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5 things I learned during my pre-graduation practices in the U.K.

With the imminent threat of another COVID-19 wave, I started my final year placements in a hospital in the East of England, in August 2020. I was one of the fortunate students that managed to have very little or no disruptions to my schedule. All in all, my placement was 15 weeks long and I rotated between medical specialties (Gastroenterology, Respiratory medicine, Haematology and Cardiology) for the first 7 weeks, then General Surgery for 5 weeks and to finish off, 3 weeks in Paediatrics. The exposure and experience I gained during this placement were invaluable to my knowledge. Here are 5 key things I learned during these placements:

1. No information is pointless

In the early years of medical school, I recall myself constantly questioning the relevance of what I was learning. From Goldman’s equation to co-factors for cycles to Reed-Sternberg cells, none of the theory that I’d gathered from my pre-clinical years felt particularly useful in the clinical environment until I reviewed scans/results with medical teams every day on ward rounds. As soon as I heard some terms from the first 3 years, my memory was refreshed, and I was more engaged and comfortable conversing with doctors about patients’ illnesses. Most importantly, I was very grateful that I had been taught comprehensively. We students in the Czech Republic are very lucky in this respect, and whilst it can be tedious having to learn the most minute of things, it pays off in the end. You can never know enough it seems and the more you can learn and retain throughout medical school, will stand you in good stead for your career and also post-graduate exams. Just because you don’t utilise the theory you learn immediately doesn't mean you won’t use it later. So, stay patient, it will all fall in place and all the links will start forming.

2. Always try to get involved in the wards as much as possible

In the first 2 weeks of my placement, I was quite shy when it came to performing practical tasks, mainly because like all students, I was afraid I would make an error and the supervising doctor would think less of me and I wouldn’t be allowed to do anything ever again. However, I quickly realised that my fear of failure was the wrong approach, particularly as I was a final year student, and it wouldn’t be long before I myself would be expected to effectively and safely manage patients. From that point, I became very proactive and before each practical procedure, I would discuss with a doctor the steps and the indication for the intervention, for assessing my knowledge but also for my confidence. Just observing countless interventions alone was very useful, particularly when you are a young student grasping the basics. However, there comes a time, when you have to put into practice what you’ve learnt, as the saying goes “See one, do one, teach one”.

3. Planning your exam revision around placements is highly important

Typically, you never leave before your consultant and it seemed mine never left before 5 pm or even later. As a result, I would often be shattered when I came home, however, my day was really only beginning. After refuelling at dinner, I would try and work in short bursts to better my productivity. Naturally, it took a few weeks before I settled into a routine that allowed me to finish what I needed to – even if at times that meant leaving my hobbies and social life in the back seat. This was something that I didn’t pay a lot of attention to before planning my placement and in hindsight, I wish had come up with a more effective timetable, which would’ve allowed me to do other things that I enjoy.

4. A good doctor does the basics very well

From my time being on the wards, learning the tricks of the trade from junior doctors, almost every single one of them reiterated how important it was to do the basics well. By basics I mean, using the ABCDE approach, performing thorough clinical examinations, providing the consultant with all the latest results of investigations, writing discharge letters and using checklists for tasks. As a junior, you are not expected to be diagnosing and making management plans but rather monitoring patient’s health and following plans created by consultants or registrars. I was privileged to have a little bit more responsibility – it meant that repeatedly practising such basics allowed me to feel a lot more comfortable in a clinical environment.

5. Be prepared to acknowledge your flaws

It is impossible to know everything. With a massive field like Medicine, gaps in our knowledge are inevitable. Whilst we all strive to be flawless and fluent during university, we are human after all and especially when we start working in full capacity, we will be error-prone especially in high-pressure situations. I think the best policy if you are unsure about something, is, to be honest, and simply say that you do not know the answer. There is nothing wrong with not knowing things. I think people have a perception that when a doctor asks a question, you need to answer correctly. Whilst I understand everyone has different experiences, during my placement I didn’t feel this pressure. The doctors who were mentoring me, helped me a lot by teaching me and giving me pearls when there were gaps in my knowledge. Never be afraid to ask a question or to admit you don’t know something, everyone is in the same boat and luckily you’re in a discipline where it’s an individual’s duty to help.

Thank you for reading and I hope you found this useful, all the best!

Steven Gopaul is a British final year medical student at Masaryk student with a keen interest in General Surgery and Urology. He is also the Treasurer-Secretary at UIMS.

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