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Rachel K. Thomas, BM, BCh, BEng (Hons), BSc
With contributions from:
This edition first published 2017 © 2017 by Rachel K. Thomas.
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Library of Congress Cataloging-in-Publication Data
Names: Thomas, Rachel Katherine, author.
Title: Medical school at a glance / Rachel K Thomas.
Other titles: At a glance series (Oxford, England)
Description: Chichester, West Sussex, UK: John Wiley & Sons,
Ltd, 2017. | Series: At a glance series | Includes bibliographical
references and index.
Identifiers: LCCN 2016030094 (print) | LCCN 2016030954 (ebook) | ISBN
9781119075912 (pbk.) | ISBN 9781119075929 (pdf) | ISBN 9781119075936 (epub)
Subjects: | MESH: Education, Medical | Physician’s Role | Physician-Patient
Relations
Classification: LCC R737 (print) | LCC R737 (ebook) | NLM W 18 | DDC
610.71/1–dc23
LC record available at https://lccn.loc.gov/2016030094
A catalogue record for this book is available from the British Library.
Wiley also publishes its books in a variety of electronic formats. Some content that appears in print may not be available in electronic books.
Cover image: ©Getty Images/Steve Debenport
An alternative title to this book could be: ‘An insider’s guide to what I wished I knew before starting medical school’. It aims to provide you with tips so that you gain a running start to your medical school training. Some areas of knowledge are already ‘assumed’ during your medical course. These assumptions, for example about the course itself, interaction with both patients and medical professionals, and support progressing through medical school, can be assumed incorrectly. As a result, you have to learn some aspects, the time-consuming ‘hard way’ – by trial and error! Your time will already be a premium commodity, so minimising, or eliminating, time spent having to wonder about background issues will free up more time for you to concentrate on your studies and clinical activities. This book provides an insider’s view of helpful information to build a solid basic foundation for your learning, which you can then build on throughout your medical studies and career.
This book does not aim to give in-depth coverage of specific areas, as there are many resources including other At a Glance titles, and the General Medical Council’s Outcomes for Graduates (originally Tomorrow’s Doctors) and Good Medical Practice for this. There are also many useful books by writers such as Atul Gawande and Ben Goldacre that can offer broader perspectives on medicine. The idea of this book is to help give you confidence, and to help you realise that you already most likely in command of some assumed basics underlying medical school.
Rachel Thomas
Thank you to all who have been involved in creating this book.
Thank you firstly to the contributors – Dr Diana Thomas for manuscript editing and general contributions, Dr Rusiru Kariyawasam, for chapters on dealing with stress, solving issues, communication skills, balance and other uses for medical degrees, and Dr Shreya Bali, for chapters on behaving in theatre, evidence-based medicine, guidelines and protocols, examining a patient, assessment and management of an unwell patient, and assessment of hydration and nutritional status.
Thank you to Camilla, Hugh, Matthew, Andrew and James Thomas, and Quentin Deluge.
Thank you to Camilla Thomas, Nick May and Dr Alexander Kumar for help with photographs.
Thank you to Simon Roer and colleagues at the General Medical Council.
Thank you to Karen Moore, Loan Nguyen, Francesca Giovannetti and Kathy Syplywczak for their continued assistance at Wiley-Blackwell.
Finally, thank you to all the doctors and medical students who provided valuable feedback on drafts of the book.
It goes without saying that medical school is an exciting experience and a big commitment. It will enable you to meet new friends, as well as discovering new social and academic opportunities. As with any big commitment it can be made easier with adequate preparation, well-informed expectations, clearly defined goals, and well-utilised tools and supports.
Succeeding at medical school, and then in the various careers that medicine offers, requires more than intellectual rigour. The human body is one of the most amazingly robust, yet phenomenally intricate, systems in existence. So intellectual rigour is indeed a requirement.
It is very important to not get bogged down in the sheer enormity of what must, at some point, be learned. There is no denying that there is lots of it! Get used to this fact, and then move on, as past this point it is much more interesting. The learning of the facts is just a part of being a ‘good doctor’ – an important part, but just a part (Figure 1.1).
