Read Time: 5 minutes

In this article, Anush will discuss some of the best apps and online resources in order to maximise your learning in pre-clinical medicine.

Smartphones and tablets are an intrinsic part of our lives (for better or for worse). Distractions aside, here as some apps we’ve found really useful when studying and preparing for exams.

Anatomy Apps

TeachMeAnatomy – Free (iOS/Android/Web)

Struggling with anatomy and need more visual summaries of what is going on within the oh-so-complex human body? TeachMeAnatomy is a Wiki of all the anatomy you’ll need to know during medical school. Concise and colourful, it has lots of very useful labelled diagrams, without vast amounts of text. An especially useful feature is being able to test yourself on the material you’ve just learnt through quizzes.

Link: teachmeanatomy.com

Acland’s Anatomy Atlas – Free (Web)

The famous Robert Acland takes you through the anatomy of the body using real dissections in this blast from the past. Filmed in the late 90s, UCL gives us institutional access to an online version of this, arranged by organ system.

Link: https://aclandanatomy.com/

Biodigital Human – Free (Web/iOS/Android)

Imagine taking your dissection table on the go with you, wherever you are and whenever you want. This is the Biodigital Human, a free tool you can use on your computer or mobile device. You can focus in on part of the body with pre-made models, or start off with a complete human body and dissect it layer-by-layer.

Link: https://www.biodigital.com/ 

Note Taking and Revision Tools

Notion – Free (Web/iOS/Android)

An all-in-one workspace allowing you to organise your notes in a Wiki-esque format, Notion promises to be more than just a word processor. You can collaborate on notes, add tasks, sort them in complex databases and embed dynamic content, like useful videos and audio clips. All you ever need to stay on top of uni work! Best of all, login with your ac.uk email address and enjoy unlimited storage and premium features for free.

Link: notion.so 

Google Drive – Free (Web/iOS/Android)

The original collaborative word processor allows you to write together with shared notes and presentations. It worked well back in 2015 when I started university and it works just as well now. If it ain’t broke, don’t fix it!

Link: drive.google.com 

Anki – Free (Web/PC/Mac/Android) or £23 (iOS)

Spaced repetition is a fantastic way to help make those facts stick – reviewing content regularly ensures it is fresh in your memory. 

 

Anki is a flashcard app that makes spaced repetition easy – it contains algorithms that calculate exactly how often you need to review information for optimal memory commitment, based on how confidently you previously recalled the information. All you need to do is make the flashcards (or import a revision deck).

Link: https://apps.ankiweb.net/

Microsoft Onenote – Free (Web/iOS/Android)

A fantastic tool that allows you to put all your notes in one place, whether they be digitally handwritten or typed, OneNote lets you import documents and other media, allowing you to annotate them however you wish.

Link: https://www.onenote.com/

Read time: 4 minutes

In this post, Maddie Wigmore-Sykes, a final-year medical student, demystifies the NHS ePortfolio and explains the best ways to get yourself MiniCEXs and CbDs. 

Starting your clinical years of medical school is a time of excitement and new experiences, including your new companion: the NHS ePortfolio! Designed to help you gather feedback and reflect on your performance, the ePortfolio is something to get your head around and get used to – we’ll be filling out CbDs and MiniCEXs for a long time.

The bread and butter of the ePortfolio is the supervised learning event (SLE), a form you can send to doctors (FY2 and above!) who have witnessed you performing examinations or taking histories. They can then provide you with areas you did well on, and some areas to work on. At UCL, we’re expected to do four or five of these per term. SLEs are broken down further into CbDs and MiniCEXs, but what do they actually mean?

What is a CbD and how do I get one?

CbD stands for case-based discussion. The best way to get a CbD is to find a patient, take a history from them and then write up your findings. Try to think up a management plan based on the patient’s case and do some reading around their condition for bonus points. You can then present the patient to a doctor in the team who might ask you some questions about the case, such as what your differentials are and what you would do next if you were managing their care. 

Module tutors are well-placed to present CbDs to. If you set up a meeting with them every few weeks, you can present a new patient to them each time and get a few CbDs straight off the bat. You can also just ask a friendly doctor who you’ve met a few times if it would be okay to present a patient to them – they’ll almost always say yes!

Here’s an example of what to write in your CbD ticket to send to a doctor (not a real patient):

So how do I do a MiniCEX?

I’m not sure if anyone really knows what a MiniCEX stands for or what makes it mini, but please let me know if you do! Effectively they’re all about examinations and you’ll need a doctor to watch you perform one on a patient from start to finish. They might then ask you to present your findings, which is really good practise for OSCEs and future life. 

Bedside teaching is a perfect opportunity for getting a MiniCEX, so it’s worth brushing up on some examination skills beforehand and then being brave and volunteering to have a go! Twilight tutors are also keen to get patients with good clinical signs for you to examine as well. 

