You are a prospective medical student, preparing for your upcoming medical school interviews or a parent keen to know what your child is going to learn in medical school? You wonder what a medical student actually does? Find out what a fourth year medical student gets to see and experience. This will be useful to show during your medical school interviews that you know a little about the profession but also you are aware of what medical schools expect from you.
Ear Nose and Throat (ENT) Surgery Block
I am about to start my Ear Nose and Throat surgery block, having just finished the Urology block. Going into a completely new specialty is a bit nerve-racking. Let see how the first day goes…
Previous night: Alarm set for 6am, need to leave enough time to get to hospital for the 8am ward round and it’s autumn time so there are bound to be train delays!
The next day.
6am - 8am: Running a bit late but just made it in time for the train!
8am – 9am: Ward 9 – Ears-Nose-Throat.
I introduce myself to the team, ‘I’m a fourth-year medical student’ (this must be my most utilised phrase). The team of two registrars, a senior house officer (SHO), a Foundation Year 2 doctor and a medical student surround the patient. As the youngest member of the team, I draw the currents around. In front of us is a lady with a progressively enlarging neck lump. I listen to the conversation, and the SHO hands me the notes to write in while she observes. I keep up with the consultant’s comments and double check with the SHO before we move onto the next patient.
- TOP TIP: Read around the subject before you start your placement it will prevent awkward silences and encourage the doctors to teach you more!
The next patient has a tracheostomy after a recent surgery. While the surgeons examine the tracheostomy, I observe to see what they do and how. Personally, I remember things a lot easier if I have seen it in practice. Therefore, ward rounds are a great place to get an idea to the kind of presentations you might see in that specialty. In terms of skills building, I find ward rounds very good for end-of-the-bed diagnosis*. Being able to solely observe the patient and get an idea of the possible diagnosis.
I used to find ward rounds very intimidating but have grown to like them. They are a great place to get to know the team, understand the roles of the doctors, as well as give them a chance to know you.
- TOP TIP: Make the most of the ward rounds by asking questions, volunteering to examine the patient and asking if you can write in the notes. Medicine does entail learning the knowledge but more importantly, through your years in college, you need to understand the various roles you will have and how to become a team player. Experience of this can only be gained in the clinical setting.
*End-of-the-bed diagnosis: A method by which you come up with a list of possible diagnosis based on what you can observe in terms of the patient and what is surrounding them, e.g. medication or oxygen mask.
9am - 1pm: Out-patient Department – room 3.
I enter the room with the consultant faced towards the computer screen. He turns around and asks me to do a Rinne’s and Weber’s tests (tests which use a tuning fork to investigate the patient’s hearing) on him (as I said before a little reading beforehand can go a long way!). Once the clinic starts he gives me a summary before the patient comes in, during the consultations I get to practice my examination skills while learning how to manage the conditions. In clinics, not only do you get to practice your skills, but you can discuss the findings with the doctor, which in other clinical settings can sometimes be difficult to get.
- TOP TIP: In between patients is the time I find most useful as often it turns into a mini teaching session, where the doctor quizzes your knowledge (trust me you will know more than you think) as well as giving you suggestions for improvement. Think of it as one-to-one bedside teaching, isn’t that useful?
You will find that not all doctors are able to teach during clinics, and they may have a very busy list. In which case, all you might be able to do is observe. But don’t give up before you try – ask them questions on the patients you saw or ask whether you can examine the next patient.
- TOP TIP: Being proactive is a key as a medical student. If you give the impression you want to learn high chances are they will teach you, and often it is not something the textbooks can.
1pm – 1:30pm: Lunch. I attempt to eat my lunch in 10-15min, another skill I have developed through the years, though its usefulness is still questionable. After lunch, I make my way to the scrub room.
1:30 pm – 5pm: Theatre 2.
I get there a bit early to introduce myself to the theatre staff. One of my medical school requirements includes being competent in certain clinical skills. We need to get our skills signed off in a ‘clinical passport’ and today I need to do some cannulations.
- TOP TIP: I have found that showing up slightly early and familiarising yourself with how the team works helps you gain more from the experience.
I had gone to this theatre several times in the past for other specialties therefore knew the staff. Having built a good rapport with the members first time around you will find they will remember you and are willing to help. I observe the anaesthetist in the preparation room and help with the cannula and bag-and-mask ventilation. Once the patient is taken into theatre I swap over to the surgery side and observe the operations. Generally, I go to surgery for interest and as it is so specialised I would not expect the details to come up in exams. I had attended the ward round with the surgeon in the morning, so it was very easy to engage in conversation, and she explained the procedure as she went along. They finished all the surgeries around 5pm.
- TOP TIP: On multiple occasions, I have found that by getting to know the staff (even if you may not understand their jokes every time) I was able to build a good rapport, and even after switching rotation they remembered me. Don’t be under the illusion that only the doctors/surgeons can provide teaching. Other staff members including nurses, Healthcare assistants, operating department practitioners (ODP) and so many more have their own specialist knowledge base and are usually very willing to teach. An example from my experience would be when an ODP taught me how to cannulate. Even though I had done the simulations and had a few successful ones, the tricks he taught me through his experience of doing twenty a day, made the process of cannulation much clearer.
Reflecting On My Experience
It was a very busy first day going from ward round to clinics and then surgery. Reflecting back on it I was able to build on my skills and knowledge in different ways by attending a variety of clinical settings. As a medical student and more importantly as a doctor you will always need to reflect on your experiences. How have you improved from doing that activity, what could you have improved for next time, what did you learn? These are common questions that will repeatedly come up in your future career.
For example, looking back on my day next time I go to the theatre I will aim to ask more general questions such as indications and complications of the surgery as opposed to the details of the procedure.
- My final TOP TIP would be to not only experience a variety of clinical settings but to reflect on all your experiences. I know it can be very tedious but by the time you become a junior doctor and have to do it as a part of your portfolio, it will have become second nature to you!