Thursday, 14 July 2016

How to Get the Most from the Ward

As a medical student, I always felt I was in the way and a bit out of place. Particularly in third year which was the start of our clinical rotations in hospital. I wasn't sure when was the right time to go on the ward and what I should do when I got there. Should I join the ward round or should I just complete jobs? It was a new environment and it took me a while to adjust to it. Consultants to me seemed scary and ominous and I really didn't want to bother them unless I really needed to. Eventually, I began to learn what worked for me.

Ward rounds were really not useful to me. Most things, probably everything, went straight over my head. I didn't understand what was going on and what all the acronyms meant. After a while I felt stupid asking so many questions  and I resolved to write down everything I didn't understand and then look it up later on. Sometimes I did, sometimes I didn't. When there's a list of random words and phrases on a paper, it loses its context and I'm left just Googling. I would forget these things later on anyway. I tried again and again but I eventually realised that ward rounds weren't the best learning opportunities for me. Walking behind a couple of doctors as they passed from patient to patient made it hard for me to keep my focus and not be bored especially when I didn't feel involved. It was different in fifth year. When I took part in ward rounds I was more involved and I had a better understanding. I would look through patient notes, see the progression of disease or the different treatment plans that had been trialled and piece things together. So my points is: be as involved as you can.

I found it useful to just break away sometimes and go off with another third year and take histories. We'd sit with the patient for about half an hour and write down our findings. I learnt more this way. If I came across that condition again, I could think about the patient I came across and it would stay longer in my mind. If you Google all the signs and symptoms that a condition has, it becomes more memorable if you can associate a disease with an actual patient . They'll describe how they felt and how they reacted and it paints a more memorable picture.

I found listening to murmurs really difficult. The first and second heart sounds were so close in succession, I wondered how I was supposed to decipher anything else in between them. I needed to practice. Listening to aortic stenosis on Youtube was much easier than a real person. Why couldn't they sound that clear in real life. It took forever to do and to be honest I'm just about got the hang of differentiating between aortic stenosis and mitral regurgitation.  

Ask the doctors on the ward if there is a particular area you need more practice on. They see the patients more often and can point you in the right direction. Some might even be willing to teach you at the same time.

Being helpful. People can't always rush to help you because they're busy. If you can lend a hand, not only will they be grateful, they would be more likely to help you out as well at some point. I would take bloods, insert cannulas and other things that were easy to do in theory but time consuming in reality. I found people were more open to me and didn't see me as some annoying student that got in the way.

You have to keep an eye out for different opportunities. As a requirement for passing the year, I would need to have certain skills signed off. Not all the skills could be signed off on the ward I was on and sometimes I would have to venture out and look elsewhere. A lot of the time you had to be very forward with skills or else you really wouldn't get them done. Inserting a female catheter was a requirement and I was able to do it in the labour suite.

Be kind to patients. Patients are willing to help you with your learning. Respect that and don't abuse it. Don't be afraid to approach patients and ask them if they would be willing to allow you to practice a particular examination. Majority of the time they will say yes. They're bored. They have nothing else to do and it can be entertaining but most of all they want to help as well.

The ward can be a battlefield, but it became easier for me when I gradually got used to it.


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