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The Medical Student’s Survival Guide 2
GOING CLINICAL

ELIZABETH COTTRELL
Foundation Year 1 Doctor
University Hospital of North Staffordshire

Radcliffe Publishing
Oxford • New York
Radcliffe Publishing Ltd
18 Marcham Road
Abingdon
Oxon OX14 1AA
United Kingdom

www.radcliffe-oxford.com
Electronic catalogue and worldwide online ordering facility.

© 2007 Elizabeth Cottrell

All rights reserved. No part of this publication may be reproduced, stored in a retrieval system
or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording
or otherwise without the prior permission of the copyright owner.

Elizabeth Cottrell has asserted her rights under the Copyright, Designs and Patents Act, 1998,
to be identified as Author of this Work.

Neither the publisher nor the authors accept liability for any injury or damage arising from this
publication.

British Library Cataloguing in Publication Data

A catalogue record for this book is available from the British Library.

ISBN-13 978 1 84619 213 5

Typeset by Egan Reid, Auckland, New Zealand

Printed and bound by TJI Digital, Padstow, Cornwall, UK
Contents
About the author ix
About the contributors x
Acknowledgements xi
CHAPTER 1 INTRODUCTION 1
Further reading 4
CHAPTER 2 CLINICAL YEARS 5
Clinical placements 5
Clinical skills 8
Ethics 9
Tips for successful clinical experience 14
Learning hospital lingo 17
Answer templates for clinical questions 19
How to wear a stethoscope 22
Further reading 23
CHAPTER 3 TALKING WITH PATIENTS AND COLLEAGUES 25
The importance of learning good communication 25
The difference between men and women 26
How to learn communication skills 27
Breaking bad news 28
Phrases medics use which cause confusion 30
Patients do not always say what they mean 31
Patients are not always saying what you think they are 32
Patience with patients 33
Children 33
General tips to get you one step ahead 34
Further reading 36
CHAPTER 4 HISTORY-TAKING 37
How to do it 38
Making notes 45
 Tips to help you perfect your history-taking skills 45
Further reading 46
CHAPTER 5 EXAMINATION OF PATIENTS 47
Rapport 47
Permission 47
Chaperones 48
Dignity 50
Use your senses 50
System templates 54
Say what you see 55
Final words 56
Further reading 56
CHAPTER 6 PRESENTING PATIENTS 57
Basic format for presentation of a patient 57
Further reading 60
CHAPTER 7 WARD LIFE AND ROUNDS 61
Ward life 61
Ward rounds 68
Further reading 69
CHAPTER 8 CLINICS 71
What clinics do for you 71
Tips for getting along well in clinic 72
CHAPTER 9 THEATRE 73
Vital steps for operating theatre success 73
Your first visit to theatre 74
Preparation for your theatre experience 74
Behaviour in an operating theatre 75
Activities you can undertake in theatre 75
What not to do 76
Further reading 76
CHAPTER 10 COMMUNITY PLACEMENTS 77
During the consultation 78
After the patient has gone 78
Working independently 79
Skills you can practise in the community 80
Not just about general practice 80
Follow up the patients you see 80
A final word 80
CHAPTER 11 HOW TO GET THE MOST FROM MEDICAL SCHOOL 83
Sign-ups 83
Work with all types of professionals 84
Studying abroad 84
External courses 85
Further reading 85
CHAPTER 12 ELECTIVES 87
Resources to help you plan your whole elective 87
How to choose what to do 88
Finances 90
Arranging your elective 92
Ensuring it all goes well 92
Health 95
What to do when you get there 98
Further reading 98
Useful websites 98
CHAPTER 13 WHEN THINGS GO WRONG 99
What to do if you have a problem with your medical team 99
Restriction of religious practices 101
Assessing and managing deteriorating patients and emergencies 103
Coping with patients dying 105
Mistakes 106
Needlestick injury 108
Further scenarios 109
Further reading 109
CHAPTER 14 DIFFICULT INDIVIDUALS 111
Why are individuals ‘difficult’? 111
Complications of the label ‘difficult’ 113
How to manage ‘difficult’ individuals 114
CHAPTER 15 LIFE AFTER MEDICAL SCHOOL 117
Career planning and advice 117
Postgraduate training 117
Preparation for job applications: your career countdown 120
Graduation 125
Surviving life as a junior doctor 126
Useful resources 132
Education: it never ends 134
What may the future hold? 134
Further reading 135
Useful websites 136
EPILOGUE 137

