Ep 3: Clinical Placements at Medical School

What is it really like go on clinical placements as a medical student? Find out in our latest podcast episode! Medicine students Komalpreet and Connor, and graduate Dr Sebastian Spencer, give their insight, including: What they do on placements; How they benefit from their experience; The challenges they have faced, and how they overcome them; and their favourite things about placements, and advice for students starting out on placements.

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Transcript

00:00:02 Connor 

Hello and welcome to the Hull York Medical School podcast. I'm Connor, a 4th year medical student. Today we're at Hull Royal Infirmary, so apologies if we suddenly have any noise coming from outside. 

Today we are going to be talking about what it's like to be on clinical placement as medical students, so with me we have... 

00:00:21 Seb 

So, I’m Seb. I'm a Research Fellow at Hull at the minute, but I am a HYMS grad from 4 and a half years ago. 

And I did also work for the clinical placement team for two years in the meantime. 

00:00:36 Komal 

Hi my name is Komal. I'm a third-year medical student and I'm based in Hull at the moment. 

00:00:42 Connor 

Fantastic, so I think we'll crack on straightaway and we'll go on to our first topic. So, what do we do on clinical placements? 

00:00:51 Seb 

So I’ll let Komal start, who is most up-to-date. 

00:00:52 Komal 

OK yeah, so it depends on what year you're in because it's slightly different when you start off. 

So I actually started in Gateway so it was a bit different then. A lot of it was... there's a bit of theory behind it when half the session you go through the topic that you're learning, but more of a clinical basis rather than theory that you do in like lectures and PBL. 

And then the other half you go and meet patients. And we did that in year one and two as well, but it was slightly different where the sessions were slightly longer as you proceeded through the year. 

So year one was half a day and year two was a full day. So either the morning you'll spend doing like a resource session, where you'll cover the topic, looking like at the clinical side of it. And then the other half you go and speak to patients with your Clinical Teaching Fellow. 

00:01:42 Connor 

Fantastic and who are you with when you're doing that? In groups, individually? 

00:01:47 Komal 

Yes, it was groups. So, the resource session was like a large group, so it was like Gateway because there's only a few of us. There's about 21 students, so there were 10 people, one large group, so we'd have large resource session together and then we'd be split into like threes or fours for the teaching in the afternoon which is when we got to see patients and we take turns to ask patient questions and perform examinations. 

00:02:15 Connor 

Fantastic, so I'll speak from sort of my recent experience on clinical placement as a Phase II student, so in year three and four. So, you start to rotate around sites, you're on full time clinical placement, so I've been at Hull and York and after Christmas I'll be going to Scunthorpe. You get to choose a buddy to go around with and so you're not moving around all by yourself. 

However, a lot of the time on clinical placement you may be doing it independently and going to various clinics, going on ward rounds, shadowing consultants or other doctors, as I've shadowed Seb in the past. 

That allows you to day-in day-out, see a number of patients, a number of presentations, and it's really enhancing your breadth of clinical knowledge. 

Seb, do you have anything to add? 

00:03:10 Seb 

Yeah, well, I think the highlight really, so I think the thing about clinical placement is don't forget our clinical placement is in the NHS. Every ward and department works differently, so your placements can be very dynamic. At the Medical School we have a skeleton sort of structure for clinical placement but you've got to be dynamic and you've got to adapt to the situation. So, there's not going to be the same patients there every day. Your wards will be staffed in different ways. They will be geographically in different places, they won't even look even similar. 

And also you'll be working with different clinicians. You mentioned Clinical Teaching Fellows, so they do a lot of clinical placement teaching here and in York, so they're recent graduates of Medicine and Physician Associates Studies. But a lot of the time it might be a consultant, or it might be a specialist nurse, or it might be a GP, or it might be a physiotherapist. You just adapt to a different situation. I think being flexible and just being open, turn up, see what's going on and you'll find lots of different ways of learning and being presented the same thing. 

You'll find things that you like a lot and probably some things you don't like quite so much. But your buddy as you mentioned quite possibly be the complete opposite in terms of what they respond to the most. 

So it's hard to define clinical placement. I think really anything I would define strictly to is something that you can only learn by being there, as opposed to being in a library and reading a book. 