Here’s an example of what to write in your MiniCEX ticket to send to a doctor (not a real patient):

Actually getting your SLEs signed off

To complete an SLE, you have to log onto your ePortfolio and send the doctor assessing you a ticket. You can do this by going onto Forms and then Ticket Requests. You’ll need to know the doctor’s email address to send them a ticket, so make sure you have that written down! Remember, the doctor has to be an FY2 or above to fill in your ticket. I’d also recommend uploading a photo of you to your ePortfolio profile – some doctors will get a lot of tickets and you want them to remember who you are.

Inevitably, some of your well-crafted tickets will not get filled in, so it’s worth doing a few more SLEs than you need to, just to make sure they all get done. The ePortfolio has an option to send reminders, so if it’s been a few weeks, don’t be afraid to send one. It might take a while for doctors to complete your ticket, so try to be organised and get your tickets sent out before the end of the module to prevent a mad dash to complete your ePortfolio! 

 

In summary

1. If you’re feeling nervous, do some SLEs with your module tutor. You can prepare in advance of the sessions and you’ll feel more comfortable with someone you know.
2. Volunteer in bedside teaching to do the history or examination, it’s a great opportunity to have a doctor watch you perform these skills.
3. When you’re in clinics or in the Emergency Department, you might be the first person a patient sees so you can elicit a history and examine someone without already knowing their diagnosis. This might be a bit trickier, but is definitely the most valuable way to do an SLE.

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: 4 minutes

In this post, Maddie Wigmore-Sykes, a final-year medical student, gives her take on how to get started at medical school and what to do if it all starts going a bit wrong. Expect some motivational content along the way.

Finding your groove

When I first arrived at medical school, excited and more than a little scared, I had no idea what to expect, nor what was expected of me. I remember sitting in a lecture theatre, completely unable to follow what was being said, surrounded by 300 other people who seemed to know exactly what they were doing. They probably weren’t any more enlightened than me and, even though there will always be that person who claims they’ve done the whole course by Christmas, most of us were just pretending we knew what to do.

It is clichéd, but true, that medicine is a marathon not a sprint. You do not need to turn up on your first day with an understanding of how to learn from lectures or knowing what an OCaPE (Objective Clinical and Practical Examination) is. Spend the first few weeks, or months, getting your bearings and experimenting with different learning styles to find one that works for you. Here are a few suggestions on how to take notes in lectures:

• • • Print and annotate on the slides
    • Review the lecture slides before the lecture, make a template for your notes  and add to them during the session – this requires some forward-planning
    • Type as you go (if you can keep up with the fast-talking lecturers!)
    • Rather than writing notes on the information given to you in the lecture, write questions to test yourself, along with short answers, or note down which page of the lecture slide shows the answer
    • Call me old-fashioned, but I found that handwriting notes helped me to stay focused during lectures

After lectures, try consolidating your learning with some fun (ish?) activities. Test yourself with flashcards or set up a revision group with your friends where you can quiz each other – make it a regular thing so you’re committed to going through your notes. 

There will be endless resources recommended to you by both fellow students and lecturers. It’s impossible to use them all, so it’s worth trying a few before you buy, and just because your friend has already completed *insert random question bank here*, doesn’t mean you have to as well. Stick to your learning outcomes for each lecture and find materials that complement those and you’ll be all set. For more information on some of our recommended resources, as well as how to improve your learning in our new online Covid-19 world, check out Vikram’s post: A Four Step Guide to Working from Home.

Losing your groove and getting it back again

Six years is a long time to be on your A-game and a lot of us will have a wobble or two at some point. I never quite found my footing in first year and ended up failing and having to resit the exams; as a previously high achiever at school, this felt confidence-shattering at the time – how could I possibly become a doctor if I couldn’t even get through year one? Clearly I was wrong, as I’m now set to graduate in 2021, but it took me a long time to get over it. 

With the competition inherent to medical schools and our own personal drives to succeed, it’s no wonder we feel this constant pressure to prove ourselves. We’re ranked from our very first formative and subsequently measure ourselves on how well we’re doing compared to a cohort of very academic people, losing sight of the fact that simply being a part of this cohort is an amazing achievement in itself. It’s natural to want to do as well as we can, but if you do ever feel disappointed in your performance, pick yourself up and remember that a ranking in a year group does not define who you are or how good a doctor you can be. 

It’s okay to feel overwhelmed sometimes, medical school is difficult! If you find yourself wobbling or just need a bit of support, look after yourself and remember that help is always available. Transition mentors and other older year students can be great sources of advice and we’re always happy to offer guidance where we can. Personal tutors and the medical school student support team can also not only help with practical solutions if you’re struggling with motivation and organisation, but also assist you with any health and welfare concerns. 

TLDR: Medical school is difficult, but if you stay calm, get help when you need it and remember you’re more than your latest exam result, you will be okay.

 

Read time: 6 minutes

Vikram Thirupathirajan, a fifth-year medical student, shares his experience and tips on working from home as a medical student.

Medicine cannot be studied purely from a book or a computer. To understand its breadth and depth entirely, I’d find myself engaging in face-to-face small-group teaching – be this in the Anatomy Lab and CAL sessions in preclinical years, or clerking patients and bedside teaching in clinical years. 