You may already be familiar with the Hippocratic Oath, which is the historical oath relating to the upholding of ethical standards by doctors (Figure 1.2). This was updated from the Greek text to a modern version in 1948 (Figure 1.3).
Other parts include a strong interest in humanity in general, and particularly the sick. This may sound obvious, but it is key! As you will discover, patients tell you the answers, if you learn to listen and to communicate sincerely and effectively with them. Being able to understand their social context, and the impact of a disease on a person’s quality of life, is important. Being interested in diseases, their diagnosis and their treatment is also crucial. But it is likely that you are already equipped with these skills and interests, or medical school may not have called for you. So instead of being deterred by the sheer volume of facts, take comfort in the skills you already innately have.
At times, being at medical school is like being a detective, gathering all the hints, putting them into the appropriate order, and then piecing the underlying illness together. And there are many other areas – such as eliciting signs, learning the language, creating possible differential diagnoses, performing diagnostic and therapeutic procedures – which you will in time master with practice (Figure 1.4).
Different medical schools differ in their approach to learning. Some integrate clinical care very early on, while others ensure a theoretical foundation before you are let loose on the wards. There is no right or wrong way to learn medicine – as long as you end up being a safe doctor, then you have learned successfully.
Usually, the first few days of medical school are like any other first few days at university – they are often spent with administration and introductory lectures. Perhaps prepare a brief statement about who you are, why you want to study medicine, and any particular interests, as these questions are often used to ‘break the ice’.
Starting anything new can cause a range of feelings, from excitement, to nervousness and stress. The experiences are deeply personal and unpredictable. The extent that people feel these emotions, and actually show them, differs greatly.
So, if you feel a bit anxious, take comfort in the fact that you are most likely not alone. It is safe to say that many students on their first day suffer with nerves. This sense of nervousness can continue for some time. It will pass, as you become more competent and confident in your skills and knowledge.
Medical school is a unique experience. As part of the healthcare profession, you will gain access to areas of people’s lives that is unparalleled in any other profession – patients, who were strangers to you a moment earlier, will share deeply personal, and at times troubling, experiences and information. It goes without saying that this honour can cause a degree of personal stress, particularly when first starting medical school. The stress associated with patient deaths, non-accidental injuries and other aspects of medicine rarely lose their impact, but you will develop coping strategies over time. Aside from the stress that can be associated with patients and learning, there may be the added pressure of financial stress. Life does not stop when you start medical school, and in addition you may also have to cope with your own personal stressful life events such as bereavements and divorces.
There are many and varied coping strategies for the stresses of medical school. These will be covered in depth in later chapters – however, for the first few days, meet people, find your bearings and accept that there is a long, interesting, winding path ahead in your career, a career that is simply like no other.
Start to enjoy the independence, choice and freedom that can come with starting a course at university, and become familiar with the various extracurricular activities and societies that exist. These will help you cope with stresses, and make your time at university more enjoyable in many respects.
Never be afraid to ask for help. Everyone had to learn once, and your seniors, your colleagues and your peers all know this, and thus will usually be happy to help. It is preferable to ask for help early – as often ‘a stitch in time, saves nine’.
Trust your own capabilities, and never feel pressured into performing a task that you do not feel capable of doing. Even if the task seems basic to someone else, it is important to have enough confidence in yourself to know both your capabilities, and your limitations. You will always have both, the important skill is recognising where the line lies between the two!
As will be covered in the following chapters, ensure you adhere to important common principles from your first day at medical school – including fully and correctly identify the patient, and respect their confidentiality. You are a doctor in training, and one day soon it will be you on the ward helping these patients. Start cultivating the habits you will require in your career – from adequate hand hygiene to thoroughly documenting actions and interactions – so that these will be second nature once you are actually working as a doctor. Start learning by looking at guidelines and protocols, and embrace primary literature and best current practice to help your learning.
