Starting on the wards...

PeterMC

Hi everybody!

Heading into third year of med school in the next few weeks and this means getting to go on our first proper clinical placements!! Well excited about actually getting to see real patients and not just spend days in lecture theatres talking about them...

So my question is - what advice would you give to a wide-eyed med student coming on to the wards for the first time? Things to make sure I do and (probably more important!) make sure I don't? Any tips to help get the best out of the experience?

Thanks!

Svalbard

In no particular order:

-Avoid going about in large groups, you only get in each other's way(and everyone else's!!!).
-Be aware of your surroundings and the fact that you are not invisible or inaudible. How you behave does give patients and staff an impression of you, your medical school, med students in general, doctors, the hospital etc. No standing around making jokes with your mates for all to hear.
-For the love of God dress appropriately. Look to your seniors. Be clean. Ladies, cover up. Leave the 5 inch heels and dangly earings at home and tie your hair back/put it up.
-Be curteous to everyone - consultants, NCHDs, nurses, porters, ancillary staff - ALL of them know more than you and can be very helpful.
-Be curteous to nurses in particular, but don't suck up.
-Being curteous does not mean apologising for your existence every 5 seconds. You have every right to be there, to ask questions, to see patients.
-Don't think you need to spend ages reading books on clinical examination, just jump in and do it. There is no substitute for experience. Don't be afraid if you are not sure. Med school is the time to be unsure, to do stupid things and ask stupid questions. Better now than when you are qualified.
-Go to all your ward and bedside tutorials. They are the best teaching you will receive in med school. Don't be a wallflower, speak up if you know something or have a question. Volunteer to present pt histories to your seniors.
-Don't be a wallflower, but don't be an obnoxious ass either.
-In final med don't crash tutorial. Its rude. You had your go, now it's someone elses turn.
-Take the time to learn some practical skills - IV cannulation, ECGs etc
-Do not assume anyone is going to take you by the hand and spoon feed you all you need to know; people are very busy. Be proactive.
-Take as many histories and do as many exams as you can. Also look up relevant investigation results. Figure out how YOU would investigate and treat the patient. Present your findings and your plan to a willing ear.

Sorry if that's all over the place. I'm sure there's lots I forgot. If you want to know anything specific ask away.

rgnmb

Check with the ward manager or nurse looking after the room before going to see a pt.

This can prevent some very uncomfortable moments.....

Trying to take a hx on someone with no english, someone who just got very bad news, etc etc

Oh and don't hang around the front of the nurses station or chart trolley!

Good luck!

Dr Galen

i'd agree with a lot of what Svalbard says. Your there to learn so don't let people make yu feel like you shouldn't be there. As a nurse, I've had pretty obnoxious students (of all kinds) come up and annonuce their presence etc. They got pretty short shift tbh. The people who had a bit of manners, introduced themselves properly and asked questions always got a bit of time. I was happy to point out any interesting patients, explain anything for them and point them in the right direction to get a coffee.

A while ago, I actually got to work with someone who had been a student in the hospital, and remembered me from their student days. I felt so proud that she had made it through etc lol . It had a great upside in that she introduced me to her hot friend, and told her all about how nice I was when she was a student......;)

I suppose you just really need to keep your wits about you, and cop onto your surroundings. Wards are busy places, people get stressed. If you see someone running it's generally not a good thing, watch out for beds and trolleys sneaking up behind you, a bit like driving you need to check your "mirrors". Also bar in mind, that open spaces on wards are few and far between, don't stand in a bunch of 17 med students waiting around, believe me you'll get in the way. Again a healthy dose of common sense will help you there.

Most of all smile. Smile at the nurses when your talking/chatting. Smile at the patients, smile to everyone. Obviously not in a freaky way, but you know what I mean.

AmcD

Be grateful to the patients who will talk to you. Do not treat them as part of the fixtures and fittings of the hospital that have been laid on for your education. They are real people. Imagine how you would feel if your granny was in hospital and had groups of students asking her invasive questions or being rude to her.
As long as you are polite and sociable, patients will generally not mind talking with you. It can break up the boredom of the day. But be conscious of not getting in the way of meals, visitors or trips off the wards for investigations. You will score highly with hospital staff if you are friendly and don't get in the way.