APPENDIX: RESOURCES 139

Talking with patients and colleagues 139
How to get the most from medical school 139
Electives 139
When things go wrong 140
Life after medical school 141
REFERENCES 143

INDEX 149
About the author

Elizabeth Cottrell, a Foundation Year 1 doctor, achieved MBChB (honours) while at

medical school. She learnt a lot from co-writing her first book, The Medical Student
Career Handbook, during her final year at medical school. This invaluable experience
helped her to develop the Medical Student Survival Guides with national medical
student involvement from the start. Elizabeth has drawn from her experiences, and
those of other medical students, to provide useful information.

ix
About the contributors

A few individuals deserve a special thank you for the vast amount of time, effort,
work and support they have provided during the development of The Medical
Student’s Survival Guides. Each individual provided his or her time and expertise for
nothing. The following individuals have been significantly involved in contributing
to and critiquing chapters:

Dr Robert (‘Bob’) Clarke, Associate Dean for London Postgraduate Medical

Education and ‘a legend’ to many medical students nationally. Also, thank you so
much for your fantastic revision courses that helped me to become a doctor
Ms Kate Fraser, The University of Manchester Medical School
Dr Basma Hassan, Foundation Year 2 in the West Midlands Deanery
Ms Pauline Law, University of Dundee Medical School
Mr David Little, The University of Manchester Medical School
Mr Vishnu Madhok, University of Dundee Medical School
Dr Christele Rebora, Foundation Year 1 in the London Deanery
Mr Imran Sajid, The University of Manchester Medical School
Ms Laura Stevens, University of Dundee Medical School
Mr Paul White, University of St Andrews Medical School.

The following individuals contributed to the content of the Survival Guide: Allie
Blair (The University of Liverpool), Rachel Boyce (University of Aberdeen),
Nat Bradbrook (The University of Manchester), Zoe Cowan (The University of
Leicester), Stephen Domek (University of East Anglia), David Douglas (University
of Dundee), Esther Downham (University of Dundee), Kate Geraghty (The
University of Leicester), Anna Kieslich (University of Dundee), Elizabeth Li (The
University of Manchester), Jemima Miller (University College London), Oliver
Shapter (University of Aberdeen), Ross Stewart (University of Dundee), Katie
Thorne (The Hull York Medical School) and Alexandra Williams (University of
Leeds).

x
Acknowledgements

Thank you to Dr Charlene Kennedy, Foundation Year 1, who encouraged me right

at the start, when the Survival Guide was just a bubble of inspiration floating around
my brain!
A thank you must also go to all my peers, colleagues and patients, who have
provided me with the material, inspiration and experiences from which the book
is written.
Lastly, a ‘thank you’ must go to my husband, my friend and my rock, Paul.
Without his support, help and encouragement I would not be the happy wife,
doctor, daughter and sister I am now.

xi
CHAPTER 1

Introduction

Medicine is a vocation in which a doctor’s knowledge, clinical skills and judgement

are put in the service of protecting and restoring human well-being. This purpose
is realised through a partnership between patient and doctor, one based on
mutual respect, individual responsibility, and appropriate accountability.
In their day-to-day practice, doctors are committed to:
● integrity
● compassion
● altruism
● continuous improvement
● excellence
● working in partnership with members of the wider healthcare team.

These values, which underpin the science and practice of medicine, form the basis
for a moral contract between the medical profession and society. Each party has
a duty to work to strengthen the system of healthcare on which our collective
human dignity depends.1

Medical school is fantastic, fun and fulfilling, but it is also tough. It may mean
leaving home, fending for yourself for the first time, and it is mentally and physically
challenging. The sister book to this, The Medical Student’s Survival Guide 1: the early
years, contains information on:
➥ medical school: the early days
➥ the people you will meet
➥ competitiveness, attitude and behaviour
➥ course structure
➥ learning and exams
➥ projects
➥ presentations
➥ money
➥ life away from medicine
➥ medical student socials

1
2 The Medical Student’s Survival Guide 2

➥ when things go wrong in the early years

➥ how to get the most from the early years.