00:04:52 Connor 

And I think that goes with what we hear I think time and time again. You get out of it what you put into it. So by turning up and by choosing where you want to go, so you will have timetable teaching sessions, but there's a lot of time where you can sort of choose where you go and how you meet your learning outcomes. So, you might find that an outpatient clinic is more your style than going on the ward around that morning. Or you know, going into a theatre and being with a surgeon. That maybe that's your thing. 

I think that feeds on to our next topic of how we benefit from placements and how that fits in with our learning outcomes and how it's tailored to make sure that we're really getting things out of it. 

So, you will move around various wards and various departments, and so you'll spend time on respiratory wards and respiratory clinics and you're on that block. 

So, ultimately there is a structure there that allows you to go and sort of have an idea of where to go, how to get your learning outcomes, but then ultimately a lot of it's down to you. 

But then I think what people might be saying is if there's a lot of self-direction to it, are there any difficulties or challenges that we might face? 

00:06:17 Komal 

So in terms of difficulties, I don't know in terms of self-directed. I think the difficulties that I found so far is sometimes patient interactions because they can affect you. 

So I recently just had the mental health block so as you can imagine, I've spoken to patients that have gone through a lot. So, this is like one of my first consultations that I had with a patient of that block. During the consultation itself, I felt myself getting overwhelmed and you have to maintain that composure because you can't let the patient see that you're feeling all of this as well. 

And it's also after the consultation. You have to think about how to not let it affect your practise as well. Like you're allowed to have your emotions, you're allowed to, you know, think about the patients. But you need to make sure it doesn't affect your practise and it makes you stronger as a doctor, well as a medical student and then a doctor in the future. 

00:07:10 Seb 

From my perspective as a tutor, what I found is that, so in your first two years and in Gateway, if you do the Gateway Year, your schedule is quite tight, it's quite rigid. You know where you're going to be and who you're going to be with. And as you advance through the years, particularly as you get to sort of your final year, the amount of time that's fixed onto a particular teaching session like prescribing, you know what room you're going to be in, what exactly where you going to be in, for how long and who's going to be teaching you, is less and less. And you're expected to find your own work style and work schedule. You’re expected to do so many hours. Now when you do those hours is quite flexible. You know, if you're an early bird and you want to start at 7 and finish at 3, that's fine. As long as you go to the the bits that are actually scheduled. 

I think some students really struggle, particularly those who are undergraduates, struggle with working out what to do in those times. They’re used to having or being told where to be and when. And that's quite easy. You know, you turn up, you know what you're expected to learn. You know what the topic's going to be. So, you have your own expectations and you sort of work with that. And it's great because you're meeting your learning outcomes. What about when you're told these learning outcomes, you need to meet yourself, you need to find the time and find the learning opportunities. You need to be dynamic and you need to go into the hospital and find them. 

What's behind all of that is that we're trying to teach you to be independent and to be problem solvers, not just on a ‘this patient has this symptom’, but as this system's not working, or where do I find this information? Who can help me in this situation? Who do I need to speak to? 

Those hidden curriculum, soft skills we call them, buzzwords, sort of teaching you to become more professional, more independent, and more sort of a member of the ward working team. 

I think, you know, the real memorable students for me are the ones that fully embed themselves within the team and you notice them when they rotate really, because there's a gaping hole in the team. Someone you relied on. You knew they were there. You could work with them all the time. 

And those students are the ones that excel. So they just get it. OK, I'm so the student, but I'm starting to become a clinician and it's to be professional and to be present. 

So I think, but it's a really difficult transition. You know? If you think about undergrads they might only be 20 years old at this point. They've been in school for far longer than they've not been in school. 

00:10:03 Komal 

Just to add to that, is like the fact that we've got quite a lot of self-directed learning scheduled into our timetable. There's often the worry that people might end up just taking those as days off, pretty much. 

Whilst the purpose of them being there is so that we become more proactive. So, I think a lot of medical students that I know we end up, you know, meeting like clinicians, consultants, registrars, ask them do they have clinics going on and try and like schedule them within those sessions. 

00:10:32 Connor 

No, absolutely, and I think all the challenges that we've spoke about, I think you can sort of summarise as sort of professional development. 

00:10:40 Seb and Komal 

Yeah. 

