By Elizabeth Wallin
With the new medical school term about to start, lots of fresh-faced medical students are about to hit the wards for the first time. Finding the right balance between lectures, bookwork, and bedside experience is difficult and different for everyone. Some learn best in the library, others in theatre, and others by sticking like glue to a qualified doctor. Whatever works for you, there are a few tips that I can pass on, based on my own experiences, several years of teaching medical students, and listening to the grumbles of senior clinicians and teachers.
- See at least one patient every day. Everyone will tell you this, and nobody ever does it. However, if you only take one tip away from this post, please let this be it. There is no substitute for experience and the more histories you take and patients you examine, the better you will get. If you see a patient, take their history, examine them, and then read their notes to find out what has happened since admission, what their diagnosis was, and what treatment was started. You then have something to focus your reading on and a face to remind you of that condition. Yes you need to read up on them all, but it’s easier to remember facts if they have human details attached to them.
- Always see the patient before you read the notes. This is a tip for junior doctors as well as medical students. Many patients will have been labelled with a diagnosis but sometimes these diagnoses are incorrect, or preliminary, or evolving. Even if they are correct, learning to listen for a murmur, or test for whispering pectoriloquy is more important than getting the answer right. You hear what you expect to hear and see what you expect to see, but signs change. You may turn around to present your findings, confidently stating that the patient has a pleural rub, only to discover that the registrar you are presenting to knows that the pneumonia has been treated and the rub is no longer present. Rely on your own ears and eyes. You won’t always get the answer right and you will miss things, but admitting you can’t hear something means that the person teaching you can correct your technique or show you ways of making signs more prominent. Remember that even senior cardiologists request echocardiograms to confirm valve lesions.
- You learn most from experience. Following a junior doctor around, taking histories and examining the patients they direct you towards, or asking senior clinicians to teach you examination skills and correct your examination routine are the best ways of learning medicine. The clinicians you learn from have years of experience and try to keep up to date with their subject. Many will be delighted to pass knowledge on to enthusiastic students. In addition, every patient tells a unique story, you cannot put emotions onto paper, feel enlarged livers from a textbook, or understand how uncomfortable cannulas are from inserting them on a model arm. The caveat to this is this is…
- Don’t rely entirely on experiential learning. Experience is the most valuable way of learning, but only when reading around the subject backs it up. Perhaps the consultant teaching you has a preference for a particular way of performing a procedure, that doesn’t mean there aren’t other methods. Perhaps the patient you are seeing has been given a less common drug: is this because they have allergies or failed first line treatment? Your medical school library should have books on all subjects, borrowing one on the area you are rotating through will help you back up your learning. In addition, there are many online resources that can help, but try to stick to reliable, evidence based sources rather than just Googling your subject. Check also whether the textbook you are reading has associated web-based content.
- Attend lectures and give feedback to your lecturers. Yes, a 9 a.m. start is difficult to get out of bed for, sitting through an hour on the glomerulonephritides may feel like it confuses you more, not less, and you will end up with copious notes that make little sense afterwards. However, when you are starting work at 7:30 a.m. and your Consultant is asking the 27 causes of the symptoms you’ve just diagnosed in your patient, you’ll look back with longing. If only you’d listened and made notes. If only you’d got up in time. Your lecturers should be experts on the subject and should give you up to date and interesting information. If they don’t, or their style isn’t very engaging, give feedback. Things won’t change unless you tell your medical school that there is a problem. Be honest, but polite and constructive in your criticism. Remember there is nothing more disheartening than lecturing to a half-empty room of bored and sleeping students, so get involved, ask questions, and recall your lecturer got up far earlier than you did.
Hopefully these tips will help you to get the most out of your time at medical school. It should be a fun experience and one of the best periods of your life, but remember that at the end of it you’ll be expected to be a doctor. That’s a scary thought, so do what you can now to make sure you’ll be the best doctor you can be. Good luck!
Elizabeth Wallin is one of the authors of the ninth edition of the Oxford Handbook of Clinical Medicine. She is a Specialist Registrar in Renal Medicine at Addenbrooke’s Hospital, Cambridge, UK. Oxford Medical Handbooks are also available online as part of Oxford Medicine Online.