PeterMC

Thanks for all the replies!! Really great food for thought

tallaght01

The hospitals get huge money for having med students there, so they're basically being paid to teach you. Don't feel they're doing you a favour. Don't let people make you feel that you're always in the way.

You need to be professional towards everyone. But as someone above said, you don't need to suck up to everyone. Don't be a pussy.Med students have a horrible habit of doing this, and it just makes people more wanky towards them. If someone isn't as nice you as you are to them, either assert yourself if they're stopping you doing something unreasonably, or (to be honest) just treat them the same way they treat you.

Controversially, I'd advise spending only as much time on the wards as you have to. Never again in your life will you have the OPTION of spending time on the wards. If you do long shifts during the week, then take some time off during the day another day to make up. You have your whole life to spend on wards.

Lots of patients are lonely, and have very few visitors. It's boring as hell being in hospital. Spend some time with these people. The elderly like a chat. Get to know some of the people who will be in for a while. They'll get a lot out of it, and you'll learn a lot about them. If you get a chance, get to know some of the drug abusers and the alcoholics and the asylum seekers. If you get to know them and how they've ended up where they are, then you'll maybe avoid the cynicism that so many hospital staff exhibit.

Be a student and enjoy yourself. It's just a job. You're at uni. You're young. Act like it!

Kianna

I'm new here, hello everyone, this is a really interesting thread!

I'm also a med student, like the OP, and raring to get to see real patients

I was just wondering, what stethoscope might any of you recommend as a first? Everyone in the years above me seems to have Littmann Classics, just looking for another point of view before I go ahead! Also, I'm really excited, and just plain like talking about anything associated with the real thing.

flerb22

litmann classic, oxford handbook, pocket sized note book, lots of pens, pen light, tendon hammer
+/- white coat depending on hopsital dress policy

ask the team you are assigned to if there are any interesting patients with signs that you can illicit in physical exams, or if there are any good histories.

do as many physical exams as you can, and present cases to the doctors in your team and to other students as much as you can.

now on to 4th med! i start in obs and gynae in a week and a half - eep.

bleh1234

A lot of my advice echos what other posters have said but I'm constantly amazed by what students think is acceptable behaviour in hospital.

1. Be early aim to be on the ward ready to go 5 minutes before the wards round starts. Early morning ward rounds are painful for everyone showing up late shows the team you don't want to be there. You're end of rotation assessment will be predominantly based on the reg's assessment of your attendance, enthusism and knowledge.

2. Get involved in the ward round if your intern is carrying all the charts it's generally appreciated when you offer to help them with them.

3. Consultant rounds are often sporadic, most interns are happy to take the mobile no of one of the group and contact them when rounds occur make sure the message is passed on to all the group.

4. Never refuse to go on a consultant ward round without a valid reason, I'm still in shock from the time I called a group of students only to be told they
were having lunch.


5. Dress appropriately, it's a hospital with sick people not a fashion show, remember you will be bending down and stretching over things when examining patients, and to quote one of my [HTML]old[/HTML] profs 'gentlemen if you are in the habit of shaving daily please continue to do so'

6. Don't apologise for your presence you have as much right to be on the wards as everyone else, I remind my students that you don't hear student nurses, physios etc apologizing for their presence.

7. Don't overwhelm patients go to see them in groups of 2 if they don't want to talk to you then ask to come back later/ tomorrow if the don't want to talk to you don't take it personally just find a different patient

8. If you have a patient with great signs arrange amount yourselves to see them on different days.

9. Take a full history and do a full examination of the relevant system on all patients. Try to present the history and exam your ddx and ix to a team member without looking in the chart, then go back to the chart and find out what you missed.

10. Doing one good history and exam in a day is a good days work doing it as described above with your partner means each of you gets to take a history and observe the other person, be critical with each other after you leave the patients room.

11. Be polite to everyone you meet in the hospital, like everyday life you'll meet some very helpful people, some who are less than happy to see you and the majority will be in the middle.