00:10:40 Connor 

You have to sort of take them all as, well, here's something that I need to go and develop, so whether it's dealing with quite emotive and difficult encounters, or whether it's time management and how to go and plan your own learning. 

The things that you might not, you know, most people haven't experienced at school before starting their undergraduate education, but it's something that you sort of have to get to grips with quite quickly, but it's a necessity, and it's something that by the end of it, everyone manages to do. 

Things seem quite scary to start off with, but ultimately everyone gets there in the end. 

00:11:26 Seb 

And I think the support is there. So not saying that you're completely left to your own devices, sort of dropped in the frying pan. The support’s there. You know, we've got fantastic Student Liaison Team and the Clinical Teaching Fellows are all recent graduates. The majority of them HYMS graduates, or have worked within the Trust, so you know here and York. So they know the environment. They know where opportunities lie and where there are more challenging departments that are really, sort of very busy, particularly through the pandemic, who won't probably be able to support you that much, but there might be other things like so those departments might be crying out for someone to go and do their bloods, and if you need to get your bloods signed off then ideal. But you're not going to expect a two-hour lecture from one of the consultants because they've got 50 patients to see. 

Whereas other departments will have different things and balances, so I think the supports there. You've got the students in the years above you. 

And it all relates to, so when you graduate, you still have a curriculum that you need to meet. You know we've got Horus for the F1s and F2s, and there's learning outcomes and learning objectives that you have to meet and evidence. 

Now when you're working 50 hours a week, you do have a little bit of time that’s protected. But really you have to be independent and confident to find those learning opportunities, or not even necessarily finding them, but evidencing them. You know, you need to tell the consultant or registrar, is it alright if tomorrow can we do this form, can we go through this, or I'm not comfortable with this? Can you tell me about this, you know? Those sorts of things. 

And it and it works. I think we see this, you know, I’ve taught for HYMS a few years now. A couple of students I’ve seen in multiple years, and they're sort of growing. And then you see they’re becoming more and more independent. And then they come up to you and it's not even a question anymore, they've said, oh, I've started cracking on with this, I’ve started doing this, is it alright if you support me with... You know, they're part of the team. 

And the HYMS grads do hit the ground running. I think there's a reason a lot of HYMS grads stay in around Hull and York and the other hospitals. I think because it's a supportive training environment and they just are clearly quite comfortable working on a ward, whereas compared to some other universities that have different structures. 

00:14:06 Connor 

I think we can move on to quite a nice topic now. What's our favourite thing about placement? 

00:14:13 Komal 

I think my favourite thing about placement is actually talking to the patients, because you get to practise it a lot during clinical skills sessions in whilst in Year 1 and Year 2, but you, because you only have placement once a week during Year 1 and 2, it's hard to be able to do that constantly and get that rhythm, get good structure and so being able to do that on a daily basis I found really useful because it's built up my confidence about talking to patients. 

Especially because, as well, when you become a doctor, you need to be able to have a structured consultation that's within the time limit, and it's concise and you've got everything you've wanted and the patient’s satisfied by the consultation. 

So being able to do that and learning how to do that, I think that's a really good opportunity. Because I remember starting off consultations, they were as long as an hour and now I've managed to like sort of, you know, make them a bit quicker, but then also have the same amount of, you know, satisfaction out of those consultations and the patient hasn't felt like they've been rushed, so I've really enjoyed that. 

And I've also enjoyed doing the skills because you don't really do many skills during Year 1 and 2. You get to practise examinations, but things like taking bloods and all that, you learn in Year 3 with the Clinical Skills Facilitators. So, I've really enjoyed that practical aspect, and I've really enjoyed that, yeah. 

00:15:43 Connor 

I'd say from my experience and it sort of varies, as we've said, depending on where you go, but it's about feeling part of the team and really joining in with how the ward or the department runs, because I’ve feel like it.... from my experiences where I've really felt part of a team or part of what's going on, I've been able to get the most teaching opportunities there. I've been able to speak to the most number of patients and had, you know, I just learnt throughout. You've been able to get the most number of procedural skills done. I just felt like the most productive times, but also from like, you’re sort of valued and like you're certainly a, you know, an actual team member, which I know some medical students can feel like that isn't the case or like you're supernumerary. 

