What is clinical placement like?

For many university students clinical placement is the first time you will get to interact with real patients. These will be people with real problems and concerns and for the first time you will be expected to play a part in their treatment. This placement is your very first window into what being a doctor is really like. You will be up close and personal with daily issues faced by doctors, the procedures they perform (and will sometimes expect you to do) as well as really develop your clinical reasoning.

To give you an idea of what its like let me take you through a day being the student attaché to the General Medical Unit at a metropolitan hospital. Before we get started, let’s quickly talk about what the Gen-Med unit actually does. The unit is hyper broad spectrum in the patients it sees, the presenting complaints can be anything from headaches to incontinence. The purpose of the unit is to stabilise, deal with immediate concerns, treat presenting complaints and then decide whether patients need specialist attention. At the unit I was attached to there were two interns, one registrar and one consultant.

As a student there is a lot of flexibility in hours but to maximise your experiences your day should start when the other members of your team's does. The Gen-Med unit start at 8am which might seem early but remember most surgical teams start much earlier! At this time the interns and registrar will arrive and do a preliminary survey of all the patients already in their care as well as take histories and examinations from new admits. The role of the student at this time is to either shadow one of the interns as they talk to patients or be given one or two of the new admits to interview or examine. It’s important you take a thorough history and do a complete examination because these are not simulated patients.

After the initial rounds are done the consultant rounds will begin at roughly 10am, though this changes from team to team. A big hint here is to not expect the hospital to run on time. Very rarely does everyone show up at the times scheduled but this is due to the nature of the hospital. There are always emergencies and issues that consultants need to deal with and that you, as a student, should accept and understand. Once the consultant arrives each patient under the team’s care will be presented to the consultant. Then there will be a discussion at the bedside of each patient regarding the treatment and actions required for that day. During this time copious amounts of notes are written in the patients file including history and examination findings as well as management plan. Sometimes you will be expected to present the patients that you interviewed and this is a tough skill to learn. On most teams the consultant ward rounds and bedside discussions is where the bulk of the ward teaching will occur. Don’t expect hospital learning to be structured, it never will be!

After a plan has been worked out for each patient the consultant will generally leave and the interns and registrar are now in charge for the rest of the day. From the end of consultant rounds you are essentially free to make your own choices regarding what you would like to achieve that day. You can stay on the wards and talk to patients, shadow the interns as they go through each patient’s management checklists or go to the library and do your own study. If you stay on the wards you will have many opportunities to do medical procedures that you have learnt such as cannulations, catheterizations, injections and even performing ECGs. At most hospitals you can stay as long as you like but the interns' day will finish around 5-6pm.

The biggest piece of advice I can give you about clinical learning is that its very different to book learning but equally as important. The ability to talk to patients appropriately and understand the mechanics of the hospital can’t be learnt from textbooks. At the same time passing exams and structuring your knowledge can’t purely be done from ward learning so a combination of both will be required! In my opinion though placement is definitely the best part of medical school, simply because it’s the first time you will be doing hands on things that you so far have only read about!