12. Practice practical procedures, especially in 3rd year, by the time it comes to final year you'll be too focused on exams to learn cannulation, last year all my students had done at least one successful cannulation by the end of their rotation, and other procedures as they came up. Unfortunatelycant say the same for all interns.

13. Go home, if the team says go say tbank you and leave soon enough you'll have to stay. Also if the team is quiet you've taken and presented your history for the day go home.

14. Remember your team have to look after their patients as well as teach if they have a particularly sick pt they may not be able to teach as much as you may like that day.

15. Don't waste time your aim should be to learn as much as possible while you're in the hospital you can read at home.

16. If your on surgery find out what cases are on the theatre list and read up on the disease itself the night before. Link your study the the patients you see if you take a history of RA that evening read up on RA you'll remember much more if you link methotrexate to Mrs X rather than just reading about it.

17. Have fun the clinical years are the best part of med school, you'll never be so free to do what you like, learn without the pressure of being responsible for patient care and to a certain extent determine your own schedule.

18. Finally remember you are a professional responsible for your own education, act like one at all times in the hospital you can blow off steam at home away from patients and their relatives

Bluebell55

Great tips from everyone here, could have used these when I first began my clinical years. One thing i vividly remember being told by lecturers is that, especially in busy hospitals, students can tend to blend in to the background if you don't integrate youself into the team. So as other posters have said, be the one to ask the "stupid questions" (no such thing!); be the one to volunteer to go to see scopes/outpatients; take offers from your intern/sho/reg to come in early/stay late to learn something new..

You will only reap benefits from your rotations if you put effort in- be enthusiastic, pleasant and eager. If you're asked to revise a particular thing for the next day, do it. You will get the credit for it.

Networking is a big part of working in the hospital, so get to know the names of people. Don't be afraid to ask for help if you get lost. Ask older students for help.

You will have good days and bad days... On bad days you might be told to go home after being in the hospital for 20 mins as the team is too busy/ not busy/understaffed... Take advantage of it to read up/catch up/relax. Other days you might get opportunities to put in cannulae/take histories/go to outpatients etc...

Finally (sorry for being long-winded), try to find out abotu journal clubs, grand rounds, presentations that are happening in you hospital. You often learn a lot, and it can also mean free tea/coffee/lunch- handy for students

daithi_student

Get to know the student nurses if they're on the ward, we know what its like being a student in the hospital and we're mostly a nice bunch! we know the patients and the wards pretty well and can tell you who to avoid, we usually have a good craic with the students and junior docs in my hospital.
Good Luck on the wards!

panda100

Kianna wrote: »

I was just wondering, what stethoscope might any of you recommend as a first? Everyone in the years above me seems to have Littmann Classics, just looking for another point of view before I go ahead! Also, I'm really excited, and just plain like talking about anything associated with the real thing.

Colourwise just stick to black unless you want to stick out like a sore thumb. There was a girl in our class who had a pink one and she was always picked on by consultants.

Chunky Monkey

panda100 wrote: »

Colourwise just stick to black unless you want to stick out like a sore thumb. There was a girl in our class who had a pink one and she was always picked on by consultants.

I have a Littmann classic but don't take my word for it...know where to put it but no expert on the sounds yet

Mine's bright orange

bethm24

love this tread....! im a nurse. my advice-just be polite to all, nice to the patients, that impresses people . just be pleasant best of luck

Vorsprung

Just a couple of things,

Dress appropriately as someone said already. Nothing annoys me more than someone who looks shabby going around the wards.

Steths wise, Littmann Classic is fine at undergrad level. Buy off eBay, don't pay the huge prices in town. There's a few eBay shops that sell them and they're exact same but way cheaper. Burgundy is a fetching colour

Kianna

Thanks for all the advice.

I've got someone who wants to buy me my steth but knows nothing about them (and doesnt believe me when I know no more) but objected to the littmann classic because he wanted to spend more on it. I know it sounds silly, but he means well, so can anyone recommend something else? Just go for the littmann cardio III maybe?

bleh1234

Kianna wrote: »

Thanks for all the advice.

