Resus in the Trauma Unit at Chris Hani Baragwanath Hospital, Johannesburg, South Africa
You've finally made it to final year. The beginning of the beginning - where being a student ends and doctoring begins. At least that's my take on it. I suppose foundation year 1 is viewed by most people as the transition between medical student and doctor but for me it was final year. More specifically it was the elective. I went to Chris Hani Baragwanath Hospital in Johannesburg for six weeks of Trauma followed by a couple of weeks at Isilimela Hospital – a rural hospital in the middle of nowhere on the Eastern Cape. Making the most of your elective is probably another post entirely but suffice it to say that the experience did more to make me a doctor than any of my firms in London’s teaching hospitals.
The difference was the expectations that the clinicians in South Africa placed on their students (both foreign elective students and their own). They expected students to be part of the team. We had a job to do and a role to play just like everyone else. You were expected to contribute, within your clinical aptitude, to the clinical management of patients – primary surveys, suturing, cannulas, bloods, catheters, chest drains, LPS, central lines and so on. You were expected to be on the post-take ward round after your night shift. You were expected to be at the M+M. A bit like being an F1 then. Just less paperwork, more responsibility, more procedures and a lot more fun. I left for South Africa a student and came back to London a doctor. Not because I had more knowledge or could do more but because my attitude had changed. I’d become comfortable doing the job I’d been trained to do. I was at ease with patients – no longer reticent to speak to them or examine them.
Nowadays (I’m really showing my age here), most (if not all) medical students do their electives after Finals and I can understand why medical schools choose to structure their courses that way. But you miss out on taking the confidence you gain from going on elective and letting it shine in your final exams. I’ve been an examiner for Imperial College Finals and we’re not looking for students to be the next Christian Barnard or Harvey Cushing; we’re looking for our next F1. We’re looking for doctors that look like they’ve been in a hospital before. Doctors that are polite, comfortable and confident talking to and examining patients. Doctors that are going to recognise a sick patient and talk sensibly with their colleagues. You can know Cheese and Onion back to front and be able to parrot the latest NICE guidelines for the management of hypertension but if you can’t take a solid history and perform a slick examination in your sleep you’re in trouble.
So my advice for final year – stop being a student and start being a doctor. Don't wait for your elective - start now. Get involved with your firms. Contribute. Take on responsibility. Be part of the team. Stand at the front, not the back. Ask questions. Talk to patients. Touch them (with their consent). Act like a doctor now and when you walk into your Finals you’ll leave your examiners with no doubts that they’d be happy to have you as their next F1.