So it’s safe to say the COVID-19 pandemic and the changes made to everyone’s way of daily living has caused studying medicine to take a bit of a hit too. Even after lockdown’s ease, safety is important, meaning UCL’s style of teaching has also changed for this academic year at least. 

Therefore, the standard bookwork that we all do may not suffice, as you might find yourself, as I did, having to also cater for the learning that you’d normally do away from the desk. So here are the four things that I did to try and make it work. 

One: Make your routine, break your routine

You will find this step in almost every work-from-home post. It’s important.

Before the pandemic times, everyone had a structure to their average day; at a particular time, you’d have to be at a certain place. Being sat at a desk for a long time would often make me lose track of time and with no routine and mindlessly working, I get less efficient. 

Therefore, make it a routine to attend all online teaching live, rather than watching a recording after. Make it a routine to schedule time each day to do asynchronous Moodle activities that are designed for you to complete in your own time. Make it a routine to schedule time each day to do your own studying. A routine doesn’t need to be stating each specific task that needs to be done every day. Rather, it just needs to acknowledge that you have time set aside for each type of activity – the main aim is to get structure to your working day.

However, yesterday won’t be like today and today won’t be like tomorrow – the unpredictability of it is what makes life exciting! So be prepared to break your routine at times. Sometimes online teaching may get rescheduled, or any face-to-face activities you do get scheduled coincides with online teaching. It’s fine if this happens; don’t get too focused on sticking to the routine – a balance is essential.

Two: The internet is a goldmine

Whilst no book or digital resources can beat learning the practical side of medicine in person, there are resources that can still help and provide a strong foundation. You can then build on this later once restrictions ease.

A key part of the course in the preclinical years is the Anatomy Lab. Two main resources aid in visualising anatomy well. One is Acland’s Video Atlas of Human Anatomy. This presents anatomy using dissections and prosections, which give as realistic an anatomy dissection experience as possible online. The second is using a 3D anatomy model application: UCL has access to The Human Anatomy Atlas from the Visible Body company available for students to use for free. This also allows you to visualise anatomy like you would in the Anatomy Lab.

In clinical years, the most important part of learning is being able to speak to patients, take a history and do an examination (which is also tested in preclinical years in the OCaPE). A useful resource for finding patients’ perspectives of their symptoms is Speaking Clinically – which has a database of videos of patients describing their symptoms for their different illnesses. For examinations, Moodle has numerous videos and guides for the different clinical examinations, which you can access and practice yourself or with peers in your social bubble. Geeky Medics is another invaluable resource, that has guides for clinical examination, and also for other practical skills including communication, data interpretation and essential procedures such as cannulation.

Another key thing is following a patient throughout their journey through the healthcare system. This is something that would be covered in small-group teaching and consultation clinics. Capsule is a resource that has a database of cases covering just this, through multiple-choice questions. This helps you learn all there is to know about the different diseases, i.e. symptoms, investigations, diagnosis, management.

Links to online resources:

Acland’s Video Atlas: https://aclandanatomy.com/

Visible Body Human Anatomy Atlas: https://blogs.ucl.ac.uk/library-ejournal/2017/12/22/ucl-now-has-access-to-visible-body-human-anatomy-atlas-2017/

Speaking Clinically: https://speakingclinically.co.uk/

Geeky Medics: https://geekymedics.com/

Capsule: https://learn.capsule.ac.uk/login

Three: Teamwork makes the dream work

The aim of medicine being a collaborative course still hasn’t changed, and collaboration need not be in person anymore, considering the ample amount of technology available for video calling. After using it every week for six months myself, it was without doubt one of the top three reasons I passed my fourth year exams, the other two being interacting actively in all the teaching, and lots of practice questions. Therefore, I 100% recommend being in touch with your friends and peers, in person if they’re in your social bubble, but definitely online through video calling. 

All students can use their UCL emails to get free access to Microsoft Teams. Not only will keeping in touch prevent loneliness, but also collaborating is a very effective way of learning. Having regular calls to teach each other a certain topic has been the standard approach by my year’s students. Not only does this mean you learn the knowledge very well (teaching is one of the highest levels of learning!), but also ensures you are disciplined because essentially each time you have a group session is a deadline for you to learn a topic for. 

Four: There’s more to life than medicine

Working from home can get dangerous due to the place where you relax and where you work being essentially the same. This can blur the distinction between the two and we end up subconsciously doing one more than the other with an improper balance. 

This brings onto my final two points: Firstly, ensuring you have a separate dedicated workspace and a different space for relaxing. Your workspace can be anything really – from a section of your bed, to a desk or an entire room. As long as there is a definite distinction, you’ll have a track of when you’re actually working and when you’re not.

And finally, more important than ever, ensure to take plenty of time out for other activities – be this going outside for a walk, pursuing a hobby, anything. Most of us found ourselves taking a break doing something that doesn’t involve a screen or a book as we already spend so long with those while we work. Not only will this uphold your health, but also now, when we spend most of our time in a space doing activities that seem to be disconnected with the world, we will ensure we stay aware of it.

 

 

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

 

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