I've got someone who wants to buy me my steth but knows nothing about them (and doesnt believe me when I know no more) but objected to the littmann classic because he wanted to spend more on it. I know it sounds silly, but he means well, so can anyone recommend something else? Just go for the littmann cardio III maybe?

ask them to buy you a white coatto go with the steth if you're a girl arnotts do nice fitted white coats. White coats pick up all sorts so it's nice to be able to change it midweek without having to do washing.

sillymoo

Ooooohhhh thanks for this thread!!!!!

Some brilliant advice here. Im not so worried about starting rotations now

all_smilz

Love this thread too! i am also a nurse, newly qualified. (well a year)
I always FELT for junior drs and med students because you get much less "help" in the hospital.
Being polite costs nothing as other posters have stated and DRESS APPROPRIATELY.
As much respect I have for any colleague, it galls me (and most other members of the MDT) to see people wearing ridiculous heels, hair all over the place, and tarty or utterly impractical outfits. You are professionals.... and being comfortable and practical makes SO much sense.
Get a fob and stick in on to ur white coats- i have cringed when i have seen interns catheterising patients with their gloves tucked into their watch strap! And do u really want to mank up a nice watch with hospital stuff?

WASH YOUR HANDS!!!!!!!!!!!!!!!!!!!!!!!!

Ask loads of questions- it shows an active mind and ask members of the MDT as well as fellow doctors.

and ur white coat.... i lived with a med student who said she'd NEVER washed hers in 3 years....

I hope i didnt offend other posters, I am not tarring you all with the same brush but just offering what i hope is practical and useful advice.

GOOD LUCK....

bethm24

Hahahaha , ya the whole glove tucked in under glove is a big NO NO. yuck yuck yuck. :eek:

charlieroot

On the topic of steths.

1) Don't buy some fancy electronic amplifying cardiac jobby. (A Littmann classic, in hunter green of course for the discerning young med student is fine.) Anything fancy and you'll get slagged about it. Whats the point in having a fancy one with lots of complicated features when you don't know how to use a basic one (which requires more practice than you might think). Also, they ain't cheap - see point #3.

2) Don't wear it around your neck. Apparently, you're only supposed do this once you've graduated.

3) Steths get stolen/borrowed/lost. Get yours engraved or marked in some way. Also helps to have a distinctive colour.

4) I've seen really cheap (about 15-20 euro) steths in Arnotts in town, they're terrible, avoid.

5) Ebay ftw. For steths/scrubs/cloggs/crocks/white coats/hammers/forks etc.

Vorsprung

charlieroot wrote: »

On the topic of steths.

1) Don't buy some fancy electronic amplifying cardiac jobby. (A Littmann classic, in hunter green of course for the discerning young med student is fine.) Anything fancy and you'll get slagged about it. Whats the point in having a fancy one with lots of complicated features when you don't know how to use a basic one (which requires more practice than you might think). Also, they ain't cheap - see point #3.

Ah come on, these guys are in 4th year college, not primary school!

charlieroot wrote: »

3) Steths get stolen/borrowed/lost. Get yours engraved or marked in some way. Also helps to have a distinctive colour.

+1. Get a patient wrist band from one of the wards, write your name on it and tangle it around the bit where the...ear bits come off the long straight bit.Simple and cheap.

charlieroot

Believe it or not its not your fellow student that will slag you about it

Perhaps slagged was the wrong term to use. It will draw unecessary attention to yourself.
You'll most likely be singled out to do all the auscultating and ridiculed for not getting it
right with your fancy steth. Personally I think its just steth envy. Mine's fancier than yours! etc...
But I have seen it happen.

Apologies also if I came across as being condescending. I'm only a 2nd year student medical student myself.
But a lot of what I posted above wasn't immediately obvious to me at the time when I was getting
my stethoscope.

tallaght01

charlieroot wrote: »

2) Don't wear it around your neck. Apparently, you're only supposed do this once you've graduated.

.

