Laura Nunez-Mulder: Tips for clinical placements

How to excel on placement: 

Clinical placements are a major source of learning. Other areas of the course – books, lectures – are predictable and saturated with extra resources for managing your learning. On placement, your learning depends on other people. It is unpredictable, and opportunistic. Here are some tools for making the most of it.

Before the placement

Leech as much information from your virtual learning environment as you can. Look for timetables for compulsory teaching and optional or departmental teaching, lists of clinics you could attend, directions to theatres, and names and pager numbers for day one. Make the key information easily accessible – my favourite place is in my online calendar, including a ‘day one’ event with any information I’ll need for the first day in the description. A notebook or a note app also works.

Refresh relevant practical skills. You can be confident of opportunities to practise arterial blood gas on a placement in a respiratory medicine, intravenous infusion in oncology, urine dipstick in general practice, and venepuncture in almost any hospital placement. Some skills crop up more rarely, such as suturing – so if you’re approaching a surgical or emergency placement, be sure of your competency in sterile fields and knot-tying so that you can take those rare opportunities. Rusty skills could be embarrassing for you and nerve-wracking or even harmful for the patient – so brush up.

For specialist placements, scout for useful history-taking or examination skills that are beyond the core routines you have learned. For example, you could read about the mental state examination in psychiatry; the normal ranges of basic observations in paediatrics; or, common investigations and how to interpret them, such as ECGs and echocardiograms in cardiology. You don’t need to memorise the specialist curriculum before your placement, but keep a note in your phone or notebook with useful new information so that you can consult it at ease during week one.

On your first day

Pack too much. Bring your stethoscope, notebook, pen, food and water, and a mini textbook for when you have periods of waiting. Bring an extra layer – general practice and hospital clinics are reliably colder than wards. Most departments have a space where staff leave their bags, though consider keeping valuables on your person. By the end of your first day you’ll have a better idea of what you need to bring for the remaining days of your placement.

Do what you need to do to and appear bright-eyed when you make first impressions on your new placement. Whatever works for you: set your alarm as late as possible to get extra sleep; keep your morning routine of breakfast and exercise; or, drink from a thermos of tea or coffee while you travel.

Introduce yourself to everyone. Introduce. Yourself. To. Everyone. Medical students come and go at a much higher frequency than students in other healthcare professions, and in every placement you risk hovering as a passive observer for weeks, with no one quite knowing what you need and what you can contribute. Do not discount non-healthcare professionals, such as cleaners and the people who serve refreshments. Knowing and being known fosters a sense of belonging even when changing placements frequently.

Ask as many questions as you can. Ask staff their names and roles, and if you’re unsure what their role means, ask with a tone of curiosity. Ask when and where you should be to join in with ward rounds, clinics, theatres, departmental teaching, and so on. Ask about the patients you see, and the decisions the doctors make.

Be prepared for periods of searching or waiting. A small textbook is useful for the slow times. If you have prepared by following every tip in this article so far, it can feel disappointing when things do not go as expected. But whatever you experience on day one, day two will usually be different.

In your first week

Introduce yourself to everyone, everyday – including the people you have already met. Make yourself known to the team, and have patience when the team need reminding who you are; this is to be expected with such a high turnover of students.

Ask about project opportunities (if that’s your jam). Are the doctors on your team working on audits or research that you could get involved in? The sooner you can get on board, the better – then, during your placement you can touch base with the team ad hoc. A project may involve data collection or writing a draft, and is likely to be time-consuming. It isn’t for everyone.

Attend the full range of clinical activities – wards, clinics, procedures – to get an idea of what you learn and enjoy in each. That knowledge will help you make the most of your remaining weeks of the placement.

Throughout your placement

At least one day each week, commit to hanging around even if nothing seems to be happening. You may get rogue skills signed off, you may see an acute event, or you may get some ad hoc teaching in a lull. Or you may get nothing. But not quite nothing – even a slow day is an opportunity to show your keenness and to build trust with the clinical team, so they are more likely to remember you next time they come across a useful learning opportunity.

On other days, take time for self-directed study. Sometimes it is pragmatic to revise when placement is quiet.

Make the most of the OnExamination question banks if you get unexpected downtime – for example, if someone does not attend their appointment in clinic, or if a patient does not consent to you being present. OnExamination has an offline function, so if you open a question session before you head to placement, you will be able to work through the session throughout the day whatever the wifi.

For specific ideas of how to get involved during a hospital placement, read Stephanie D’Costa’s tips for success on the wards: write in the notes, write discharge letters, ask to present imaging, ask to scrub in to surgery, and more.

After your placement

Thank the clinical team and fill in the feedback forms. Your perspective could benefit the medical students who come to that placement after you.

If there was a member of staff who made an impact on your placement, drop them an email – even if it is one sentence. It’s a delight to hear positive feedback, and it is something that doctors could use in their appraisals as evidence for teaching or personal development. Someday, you’ll be in a position of collecting evidence for your appraisal, too.

Reflect: are you wondering what the point of that placement was, or feeling satisfied that you got everything out of it? And how will that affect your next placement?

Bio: Laura Nunez-Mulder is a sixth year medical student at the University of Cambridge, and former editorial scholar (2018-2019) at The BMJ.

@lnm_ru

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