A personal experience: UK 2008
I wanted an elective which would help to equip me with new skills and experiences essential for final-year medicine and beyond. I felt that going to a foreign hospital was a costly, lonely and unnecessary option, so staying here allowed me to further-understand our healthcare system. After reflecting on past experiences, I knew that I would gain confidence by working in various settings and a much larger hospital. Although a junior doctor needs to be proficient at the core clinical outcomes as outlined within the curriculum, it has become apparent from attending career lectures that a good research profile would strengthen an application to specialist training. Even though I have intercalated twice, I also wanted clinical research experience. Bearing in-mind these points, I chose to experience the healthcare setting of a tertiary hospital, spending the initial 5-weeks attached to the Royal Victoria Infirmary, Newcastle. After studying this during fourth year, my research focussed on PBC, a progressive autoimmune disease of the intrahepatic biliary ducts.
I felt that the elective period was a good opportunity to spend more time with my family, so I did a further 5-week placement within general surgery and orthopaedics at my local hospital. As I have a surgical career in-mind, I felt that the elective was a perfect opportunity to further-experience this field and some of these sub-specialities within it. This would allow me to assess whether my personality and skills were compatible for such a career move. I could also experience the healthcare system within a rural district general hospital setting and a more research-intense tertiary environment.
From 17-July to 12-August, 2008, I saw 34 operations (50 hours) in general surgery and orthopaedics. I saw relatively common general surgical procedures like hernia repairs, skin lesion excisions, and complex cases like an abdominal aortic aneurysm repair, femoral embolectomy and an above knee amputation. I also saw 15 orthopaedic cases including two total knee and one total hip replacement
Besides being given many opportunities to be in theatre, my placement in Cumbria allowed me to see, at first-hand, many surgical patients, both in the clinic and the admissions ward. Clinic was every Wednesday morning and my supervisor provided me with my own room so that I could see some of his new patients alone. After obtaining a brief relevant history, and, where appropriate, an examination, I would present the findings to their consultant so that he could check my findings and discuss his management plan with the patient. After clerking, I often followed them up in theatre as this is more meaningful than briefly talking, as I got to know the patient and how their condition affected their life.
All of the opportunities offered allowed me to gain confidence and it has been a worth-while and recommended learning experience. I was the only student at both hospitals, so I felt known and more part of the team. By integrating myself within the team, I essentially did the job of a junior doctor (prescriptions were checked and signed by a doctor). At the same time, I also experienced the research-intense and modern environment of a leading tertiary hospital. I have interacted with a large multi-disciplinary team including professors, clinicians, surgeons and nurses, so I feel I am now a proficient team-worker who can recognise my limitations and integrate well within a team-setting.
On reflection, experience within an operating environment has motivated me strongly towards surgery. I feel that I am now proficient at scrubbing and I have also had experience assisting with surgical procedures. I am also now familiar with some of the basic surgical tools and recognise some of the common procedures within these two specialities. I now appreciate that operating is only a fraction of a surgeon's professional commitments, but deciding when to operate and dealing with complications is likely the most difficult aspect of a surgeon's job.
Christopher G. Ghazala, B.Sc. Hons. (Dunelm), M.Res. (N'cle), final year medical student
Received May 2010