Help; I’m starting clinical!

Congratulations! You have gotten through the long, hard slog of pre-clinical and are now ready to apply your learning in the clinical environment!

As with all points of transition, this is a very exciting and also nerve-wracking time for many students.

WAMSS receives the same questions every year from students about to make the transition: what do I do, how do I make the most of my time on clinical, what if xyz happens. These questions are hard to answer as they are so situation- and individual-dependent. As such, we strongly encourag students to speak with their WAMSS Clinical Buddy or other senior students for their thoughts.

Please find below:

  • Some very, very basic information about the clinical environment,
    • Where there is less information, it means there are more opinions!
  • Some common trouble shooting questions
  • We have also compiled some tips from past MD2s on how they made their transition to clinical.

Please contact your year reps if you have any further questions you think should be added.

It does not cover student wellbeing topics, which we know are intricately linked with our academic learning. Please explore the rest of the WAMSS I Need Help! pages for more information.

Overall, congratulations again, take things one step at a time, and good luck!

ALL students should know

You will generally be allocated to 'teams', with each member having different roles and responsibilities. Knowing who is who helps you know who to ask which questions, and helps you get the most out of your placement. Here is a very brief summary of what terms mean and what they do.

  • Medical student: that's you!
  • Intern: PGY1. "Baby doctors". Doctors, but with an emphasis on clinical supervision and ongoing learning. Generally handle the bulk of the paperwork of the team.
  • Resident/RMO: PGY2+. Having now completed intern year, these doctors now have their full registration as a medical practitioner.
  • Registrar: PGY3+. Registrars have greater responsibility in medical decision making.
    • Service Registrar: not currently on an accredited training program
    • Trainee Registrar: on an accredited training program
    • Advanced Trainee Registrar: on an accredited training program
  • Fellow: A registrar that has finished their formal training, but is electing to complete sub-specialty training within their field.
  • Consultant: Have completed training. They are ultimately responsible for the patient's care, clinical supervision of the team.

See here for more information about each stage.

 

The good things

  • Where there is a clear delegation of responsibilities, things are less likely to be missed.
  • There is always someone more senior (until you are a consultant), and so there is always someone to ask for help!

Potential challenges

  • Power indifferences make easy targets of bullying. If you are being bullied, see here

The way you dress is an important part of presenting yourself as a professional. You should aim to look tidy, smart, and approachable to your patients. Some general advice is:

  • Smart business or semi-formal attire extending past the shoulders and below the knees is a safe choice.
  • No neckties, scarves, or other parts that can dangle. These are considered an infection risk. Arms should be bare below the elbows.
  • Hair should be neatly styled, and may need to be tied up to avoid falling forwards if long.
  • Jewellery should be minimal. Avoid items that could get caught or be yanked on.
  • You might like to carry a bag with you for pens, cannulas, etc.

    Individual hospitals will also have a dress code, which you might want to check.

Your role as a medical student is to learn.

This works best when you:

  • See patients independently
  • Do lots of clinical examinations
  • Practice presenting as frequently as possible
  • Practice your procedural skills

Sometimes you may also:

  • Help write the notes, prepare pathology/imaging requests (ensuring a doctor on the team has signed them off)

You are allowed to

  • Ask questions, even 'dumb' ones
  • Get things wrong
  • Not know things

Remember: you are a student! You are here to learn!

Your job does NOT include:

  • Fetching coffee, making tea
  • Writing discharge summaries

You should get orientation information before your rotation begins about where, when and who to meet on day 1 (if not, contact your year reps/the Rotation Coordinator or Admin). Some rotations will give you a timetable. Otherwise, it is good on the first day to ask your Consultant or Registrar what typical days look like, how they think you can best spend your time/what would be most beneficial for your learning and what their expectations of students are.

Generally, how the day looks will depend on the rotation you are on.

For example:

  • Surgery: 7am ward round, then to theatres or clinic
  • Internal Medicine: 8am ward round, then completing jobs
  • Psychiatry: 8am handover/team briefing, then patient reviews as appropriate.

It will also depend on which site you are at; different hospitals/team will run things differently. It can help to ask the student who had just completed that rotation how they found it.

Troubleshooting

Regardless of whether you are MD2 or MD4, you will find that teams will simply see you as a 'medical student'. This can be daunting especially for MD2s when people may ask you to complete tasks that you may not feel comfortable doing.

Here, it is important to work within the boundaries of your abilities, while also not seeming dismissive of the team extending you a learning opportunity. Knowing what to say is scary, and it helps to be prepared.

Some useful phrases include:

  • "I don't feel comfortable [doing phlebotomy] myself yet, could I watch you first?"
  • "Could I observe you do this first one, and I do the next one?"
  • "I have only [cannulated] on models, would you be happy to supervise me?"
  • "Could I do the [bladder catheterisation] with your supervision?"

It is not a sign of weakness or incompetence to want supervision - remember, you are a student! In fact, it is a great opportunity to get feedback on your clinical/procedural skills.

This is a postgraduate course and we are expected to be adult learner, which involves taking responsibility for our own learning.

  • Be proactive and ask to do certain tasks or see and present patients. If on a ward round, try to think of at least one question or learning point per patient.
  • Try talking to your team about how you might be able to get more out of your placement.
  • See what your friends on a similar rotation are doing, or ask your WAMSS Clinical Buddy their thoughts.
  • Your Clinical Mentor would also be a great person to talk to.
  • If you think it's a structural issue, have a chat with the Discipline Coordinator, as this would help both you and future students.

Beware of presenteeism, this can be a driver to burnout. See tips below from other students on how to avoid this.

Advice from previous students