Author: Jessica Y Xie

Read time: 8 minutes

Introducing our new series: Top 10 Tips – a simple guide to help you achieve your goals!

In this blog post, Jessica Xie (final year UCL medical student) shares advice on getting into research as a medical student.

Disclaimers: 

• • Research is not a mandatory for career progression, nor is it required to demonstrate your interest in medicine. 
  • You can dip into and out of research throughout your medical career. Do not feel that you must continue to take on new projects once you have started; saying “no, thank you” to project opportunities will allow you to focus your energy and time on things in life that you are more passionate about for a more rewarding experience.
  • Do not take on more work than you are capable of managing. Studying medicine is already a full-time job! It’s physically and mentally draining. Any research that you get involved with is an extracurricular interest.

I decided to write this post because, as a pre-clinical medical student, I thought that research only involved wet lab work (i.e pipetting substances into test tubes). However, upon undertaking an intercalated Bachelor of Science (iBSc) in Primary Health Care, I discovered that there are so many different types of research! And academic medicine became a whole lot more exciting…

Here are my Top 10 Tips on what to do if you’re a little unsure about what research is and how to get into it:

TIP 1: DO YOUR RESEARCH (before getting into research)

There are three questions that I think you should ask yourself:

1. 1. What are my research interests?

Examples include a clinical specialty, medical education, public health, global health, technology… the list is endless. Not sure? That’s okay too! The great thing about research is that it allows deeper exploration of an area of Medicine (or an entirely different field) to allow you to see if it interests you.

2.  What type of research project do I want to do?

Research evaluates practice or compares alternative practices to contribute to, lend further support to or fill in a gap in the existing literature.

There are many different types of research – something that I didn’t fully grasp until my iBSc year. There is primary research, which involves data collection, and secondary research, which involves using existing data to conduct further research or draw comparisons between the data (e.g. a meta-analysis of randomised control trials). Studies are either observational (non-interventional) (e.g. case-control, cross-sectional) or interventional (e.g. randomised control trial).

An audit is a way of finding out if current practice is best practice and follows guidelines. It identifies areas of clinical practice could be improved.

A quality improvement project (QIP) involves planning and implementing an improvement strategy, assessing if it improves outcomes or patient care and seeing how things could be further improved. QIPs follow the Plan, Do, Study, Act cycle.

Another important thing to consider is: how much time do I have? Developing the skills required to lead a project from writing the study protocol to submitting a manuscript for publication can take months or even years. Whereas, contributing to a pre-planned or existing project by collecting or analysing data is less time-consuming. I’ll explain how you can find such projects below.

3.  What do I want to gain from this experience?

Do you want to gain a specific skill? Mentorship? An overview of academic publishing? Or perhaps to build a research network?

After conducting a qualitative interview study for my iBSc project, I applied for an internship because I wanted to gain quantitative research skills. I ended up leading a cross-sectional questionnaire study that combined my two research interests: medical education and nutrition. I sought mentorship from an experienced statistician, who taught me how to use SPSS statistics to analyse and present the data.

Aside from specific research skills, don’t forget that you will develop valuable transferable skills along the way, including time-management, organisation, communication and academic writing! 

TIP 2: BE PROACTIVE

Clinicians and lecturers are often very happy for medical students to contribute to their research projects. After a particularly interesting lecture/ tutorial, ward round or clinic, ask the tutor or doctors if they have any projects that you could help them with! 

TIP 3: NETWORKING = MAKING YOUR OWN LUCK

Sometimes the key to getting to places is not what you know, but who you know. We can learn a lot from talking to peers and senior colleagues. Attending hospital grand rounds and conferences are a great way to meet people who share common interests with you but different experiences. I once attended a conference in Manchester where I didn’t know anybody. I befriended a GP, who then gave me tips on how to improve my poster presentation. He shared with me his experience of the National institute of Health Research (NIHR) Integrated Academic Training Pathway and motivated me to continue contributing to medical education alongside my studies.

TIP 4: UTILISE SOCIAL MEDIA

Research opportunities, talks and workshops are advertised on social media in abundance. Here are some examples:

Facebook

Search “medical student research” or “medsoc research” into Facebook and lots of groups and pages will pop up, including UCL MedSoc Research and Academic Medicine (there is a  Research Mentoring Scheme Mentee Scheme), NSAMR – National Student Association of Medical Research and International Opportunities for Medical Students.

Twitter

Search #MedTwitter and #AcademicTwitter to keep up to date with ground-breaking research. The memes are pretty good too.

LinkedIn

Opportunities are harder to come by on LinkedIn, since fewer medical professionals use this platform. However, you can look at peoples’ resumes as a source of inspiration. This is useful to understand the experiences that they have had in order to get to where they are today. You could always reach out to people and companies/ organisations for more information and advice.

