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Ten Commandments for Med Students

This is my top ten tips for the new batch of Med Students hitting the wards this month.  This is about how to be a better student and get the most out of your clinical experience.  For all those doctors out there who supervise medical students – I hope you can use this, or let me know your “rules”.

This should go without saying. The nurses are the people you will work with every day – they are the team that make your experience.  If you get on the wrong side of the team – you will find it hard to enjoy the time you spend in the ward.

You may know more theory than the average nurse – but trust me – they know more about the stuff that counts in the real world. You cannot be a doctor without knowing the “how to”. That is what the nurses do. You can know the evidence, the dose and the drug – but if you can’t set up a drip you are not in the game! So look and learn – there are no “nurses jobs” and “doctor jobs” – you need to know it all!

As a med student the thing you lack most is experience. Knowledge can be gained from the books and lectures, but only being at the bedside gives you experience.  Nothing annoys me more than seeing students ‘studying’ in a hospital.  You should spend your time in the hospital honing your clinical skills not reading books!

Often students ask:  “how did you know that was the right thing to do?”  when they observe me making a tough call.  Well – it is gestalt – we cannot explain why it is right it is just experience.  The only way to develop a spider sense is to see thousands of patients, make a pile of mistakes (in safe-student land) and learn.

In order to teach you we have to know what you don’t know! This means you have to let us know what is happening in your noggin’.  Sure you might look less smart or even silly – but unless you ask questions it is likely that a busy doctor will move on to the next patient and that micro-learning opportunity is lost forever.

 Medicine can be a complex job, there are a lot of things to know and then you have to apply it to messy humans! So try and keep it simple – you cannot paint a picture with one brush stroke. You need to know how the little bits work before trying to put it all together.  Learn general rules, and important exceptions – that is how our brains work.

Ockham’s razor: don’t explain with more when less will do. Try not to overthink your clinical work-ups.  We find it hard to listen to long, directionless presentations – this is usually the result of a smart student who has tried to be all-inclusive and not been able to differentiate important from unimportant information.

You are expected to write in the clinical notes. This is an important skill to practice. The basics – name, rank, date, time and sign every entry. Clear, legible writing in black ink. Put your immediate supervisor’s name there – so we know who to call when it goes pear-shaped. Remember – the time you spend writing good notes is more time that we can spend discussing, teaching and watching you – it is a trade off.

Make sure the doc who discharges your patient also writes / signs the chart.  Or else it never happened!

Like it or not – this is your job for the next few years. This is the one skill that you will use everyday – and especially on EXAM day!  How do you practice “presentation”:  do it a lot, practice on your fellow students and take time to think before you start talking.  Mental rehearsal is a great way to learn to think on your feet – one of the most important skills required in everyday practice.  Be concise, be accurate and know the facts in case we need more info.

Oh, and we – your supervisors – really love a slick presentation – it saves time and shows us you know what is going on.

As a student you have a lot to do – however we, your supervisors are extremely time-poor. I think it is disrespectful to turn up to tutes, ward rounds or shifts late. Sure, sometimes it is unavoidable – so let me know, call, text or email.

I see you all as apprentices – this is a job, not a course.  So treat it like you would a paid job.

The average doc uses about 40,000 words in daily practice – and we all speak the same language. You have to know this language, or else it is like tring to catch a train in Peru without knowing Spanish! The patients do not usually speak the lingo – so your job is to translate their story into “Doc speak” and tell us. But remember – if you are talking to the patient – you have to reverse this process – translate back into lay-person language. Every year we see this error in exams – don’t use jargon with the patients.

You are not a doctor…. yet. You are supernumerary, a spare part in the medical machine. Sure you can be very useful and make it all run smoother – but you cannot carry the burden of a single patients discharge. Never let a patient leave without your supervisor seeing, speaking to and discharging safely.. NO MATTER HOW BUSY the ED gets!

Patient safety: Being uncertain is a large part of the job when you are a student (and beyond). But as a student you should be protected from having to do things which might cause harm if you are unsure. Ask, ask and ask again if you are not sure. The old days of see one, do one, teach one are gone. You will learn more if we watch you and correct you / guide you than if you just ‘have a crack’ at it and hope for the best. Injuring patients is uncool! Don’t let yourself into the situation where you are at risk personally either – we work in a risky environment sometimes – so be aware of the dangers. Learn from the nurses – they are good at this. Speak up if you feel uncomfortable or need backup.

OK, that is my spiel.  Love to hear your top tips for the next generation.

Casey

Comments

  1. Jonathan Ramachenderan says

    Great list and apt timing for the commencement of the term. I wish I would have had this list when I started.

    The greatest thing I lacked when I was a Medical student was mixing the 3 essentials of clinical learning: Experience (seeing patients) Asking questions (after seeing the patient) Study (Whilst the case was fresh). Combining these 3 will not only allow you to pass exams but gain favour with your Supervisors and actually know something when you’re first called “Doctor”.

    Yep, rock up on time, smile, respect the nurses, do your homework, show initiative, smile again and enjoy being a student!

    Sorry Casey, got carried away, excellent work!

    JR

  2. My primary piece of advice is: Ask for opportunities. Occasionally your reg will get paged to the ED, or one of your patients will be going to theatres, or something else interesting will happen, and if you don’t ask if you can go/watch/give something a try, you can end up helping the intern write discharge summaries instead. (Discharge summaries are important, but so is being able to learn how to do, say, a really thorough neuro workup on a ?stroke patient – and I’m at the beginning of my first clinical year, so I have a while yet before I need to be spending a lot of time learning the paperwork.)

    Thanks for the great post!

  3. Minh Le Cong says

    read house god and the sequel
    watch every episode of ER, Scrubs and any other medical drama you can get your hands on
    realise whilst medicine occurs in hospitals, healing occurs at home
    choose now to become a healer

    • Casey Parker says

      Actually – Minh, I don’t recommend the sequel to House of GOd – Mount MIsery – it is depressing. Maybe read it once you are too far post grad to go back!

      No kung-fu aphorisms? I need to hear one…
      C

  4. Nah, forget those TV series – you wanna watch ‘Cardiac Arrest’. For those of us trained int he UK, it was more like a documentary than a drama/black comedy.

  5. Great & timely post.

    A simple tip, yet often under-appreciated tip. Have fun & enjoy being there.

    And remember that there are things that will make you do well on the exams, but there are also many things that will make you become a good Doctor. Make sure you work on both aspects & don’t let any opportunities go to waste, because it was not exam relevant.

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