00:16:36 Seb 

Wall flowers. 

00:16:39 Connor 

So certainly, when you find a good placement, or a good team and you're there for a few weeks, you really get a lot out of it. And it's those experiences that I think I've looked back on as some of the the best time that I've had on clinical placement so far. 

00:16:58 Seb 

I think those moments define your career. I think as you get further on in your career, you look back and you wonder why, sometimes you think why on Earth I've chosen this speciality. So I'm training to do renal medicine and you reflect on, you think about certain patient interactions and experiences on the ward. 

And maybe when I was applying, I didn't necessarily actively think about that but just some things remind you and then you remember, oh, actually, you know. It’s those positive, not even necessarily positive interactions, some of them, like, so those really challenging ones. 

But then you reflect and you think about them. So, I still remember the first patient that I saw in third year in Scunthorpe General Hospital and you know, after second year I was back of my mind I was thinking I'm not sure if Medicine is for me, you know. I was finding it quite challenging because it's very university-based. You had the one day in hospital, so half a day with patients. And then this one patient interaction I was like, no, I like being on the wards, this is it. I don't want to be in a classroom. Well, I mean, I then went on to be a teacher, I don't want to be a student in a classroom I should say. 

I want to be on the wards. You know, I want to be clinical, working with patients. They help sort of define you and make you feel, there's a bit of a reward. It might be a blood test that you've done on the ward, but then you feel like you've made a little contribution. And when you're just a a baby in third year, I think those little contributions mean a lot to you. 

00:18:43 Komal 

No, they definitely do. 

00:18:44 Seb 

I think I've probably done 10,000 more bloods by now, so less, but it's, you know, at your moment in your career those little interactions, they give you some reward, make you feel like you're part of the team, and remind you why you've decided to embark upon a 5-year degree. 

00:19:05 Komal 

My first year, so not my Gateway year, but my first year at Year One at Medical School, it was during Covid, so it was hard to have interactions with other, like, my peers because we were all, you know locked away separately. All the lectures were online. 

So the fact that now, you know, I'm able to see everyone, I'm able to perform all these skills, like, you feel like you're getting a step closer to your goal. 

Especially like, so for example, in Year Two when we were in person again, and we were learning all these examinations, talking to patients, I felt a bit more close to my goal. 

Now that I'm doing clinical skills and having all these teaching sessions, building relationships with consultants, because they really do want to teach. I always felt like... I was a bit worried during ward rounds, for example, I thought I might be a bit of a, you know, just a bit of an extra. They might find me annoying, but no, they actually take the time just before we see patients to explain this is the patient case, this is what we've seen, and I've really enjoyed that all these steps make me closer to my goal. And I really enjoyed that, like, I can't wait to eventually become a doctor. 

00:20:15 Connor 

Absolutely, and I think starts when you start clinical placement it's almost....  

00:20:20 Seb 

Terrifying, didn't it? 

00:20:21 Connor 

It’s terrifying but you suddenly realise, we're doing proper Medicine. 

00:20:25 Komal 

Yeah, definitely. 

00:20:26 Connor 

You step outside of the classroom and yes, you do your one day clinical placement Year One and Two, but to be on clinical placement all the time you think, we're almost there. 

00:20:36 Komal 

Definitely. 

00:20:37 Connor 

Time does fly. I'm only in Year Four but it doesn't feel like it was only two minutes ago when I was in Year One. 

00:20:46 Komal 

You know, every time I do something new I'll end up just texting in my family group chat, like, I've done this today and they're like, oh, that's amazing. And so you get more motivation as well that that way as well. 

00:20:55 Seb 

Yeah, it's always funny seeing when we teach the, when we teach you to scrub, how to scrub in. And all you guys want to do is take photos and send it to your family. 

When you’ve scrubbed in a thousand times in the middle of the night the novelty definitely wears off. But you know it's those physical reminders, isn't it, really, that you’ve made made... all right, this is why I'm here, this why I'm here. Because you enjoy it. It's cool and it's fun. 

00:21:28 Connor 

I think that sums it up very well. And I think that comes to just about the end. So to everyone listening, we hope you've enjoyed the podcast and thank you very much to Seb and Komal. Please subscribe to the future episodes of this podcast and thank you very much for listening once again.