TIP 5: JOIN A PRE-PLANNED RESEARCH PROJECT

Researchers advertise research opportunities on websites and via societies and organisations such as https://www.remarxs.com and http://acamedics.org/Default.aspx. 

TIP 6: JOIN A RESEARCH COLLABORATIVE

Research collaboratives are multiprofessional groups that work towards a common research goal. These projects can result in publications and conference presentations. However, more importantly, this is a chance to establish excellent working relationships with like-minded individuals.

Watch out for opportunities posted on Student Training and Research Collaborative.

Interested in academic surgery? Consider joining StarSurg, BURST Urology, Project Cutting Edge or Academic Surgical Collaborative.

Got a thing for global health? Consider joining Polygeia. 

TIP 7: THE iBSc YEAR: A STEPPING STONE INTO RESEARCH

At UCL you will complete an iBSc in third year. This is often students’ first taste of being involved in research and practicing academic writing – it was for me. The first-ever project that I was involved in was coding data for a systematic review. One of the Clinical Teaching Fellows ended the tutorial by asking if any students would be interested in helping with a research project. I didn’t really know much about research at that point and was curious to learn, so I offered to help. Although no outputs were generated from that project, I gained an understanding of how to conduct a systematic review, why the work that I was contributing to was important, and I learnt a thing or two about neonatal conditions. 

TIP 8: VENTURE INTO ACADEMIC PUBLISHING

One of the best ways to get a flavour of research is to become involved in academic publishing. There are several ways in which you could do this:

Become a peer reviewer. This role involves reading manuscripts (papers) that have been submitted to journals and providing feedback and constructive criticism. Most journals will provide you with training or a guide to follow when you write your review. This will help you develop skills in critical appraisal and how to write an academic paper or poster. Here are a few journals which you can apply to:

• • • https://thebsdj.cardiffuniversitypress.org
    • Journal of the National Student Association of Medical Researchjournal.nsamr.ac.uk
    • https://cambridgemedicine.org/about 
    • https://www.bmj.com/about-bmj/resources-reviewers 

Join a journal editorial board/ committee. This is a great opportunity to gain insight into how a medical journal is run and learn how to get published. The roles available depend on the journal, from Editor-in-Chief to finance and operations and marketing. I am currently undertaking a Social Media Fellowship at BJGP Open, and I came across the opportunity on Twitter! Here are a few examples of positions to apply for:

• • • Journal of the National Student Association of Medical Researchjournal.nsamr.ac.uk – various positions in journalism, education and website management
    • https://nsamr.ac.uk – apply for a position on the executive committee or as a local ambassador
    • Student BMJ Clegg Scholarship
    • BJGP Open Fellowships

TIP 9: GAIN EXPERIENCE IN QUALITY IMPROVEMENT

UCL Be the Change is a student-led initiative that allows students to lead and contribute to bespoke QIPs. You will develop these skills further when you conduct QIPs as part of your year 6 GP placement and as a foundation year doctor.

TIP 10: CONSIDER BECOMING A STUDENT REPRESENTATIVE

You’ll gain insight into undergraduate medical education as your role will involve gathering students’ feedback on teaching, identifying areas of curriculum that could be improved and working with the faculty and other student representatives to come up with solutions. 

It may not seem like there are any research opportunities up for grabs, but that’s where lateral thinking comes into play: the discussions that you have with your peers and staff could be a source of inspiration for a potential medical education research project. For example, I identified that, although we have lectures in nutrition science and public health nutrition, there was limited clinically-relevant nutrition teaching on the curriculum. I then conducted a learning needs assessment and contributed to developing the novel Nutrition in General Practice Day course in year 5.

Thanks for reaching the end of this post! I hope my Top 10 Tips are useful. Remember, research experience isn’t essential to become a great doctor, but rather an opportunity to explore a topic of interest further.

Jess

 

 

 

Read time: 7 minutes

In this blog post, Jessica Xie (final year UCL medical student) explains the ins-and-outs of out-of-hours shifts and how to be smart with your time.

As a clinical medical student, you are expected to be in clinical practice from 9am – 5pm Monday to Friday (except for Wednesday afternoons. Hooray for RUMS Sports!). This makes any time spent on placement outside of these hours (i.e nights and weekends), an out-of-hours shift. Night shifts are typically 8pm – 8am. Weekends are typically 8am – 8pm.

At UCL Medical School, the number of mandatory out-of-hours shifts depends on your year of study (e.g. in your final year, you are required to complete two night shifts and one weekend shift across the whole academic year).

You’re probably thinking, doing night and weekend shifts in hospital sounds awful… why would anyone want to? There are, in fact, many advantages of undertaking out-of-hours shifts, both for your learning and for gaining first-hand experience of what life as a Foundation Doctor/ Internal Medical Trainee/ Specialty Trainee will be like. Also, some students enjoy these experiences so much that they voluntarily attend more shifts than required.

