dealing with the presenting complaint and about the differential diagnosis. It really made me think and be on the ball. When I didn't know something - he would teach me what to look for in a history and I realized: "I'm actually learning and remembering this." Once clinic was over - I actually had a good time. I felt independent and a lot more confident in my history taking skills as I got to present my histories and then got quizzed on it. I also realized that I was quite rough with my history taking with my first patient but by the time I saw my 3rd patient - it was easy and straight forward. It was a great feeling and a great confidence boost.

Now I'm sitting about - pondering - actually no...stressing about exams (OSCE + 2 written papers in December). There's no way I can pull off taking good histories and performing examinations without practice. I need to be proactive and do what I did in my first placement. Make a schedule and follow it. Be involved and just take a step away from my consultant and tell him that I need to practice. There isn't much point following him - I've got a good idea what the specialty is about already. I need to see more physical signs and conditions to start seeing patterns and recognizing things quicker. 4 more weeks of placements - I need to get back on the wards and talk to patients!