This is mental but true. Anyone know where it comes from? The students here in Oz are much more confident and wear them round their neck. But it used to bewilder me as to why we were encouraged to keep them in our pockets when we were students. It's so much more practical to wear it round your neck.

To answer the question about someone wanting to buy a stet, I'd recommend a classic littman. BUT, if this person wants to spend a lot more, ask them to buy you a paeds stethoscope too. When listening to a baby's chest or abdomen, a huge steth can just include heart, lung and bowel sounds all in one go, and you can forget about localising sounds to a particular zone. I got a cheap paeds steth when I was a student, and it was really quite useful.

I was on a round once as a student and one girl had some mega funky cardiac thing. The consultant would constantly ask her to describe the difficult diastolic murmurs, because she had a fancy steth.

Carsinian Thau

all_smilz wrote: »

Get a fob and stick in on to ur white coats- i have cringed when i have seen interns catheterising patients with their gloves tucked into their watch strap! And do u really want to mank up a nice watch with hospital stuff?

Brilliant advice. I've only had one ward placement ever (I wasn't even a proper student then, still in premed) but every time I went in to the hospital, I'd take my watch off to wash my hands and then I'd have no watch for the entire time. Which, if I'd had to remain aware of time, would have caused a bit of difficulty.

all_smilz wrote: »

and ur white coat.... i lived with a med student who said she'd NEVER washed hers in 3 years....

Ewwwww..... :eek::eek::(

allsaintssue

Hey,
Good luck to everyone starting on the wards!!
I was terrified going into my first nursing placement..especially when one individual told me I could potentially kill people (She meant by not washing my hands..put the fear of God into me, I now have a Lady Macbeth complex!!).
Also, the only advice I can really offer is Ladies, watch out for your perfume choice,I've lost count of the amount of times patients have complained to me about doctors wearing overpowering perfumes..It is one of those things I'd never have thought of, particuarly since I used to always wear 'Poison' perfume, I've since changed to something more sublte!!

Brods

3rd year student starting a 4 week medical rotation in Naas on monday, excited but alot nervous too. Anything I could look over between now and then that'd stand to me? or would relearning the clinical exams be more useful? Ta

tech77

Brods wrote: »

3rd year student starting a 4 week medical rotation in Naas on monday, excited but alot nervous too. Anything I could look over between now and then that'd stand to me? or would relearning the clinical exams be more useful? Ta

For physical exam, just stick with Talley and O' Connor.
Some nice physical exam videos on Youtube as well fwiw.

bleh1234

Have a quick read over the main diseases in the speciality you'll be attached to. I honestly think Oxford handbook is the best book you'll ever buy as a student.

wheresthebeef

Brods wrote: »

3rd year student starting a 4 week medical rotation in Naas on monday, excited but alot nervous too. Anything I could look over between now and then that'd stand to me? or would relearning the clinical exams be more useful? Ta

Hey good luck in Naas. It's a great hospital to work in. The staff are generally all very friendly and students are still a bit of a novelty there. Moate ward is the most acute and generally most interesting of the general ward areas. If you're staying in the free accomodation across the road, bring a friend with you, the house is huge and is a bit lonely sometimes. The Library there is very good, and Toody (The librarian) is very helpful. And go up to CCU and ask the Ward Sister is they are doing any Cardioversions in the next two or three weeks, she has all the dates and times and will let you know when to come back if you want to see one. The consultant who does them is not the most personable. They also do Electro-convulsive therapy in the theatre from time to time, and although horrifying, is quite interesting. If you go to theatre, you will mostly only see laparoscopic stuff, so don't book yourself in there for a whole week. Avoid the wards in the old hospital if possible. There is free tea and coffee in the canteen, perfect for poor students like ourselves. If you're driving, parking can be horrendous, so park your car at the accomodation across the road as referenced above. If you're interested, the head of the Cardiology Outpatients is a really nice woman called Jan. She's a nurse and a cardiac clinical measurement scientist. She loves teaching and will go through ECG's and Echocardiograms with you if she has time, if you're interested. Endoscopy is also good, if you can get in there for a morning.

Brods

Thanks for all the advice folks.