Lemon-aid

Lemon banter

Stop standing around like a lemon – make the most of your placements

Posted 08/10/19

Instruments and images

Imperial College Medical School has an interesting station in Finals called “Instruments and Images”. In the “Instruments” bit, you can be handed pretty much anything and asked to talk about it. It’s quite a fun station for examiners because you can take the discussion into so many different directions and really test a candidate’s knowledge. They usually start easy and can get quite tough. So, imagine. You’re in the “Instruments and Images” station of your finals exam and one of the examiners hands you a form that looks like this:

WHO Checklist

Uh! What’s this (some of) you ask?! You were expecting a cannula or nasopharyngeal airway or something like that; not a piece of paper. This isn’t what you prepared for. This piece of paper happens to be an excellent discriminator between students that have engaged with their surgical placements and those that have not. If you’ve been in theatre, you’ll have seen the WHO Surgical Safety Checklist being done dozens of times. You’ll know what it is, why we use it and when we use it. You might even have led the “Time Out”. Easy. If you’ve just kept your head in books or stood discretely in the theatre corner trying to keep out of the way then you probably won’t.

Back to basics

Remember, the point of Finals is not to find the next Nobel Prize winner for medicine. The main aim is to make sure you’re going to be competent, safe foundation doctors. First of all, examiners want to see that you’re familiar and comfortable with hospitals and how they work. That you know the basics. That you understand the system. There’s no point in being able to talk about a Swan-Ganz catheter (which I got in my I&I station) if you can’t talk through a WHO Surgical Safety Checklist.

When you’re on your hospital or primary care placements, engage with what’s going on around you. Don’t just be a passive observer. Get involved. If you immerse yourself in the goings on of your placement you’ll pick up the basics without even thinking about it. If you keep your nose in the “Cheese and Onion” you won’t and it’ll be obvious to your examiners.

Engage!

When you’re on ward rounds, write in the notes, look in the obs/bedside folder, write in the drug charts (get the docs to sign) and present the patients. You’ll learn far more than if you’re a passive bystander. When you’re in clinic, get your own room, talk to patients and EXAMINE them. Present your patients to the registrar or consultant. There is little to be gained from watching someone else see patients for 3 hours – you need to do see them. When you’re in theatre use the time in between cases to talk about pathology and anatomy with your surgeons. Scrub in on a few cases! Learn about surgical instruments. Watch patients being anaesthetised. If you’re not scrubbed in, talk to doctor at the head end drinking coffee and doing the crossword (the anaesthetist) about airway adjuncts, vascular access and drugs. If you show enthusiasm and interest people will take the time to teach you and more importantly, you’ll enjoy yourself more.

Don’t just spend time with doctors either. Nurses are playing an ever increasing role in the management of patients – particularly in specialised areas. They will often have insights unique from doctors’ in their area of expertise and are usually very happy to teach. In particular, spend some time with stoma nurses, vascular access nurses and diabetic specialist nurses.

Time is precious

One caveat to the above – your time is precious; particularly in final year. As you go on in life and in your careers you’ll quickly discover that it’s the most precious commodity going. When it’s gone it’s gone. Do not waste it. If you are not getting something from a particular activity then stop doing it and go and do something useful. You’re an adult learner, you don’t need to be told what to do. Find the doctors that enjoy teaching and gravitate to them. If you’re getting ignored on a firm despite trying your best to engage, then look for learning opportunities elsewhere. Go and examine a few patients on the ward. Doctors are just people too and sometimes, for whatever reason, they just may not have the headspace for teaching.

Don’t just stand about like a lemon in the hope that knowledge will somehow seep into you – get involved! I promise you’ll learn more and besides, it’ll be more fun.

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