Read Time: 5 minutes

In this post, Anush, a final year medical student, will endeavour to convince you that outpatient clinics are some of the most useful learning opportunities available to you, and how you can make use of them.

Ah, the outpatients department: what most medical students seem to believe is the less interesting little brother of ward-based inpatient care. I’m here to convince you otherwise – in this post we’ll talk about what to expect from an outpatient clinic and how you can maximise your learning in this setting.

What happens at outpatient clinics?

Outpatient clinics serve a number of different purposes based on the specialty, but can broadly be categorised into two major groups:

• New Attenders (diagnostic) clinics – new patients (referred in by GPs) are seen by a specialist for the first time (e.g. someone with ongoing joint pain being referred to rheumatology).

• Follow up clinics – provide continuity of care between the specialist department and the patient (e.g. a surgeon following up a patient following a procedure).

 

Clinics vary from specialty to specialty, and may even be centred around a specific disease. For instance, orthopaedics run separate knee and hip clinics, while endocrinology have an entire service dedicated purely to diabetes.

Your typical clinic appointment

1. Patient walks in, doctor checks identifiers
2. Focussed clerking of new patient (or catch-up with follow ups)
3. Shared discussion about management plan

So I’m just watching the doctor…that doesn’t sound so useful?

This isn’t all you’ll be doing, but watching a good doctor at work can help you formulate your own consultation style, something you can use yourself when in the clinical setting or in OSCEs.

There are ways of getting involved during a clinic, but these often require you to be a little bit proactive. Here are some of the things I’ve found useful in the past:

• • Make notes during consultations and discuss the cases with the doctor you’re sitting in with
  • Ask the doctor if you can take over for part of the consultation: you can take a history or you can examine the patient (if appropriate) – both of these are great ways of getting a Supervised Learning Event (SLE)
  • My favourite option (not always possible): if there are spare rooms in your clinic, ask if you can see some patients on your own, and then present them to the doctor. This is very good practice for your own communication skills.

 

 

Would spending more time on the ward not be a better use of my time?

Doctors work in both inpatient and outpatient settings, and seeing how they adapt their skills to these is often useful. There are a few other things that outpatient clinics can provide that the busy wards cannot:

• Exposure to patients with chronic conditions that are well maintained
• A one-on-one (or more realistically a one-on-two) teaching opportunity with a specialist where you can ask as many questions as you please
• Exposure to patients with some conditions that you don’t normally see on the wards – a good example of this would be the multiple sclerosis clinic, or alternatively a cardiology clinic where you can hear and practice identifying lots of murmurs!

You’ve convinced me! Do I need to prep for my clinic?

Pre-reading for a clinic isn’t essential but it will definitely make you feel like you somewhat understand what is going on! Try and read up on how to do the appropriate examinations, and maybe some of the diseases you may see – other than that, put on your keen hat and be nice to everyone! When you arrive, remember to wait outside the clinic room if there is a patient in with the doctor – once the patient leaves, knock and introduce yourself to the doctor. If you’re lost or can’t find the doctor, ask the reception staff, they’re always happy to help.

SUMMARY

So there’s my perspective on why outpatient clinics are great learning opportunities! I will put the disclaimer that not all clinics are created equal; some may be busier than others, meaning doctors have less time to teach you, so try find the ones that help you maximise your own learning. To summarise, these are some things you may want to do during your clinics:

1. If you’re feeling very nervous – take notes during consultations and ask the doctor questions between patients.
2. If you’re feeling a bit more confident – ask the doctor if you can examine some patients and/or take a history and use this to get an SLE
3. If you’re feeling super confident – ask if there are any spare clinic rooms for you to go and clerk patients so you can later present to the team for practice