You may be a pre-medical student about to apply to medical school, a first year medical student who has just started, or a final year medical student like myself!
In this article, I shall share with you my experience on the wards of a large tertiary hospital as a final year medical student.
After completing my core three-week rotations in general practice, psychiatry, obstetrics and gynaecology, and paediatrics, I started my six months rotation in hospital based practice - a rotation where the student acquires experience in medicine and surgery within a hospital setting.
My first block was surgery, starting on the vascular ward for one week – other surgical rotations were in colorectal surgery, orthopaedics, anaesthetics and ITU for a similar period. Ward rounds in surgery generally began quite early in the mornings so the surgeons could be in theatre as early as possible to start on their theatre list. Because of this, I woke up at about 6:30 each day so that I had time to reach the hospital, change into my scrubs and be on the ward before 8 am to join the round. Members of staff on the rounds usually consisted of the nurse and consultant looking after the patient, the consultant’s registrars, junior doctors, medical students and sometimes other members of the multidisciplinary team such as physiotherapists. The turquoise-coloured scrubs which medical students had to wear at this hospital readily identified us, so after joining the ward round, the consultant and registrars often spent extra time teaching and sometimes put us on the spot by asking us questions – something which I liked as it gave me the opportunity to demonstrate my knowledge. On occasions, I was asked to take-over the role of the foundation doctor by writing in the notes whilst on the consultant-lead rounds – a job which is the ‘bread and butter’ of the junior doctors.
After the ward round which usually lasted just under an hour, I had the option of staying on the ward, going into theatre or to a clinic. Throughout my surgical attachment, I tried to create an equal balance between these three options, but I enjoyed being in theatre the most as I often had the opportunity to scrub and assist the consultant. As a final year medical student, I got to see a range of surgical procedures which included hip and knee replacements, neurosurgery to evacuate an extra-dural haematoma and plastic surgery to debride a dog bite. I often became part of the team in theatre, and on many occasions, I had the privilage of being able to shadow the anaesthesist and other members of the theatre team. Providing that I obtained the patient’s consent, I often got chance to cannulate the patient – a procedure which involved passing a small plastic tube via a small needle into a vein so that the anaesthetist had intravenous access. During the operation, the surgeon and anaesthetist often taught me by showing me what they were doing and asking me questions to apply my knowledge to the situation. On many occasions, I was offered the privilage to scrub-in and stand-up close to where they were operating so that I could see things in detail and sometimes hold surgical retractors so that the surgeon and their assistants had plenty of room to operate.
Being a final year medical student on the ward is essentially doing the job of a foundation doctor, but under supervision. There is usually a job book lying about on the desk which has all the jobs for the junior doctor to do for the day - a list which has usually been compiled during the ward round with the consultant. When I was based on the ward, I often did the jobs from this book to help the foundation doctors out and gain further experience at cannulas and taking blood samples from patients. Once the jobs were done, I clerked-in new patients who had arrived for their elective surgery. Clerking involved taking a focussed history of why they came into hospital, their proposed surgical intervention and why this is needed, their current health and whether any symptoms have changed since their last visit to the doctor, and ensuring they are fit for the operation by taking a full systemic enquiry and examination. They are then usually reviewed by the foundation doctor, nursing staff, their consultant surgeon and anaesthetist.
Life on the wards as a final year medical student is exciting but also tiring. Medical students often need to go and find their learning opportunities by interacting with staff and patients – it’s all about being independent adult learners. Moreover, after leaving the wards at around five or so, the working day is usually far from over, as many students often study during the evenings – for me, this happened after going to the gym!
Christopher G. Ghazala, B.Sc. Hons. (Dunelm), M.Res. (N'cle), final year medical student
Received August 2010