The clinical Years
Not so long after the first 2 years of medicine where over I started my 3 year that involved me starting on actual clinical rotations. Looking back I think although these rotations were useful to gain real insight away from the books and obtain the actual hands on practice needed in dealing with acute patients I felt like a didnt know enough.
In medicine we tend to over focus on theory and studying from books and writing notes. In reality although this is a good way to obtain basic knowledge on a subject, it still very limited unless you use it as a compliment to the actual clinical setting you work in.
I still remember my first day of clinical rotations, i was filled with excitement, interest and sense of achievement. My first rotation was cardiology, seeing first hand how lifestyle can have a huge impact on cardiovascular health, I think this rotation was the first rotation that made me reconsider my diet seriously and really start exercising on a regular basis.
Rotating on cardiology and seeing STEMIs and NSTEMIs first hand was really an eyeopener. Although we study ECGs from books, when you see the ECG of an actual STEMI or myocarditis or heart block its not something you forget. I think the emotion and the sense of presence in a ward or at the bedside can have a different impact when trying to absorb information.
Again the difference I think is that when you are physically or actively doing something the input you provide is a better way of learning than just passively reading information, hence why the clinical years as a doctor are the ones that are most valuable and formative, and its in these years we start to apply the undergraduate biochemistry and physiology and put them into practice.
What was my typical day like?
Working at the Main Hospital on the Island of Malta. usually doctors work from 7.45am to 2.30pm and re on duty 1 day per week (on call). My typical day as a medical student would be usually from 7.45am to about 4pm depending on the volume of tutorials or lectures.
Usually as i live close to hospital, and as a person i really need my sleep i try to get up at 7am. I head to shower, eat some breakfast and wear my scrubs and just walk to hospital, “hopefully” not being late. As the Ward rounds usually started at 7.45am 15mins would be sufficient to shower and eat my prep breakfast i would have made the night before.
Ward rounds usually start, however this is very different depending on specialty with some starting the ward rounds at 8.30am or 9am. The job of a medical student usually is to follow the consultant or FYs on the ward and try to answer certain clinical questions they they might ask you. I always used to carry a handbook or Pdf document on me in order to stay up to date and no look like a complete idiot in front of the consultant. One hand website i really found help me both as a quick reference and as clinical Qbank is AMBOSS, which i cant recommend enough.
ward round finished and the paperwork begins. This consisted of helping the House Officers type out discharge letters, prescriptions and taking or booking bloods. most of the work post ward round is admin work, and its about booking bloods, chasing bloods (that involves looking up trends on software) and discharging patients who are fit to go home.
we would usually have lectures regarding particular topics, or tutorials. I think the hands on small group tutorials where the most important part as they provide a clinical scenario for interpretation.
In the Evening after a long day I would usually either go to the gym and destress or use the time to study some languages or dedicate that time to blogging or planning a future holiday (Pre covid times!). As i locumed as a pharmacist i would also locum 2-3 times in the afternoon per week in order to make ends meet and pay the bills.
My Advice For the Clinical Years
Manage your time! Of course we hear this over an over again, however the most important skill you must learn and pick up is manage your time wisely. If you have 1hr to kill don’t just waste it review the major topics like ACS, Acute abdomen Respiratory problems like COPD or Asthma or go examine a patient with heart sounds, try to be proactive.
Staying up to date is also extremely important. If you are rotating you want to know what cases you are dealing with and you should also be up to date with treatments and investigations needed.
Being organized. Organization reduces the risk of errors that can not only look bad but be detrimental to the patient health. sometimes we might know a lot however its important to prioritize and organize jobs depending on importance or urgency when you are actually working on wards.