Why Out-of-Hour Shifts Aren’t As Bad As You Think

Opportunities, opportunities, opportunities

You’ll spend most of your time on out-of-hours shifts shadowing whoever is holding the bleep (junior doctors, SHO, registrar or consultant). These are excellent learning opportunities… you can attend to emergencies as they arise and, depending on the specialty, this include going into theatre to assist. For example, I assisted in a Caesarean section at 2am. I was also allowed to suture. This was a great learning experience and something that I may never get to experience again.

Out-of-hours shifts tend to be excellent opportunities to get procedures signed off and for Supervised Learning Events (SLEs) – watch out for a post by Maddie on how to ACE these assessments!

The ‘Junior Doctor’ Experience

With a smaller team working on nights and weekends, you’ll have more opportunities to ‘think like a doctor, act like a doctor’, with particular emphasis on the latter!

These are exciting opportunities to really develop your clinical judgement and skills. You may realise that you are more competent than you think you are, which will always give you a nice confidence boost!

However, you must of course only do things within the limits of your competency and follow all the usual rules, like gaining full consent from patients and ensuring that a chaperone is present for intimate examinations.

A Step-by-Step Guide

1. 1. Preparation

Pack a meal, snacks to pop into your pockets and plenty of fluids.

Similar to my advice for prepping for ward rounds, write down what you want to achieve by the end of the shift.

What to bring with you:

• • • Stethoscope
    • Black pen
    • Notebook or tablet/ iPad
    • Handover sheet from handover meeting
    • Mobile phone – put on silent and I recommend you to download a few of these apps:
      • BNF
      • Microguide
      • UpToDate
      • MDCalc

If you know which doctors will be doing the shift, you may want to let them know in advance that you will be joining them.

2. Attend handover

Who’s who?

Introduce yourself to the team. Ask to shadow a doctor(s) and explain to them what you would like to achieve by the end of the shift (e.g. SLE, practice a specific examination).

Exchange contact details (usually a mobile number) with your supervising doctor and make a note of the name of which doctors are holding bleeps, their bleep number and ensure that you know how to bleep. Some doctors create a Whatsapp group for the shift.

Know the schedule

Some shifts have specific times for various members of the team to take breaks… and ensure that you take one, too! It is really important that you take care of your wellbeing. Ensure that you stay hydrated. If there’s an opportunity and place for you to rest or nap, I strongly recommend that you do!

There may be a mid-shift meeting at around 2am. You should attend this. It allows the whole team to get their bearings, identify which tasks still need to be completed and delegate the work appropriately. This is a great opportunity for you to jump in and offer to help out and/or ask to shadow a different member of the team.

3. Make the most of the shift

Same as for a ward round, you should aim to help the team as best as you can.

I recommend that you ‘follow’ a patient through from when they present to the hospital, to their admission as an in-patient or discharge:

• • • When in A&E or AMU, clerk patients as they are admitted
    • Present to the doctor
    • Ask the nurses if you could take the patient’s observations
    • Perform bedside investigations, like urinalysis and an ECG
    • Perform clinical procedures, like venepuncture
    • Order investigations on the computer
    • SBAR handover to the team who will admit the patient onto their ward or write a discharge summary
    • And at each step, ensure to check that your supervising doctor is happy for you to proceed

Be proactive

Seek learning opportunities, ask patients and healthcare staff questions about anything that you’re unsure about and attend to emergencies as they arise.

4. After the shift

Congratulations! You’ve completed your first out-of-hours shift!

Take a moment to reflect on your experience: What did you learn? What did you do that made you proud of yourself? What are you hoping to achieve next?

Finally, if you have completed any procedures or examinations that require a sign off, make sure you contact the relevant person(s) for their email address(es).

Being Realistic

I’ve explained above why out-of-hours shifts are not to be feared, but let’s be realistic: out-of-hour shifts can be tough; twelve-hour-long shifts can be pretty draining. After completing a night shift or two, take the next morning or day off to reset your body clock. So don’t schedule a night shift the day before compulsory teaching! If you know that you will miss teaching, politely notify your tutor or the doctor in advance.

Also, despite your best efforts to maximise outputs, you may not achieve the goals that you intended to, especially if the shift is quieter than you expected. If this does happen, don’t be too disheartened or surprised if your supervising team suggests that you head off home a couple of hours early; you’ve gained a new experience and that’s what’s important.

Top Tips

To summarise, here are my top tips to surviving out-of-hours shifts:

1. Plan ahead to ensure that you are physically and mentally prepared for the shift.
2. Look after yourself – when you’re clerking in a patient at one moment, then assisting in theatre in the next, it’s easy to forget to take breaks! Remember: you need to look after yourself before you can look after your patients.