Similar to The Medical Student’s Survival Guide 1: the early years, this book contains
information on avoiding or managing the hazards of being a medical student,
as identified by the medical student welfare surveys performed by the welfare
subcommittee of the British Medical Association Medical Students’ Committee
(BMA MSC).
To succeed at medical school, you will work harder than you ever imagined.
Your role and your presence will not always be appreciated, and you will have to
mature quicker than many of your non-medical student peers. That said, medical
school offers unique, intriguing and humbling experiences and opportunities.
Few other degrees offer such insight into the lives of other people; this will make
you very worldly wise. Medicine provides the buzz of success, the heartbreak of
tragedies and mental and ethical challenges that go hand in hand with caring for,
diagnosing, treating and managing patients and their friends and relatives.
The two Medical Student’s Survival Guides have been developed to provide you
with realistic insights into undergraduate training. The Medical Student Survival
Guide 1: the early years contains information on the ‘pre-clinical’ years at university.
The present Survival Guide is targeted at medical students entering the later years of
their course, the majority of which will be delivered in a clinical setting. Although
it is recognised that this split is not as clearly defined as implied in many medical
schools, as some of you will receive clinical training from the first year, information
contained in each Survival Guide will be signposted in both books to assist you to
access the relevant information. The content has been informed by the enthusiasm,
experiences, challenges and successes of the author and UK medical students.
The Survival Guides may not always provide solutions but confirmation that your
views, experiences and problems are not unique. Medicine and medical training is
constantly changing and evolving. Therefore be proactive in finding the most up-to-
date information that is available. The Survival Guides will signpost you to sources
of current information on many of the topics covered.
The Survival Guides will not guarantee you a pass in your exams; however, they
will provide you with information that will make the day-to-day experience of being
a medical student much easier.
The Survival Guides contain quotes, thought bubbles, speech bubbles, arrows
and stars:
➥ Quotes by UK medical students and literature: opinions, thoughts and advice
that demonstrate the diversity of experiences that occur throughout medical
training.
➥ Thought bubbles: examples of questions you should be asking yourself.
➥ Speech bubbles: questions commonly asked by tutors and examiners or useful
phrases for you to try in the appropriate situations.
 Introduction 3

➥ Arrows: action you could take to further your experience, knowledge or

practice.
➥ Stars: important and key knowledge that undergraduate students should grasp
during medical school. Although not exhaustive, they will signpost important
concepts and illustrate the level of understanding required of you.

The Appendix contains Resources, a directory containing comprehensive contact

details for relevant organisations. Contact the organisations themselves for the most
up-to-date, detailed and accurate information.

When applying to medical school many potential students declare a

‘commitment to life-long learning’ to demonstrate their desire to obtain
a ticket to the marvellous journey that medicine provides. But what are
the different routes, diversions and delays that today’s medical students
face, and are these causes for concern?
Medical students have to build a commendable CV in an environment
where competitiveness and ambition is rife; passing written and clinical
finals is simply not enough to join the bottom of the medical career
ladder. So what can medical students do to distinguish themselves from
a plethora of cloned colleagues? Get work published? Intercalate? Join
their Medical School Committee? Evidently, competitiveness is an aspect
of any career pathway, although there must surely be a feeling of déjà
vu with personal statement writing and UCAS applications in the not-so-
distant past for final-year students.
Another concern inherent among students is that of finances. Medical
students are unusual as it is normal to spend up to six years completing
an undergraduate degree. Demanding clinical timetables and gruelling
revision regimens leave little scope for medical students to take on part-
time employment. With several banks now offering professional loans of
up to £20,000 and interest-free overdrafts, the opportunity for medical
students to accumulate dangerously high levels of debt often receives
attention from the media.
We must remember that the vocation of medicine is not a one-
way ticket, and there are indeed many routes that may be taken before
reaching the desired destination. Many doctors will reminisce about their
turbulent journey and several places that they otherwise would never
have had the opportunity to see while stopping en route. Although what
remains evident is that ‘commitment’ must be a prerequisite before
boarding. (Vishnu Madhock, fourth-year medical student, Dundee)