Laura Nunez-Mulder: Tips for returning to placements after a long break

Taking time out from a medical degree can happen to any of us – now, it’s happened to all of us. In the midst of a pandemic, medical students around the UK are returning to clinical placements following an unexpected long break. A fortunate bunch have been able to volunteer in healthcare settings, but many of us have de-skilled and spent a long time with textbooks, video lectures, and practice questions. (Read: It’s not selfish to study through the pandemic).

This is not my first break. I spent a year working full time in an office environment between my first and second years of clinical school. I was nervous to return to placements, aware that my knowledge and skills had atrophied from lack of use. This year is different: I am staying in the same year group, and I’ve done some studying. Most importantly, I’ve been here before. I know what to expect from myself, and I know what works and what doesn’t. Here’s what I learned about returning to placement after a long break.

Practical skills

Imagine a worst case scenario. You return to the wards and offer to take bloods. You have signed off this skill multiple times and decline the offer of supervision. But you find it takes a while to get started, because you forgot to put a tourniquet in your equipment tray, and then it takes multiple attempts. You’re embarrassed and frustrated. The patient has experienced avoidable discomfort and feels uneasy at your apparent inexperience.

Nobody wants this.

For the sake of your patients, anticipate that your practical skills will be rusty. Consider spending a half day in the clinical skills classroom, refreshing the core skills you’re hoping to maintain on the wards. I was surprised that my muscles remembered the movements of venepuncture and cannulation well. Instead, I had to practise the steps before and after – gathering equipment, flushing the cannula, and so on. By the time I had an opportunity to carry out a practical skill on a ward, I was confident that I could do so calmly and professionally.

Histories and examinations

While I practised practical skills in advance, I gave no thought to the skills of taking a history and examining a patient. But these skills get rusty too. In my first conversation with a patient, I found myself struggling to retain the information from the conversation in my head at the same time as deciding which questions to ask next. The structure of a typical history was not solid enough in my mind to fall back on.

I was glad to be in a low pressure environment when I took my first history. The patient had been suggested by the ward team – someone friendly, and well enough for a long chat – and I did not have a doctor observing me. The patient and I had a rambly and pleasant conversation. The next time I took a history, I was a little more competent.

As for examinations, Declan Murphy (now a foundation year two doctor) says that after his intercalated year from the University of East Anglia, he found a buddy who had also intercalated. They met up once a week, usually on a Sunday afternoon and sometimes with a bottle of wine, and ran through the different examination routines that frequently come up in bedside teaching and OSCEs. What is better than preparing for a return to placement? Preparing with friends.

Energy

Starting a new occupation is exhausting: new names, new vocabulary, new hours, and so on. Anticipate that you will find the return to placement more draining than when you left it. There are different ways to manage your energy. I found it useful to dial back social commitments in the first two weeks of returning to placement. Saakshi Bansal, a final year medical student at the University of Cambridge who took a year out for her mental health, planned a placement timetable for herself – including rests. Figure out how you can make space for extra rest in your first fortnight back in clinical school.

Expectations

You will not be able to pick up where you left off. All your clinical skills will be weaker than you remember; but they will return to you within days or weeks. You should also set the expectations of the healthcare teams you are joining. When I started on an oncology placement last week, I introduced myself: “I’m a final year medical student, and this is my first day back.” One of the nurses gave me guidance on personal protective equipment and, as I cannulated, supervised me more closely than they may otherwise have felt necessary for a final year student.

Expect frustration and nerves. Prepare to overcome them by practising mindfulness, revising key skills, and tapping into other sources of self-worth.

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Hospital and primary care environments are different to when we left them pre-pandemic, but if we can manage our own preparation, energy, and expectations, we will soon find ourselves settling back into a familiar rhythm. Even though you may face challenges at first, I hope my tips help you feel ready to return to placement.

For students starting clinical placements for the first time, sit tight: I’ll soon be sharing my tips for making the most of placements.

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

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