Thanks for making it to the end of this post! I hope I’ve managed to convince you that out-of-hours shifts can be excellent learning opportunities if you come prepared and know what you want to achieve. If you have any questions or comments, feel free to reach out to any of us.

Good luck,

Jess

Read time: 5 minutes

In this blog post, Jessica Xie (final year UCL medical student) explains what a ward round is and how to get the most out of this clinical experience.

Hey fourth years! Congratulations on passing your exams and welcome to clinical years (the more exciting part of medical school). I’m going to take you through the ins and outs of ward rounds by answering some commonly-asked questions. 

The Basics

Q: What is a ward round?

A: A ward round is when the doctors ± other members of the multidisciplinary healthcare team (MDT) (e.g. doctors, nurses, ward coordinator) visit all the in-patients.

Ward rounds take place first-thing in the morning (between 7 – 10am).

Typically 3 – 4 healthcare professionals (HCPs) will attend the WR, but I’ve been on WRs when it has been just myself and 1 doctor, and other times there have been over 7 people!

There are several important roles on the ward round:

• • • The most senior member (most likely a consultant) leads the ward round. They will greet the patient and ask how they are feeling that morning, perform an examination and decide the management plan
    • Scribe – to write down team decisions and document the ward round 
    • Someone to check any relevant charts (e.g. observations, fluid balance) 

Q: What should I expect?

A:

• • To be treated as a member of the MDT
  • To learn medicine! Most doctors are happy to teach students at a patient’s bedside or between seeing patients
  • You may be asked to help out (see ‘During the Ward Round’ below)

Preparation

Q: Where does the ward round start?

A: You will be expected to attend handover if you are scheduled ward round. A handover is a meeting during which the night team (staff who did the night shift) ‘handover’ the patients to the day team to look after. The night team will report if anything significant occurred during their shift. Handover is really important to make sure that the whole team (including yourself) is on the same page and that any incomplete ‘jobs’ (tasks related to patient care that need to be done (e.g. venepuncture)) are passed on to the day team taking over to ensure that the tasks get done!

Q: What do I need to bring with me?

A: These items are essential to ensure that you are ready to learn and contribute to the ward round.

• • • Stethoscope
    • Black pen
    • Notebook or tablet/ iPad
    • Handover sheet from handover meeting
    • Mobile phone
      • Put on silent
      • I recommend that you download a few of these apps:
        • BNF
        • Microguide
        • UpToDate
        • MDCalc

Q: How can I maximise my learning outputs?

A: I recommend that you set yourself at least one goal to achieve by the end of the ward round. This will keep you focused and ensure that you walk away having gained at least one thing. Examples of goals:

• • • To ask questions
    • To ask a doctor about the aetiology, management or progression of a specific condition
    • To WITN (see ‘During the Ward Round’ below)
    • To get a mini-CEX or CbD signed off
    • Clerk and SBAR (see ‘During the Ward Round’ below)
    • To examine a patient (see ‘During the Ward Round’ below)
    • To write a prescription

During the Ward Round

Q: What can I do to contribute to the ward round?

A: There are many things that you can do!

1. 1. Write in the notes (WITN)

Here’s a useful guide. I highly recommend that you observe doctors WITN before you attempt to. Offer to ‘prepare the notes’, which means writing the subheadings, observations and test results before the patient is reviewed by the WR team in preparation for you or someone else to WITN.

2. Take a brief history/ clerk a patient and present to the ward round team in SBAR format

3. Examine patients

Refresh your memory of examinations. It can be nerve-racking examining patients in front of senior colleagues, but remember that they were once in your shoes too. Do not miss the excellent learning opportunities offered on ward rounds: you will receive immediate, valuable face-to-face feedback.

4. Practice prescribing

Here’s a useful guide. Use the apps (see ‘Preparation’ above) on your phone to look up drug doses.

5. Ask questions

Depending on how busy the doctors are and their teaching style, you may be able to ask questions between seeing patients or at the end of the ward round. Jot down any questions in your notebook, on your tablet/ iPad or next to the patient’s name on your handover sheet.

After the Ward Round

Thank the staff for taking you on the ward round. Now might be an appropriate to time to ask doctors any questions.

Review any notes that you made during the ward round – repetition is key to understanding concepts and committing facts to memory! 

By the end of a ward round, a list of ‘jobs’ will have been created (e.g. cannulation), which the doctors divided  amongst themselves. You can offer to do some of these jobs. 

Remember to DISPOSE OF YOUR HANDOVER SHEET in the confidential waste bin.

That’s all for this first post. I hope I’ve made the idea of attending a ward round less daunting. Ward rounds are excellent learning opportunities if you come prepared and know what you want to achieve. If you have any questions or comments, feel free to reach out to any of us.

Good luck, 

Jess