As with any new skill, there is no substitute for practice. The fact that it is referred to as the ‘practice’ of medicine really gives this one away! While ‘practice makes perfect’, perfection is, at times, impossible to attain in medicine – what you can achieve, though, is the reliable and consistent delivery of superior quality care to your patients.
When graduating from medical school, you generally graduate with a Bachelor of Medicine (BM), and a Bachelor of Surgery (BS). Depending upon the institution, this may be a BMBS, BMBCh (from the Latin, Baccalaureus Chirurgiae) or various other professional awards. While named as two degrees, they are generally awarded as one degree.
The specialties are divided into medical or surgical specialties (Figure 2.1). Early training is split between the two areas roughly evenly, and then commitment to a specialty naturally leads to practising more of this area. There are generalists in each area – general practitioners (GPs) and general surgeons. These generalists may also have an area of special interest, such as a GP with a special interest in Dermatology.
Specialties such as Cardiology, Gastroenterology and Neurology are medical specialties. Generally, the medical specialties start their day at 09.00 hours, and have longer ward rounds.
Specialties such as Urology, Otorhinolaryngology (ENT) and Trauma and Orthopaedics (T&O) are surgical specialties. Generally, the surgical specialties start their day at 08.00 hours, and have shorter ward rounds, as the consultants and team members are required in theatre.
There is often good-natured banter between the Medics and the Surgeons. The uninitiated may not be aware of its existence, but once welcomed into the hallowed halls of a medical school, it will show itself as frequent light-hearted quips in lectures!
At medical school, both medial and surgical areas will require fairly similar amounts of effort. You will need to learn the theory behind pathologies, and how to diagnose and treat them appropriately. You will usually need to attend lectures, tutorials and problem-based learning sessions for both. Obviously, medical and surgical interventions are not always the sole treatment for medical and surgical conditions, respectively.
Both areas will require you to learn structured clinical examinations of the patient, and to attend ward rounds and clinics. Key within each area is learning which includes reflection. Later career progression requires this more formally, so it is advisable to begin reflective practice in your time at medical school. The General Medical Council (GMC) has guidance on what is expected as both a medical student and as a doctor, so it is advisable to become familiar with areas such as professionalism (Figure 2.2) and your duties early on in medical school.
Both medicine and surgery have a similar approach to conditions. These include areas that are covered in later chapters, including:
It is key as a student (and later, as a doctor) to introduce yourself, and to explain to the patient why you wish to speak with them and examine them. It is important that patients understand that they can refuse to speak with a student, and that if they do it will not impact on their care at all. Most patients, if not too tired or in too much pain, will be happy to help you learn, but if this is not something that they wish to do, respect their rights, thank them, and leave them.
Multi-disciplinary team meetings (MDTs) are where different members from different areas of the patient’s care meet at a specified time to discuss the patient. These are excellent learning opportunities, where as a student you can start considering other aspects of the patient’s care. They also provide opportunities to learn from healthcare professionals who are in different areas from the one in which you are currently placed. These team meetings will help you consider:
and are usually scheduled on a regular basis.
Teams involved in MDTs vary, but include:
in addition to members of the nursing, surgical and medical teams.
MDTs can help you understand key holistic factors such as packages of care (scheduled support to help a patient in their home) – as practising medicine is not just about pharmaceuticals and surgery!
All areas of both medicine and surgery require the utmost professionalism, with the GMC providing strict guidance on this. Professionalism extends beyond your interactions in the hospital and at medical school. Ensure that you pay attention to personal aspects of your life, such that they do not bring your integrity into question or disrepute.
Social media sites can easily be accessed by universities’ faculty members, future employees, colleagues and patients. Therefore consider this aspect before posting images on sites such as Facebook or Instagram. Consider changing your privacy settings so that only close friends can see your content, and consider requesting that friends respect your privacy by not posting images of you without mentioning it to you first. Twitter can be a useful avenue for connection with various health agencies, such as the World Health Organization and the NHS, but it is important to carefully consider tweets or re-tweets before making them. Some medical practices advise their doctors against having instant messenger apps such as WhatsApp, so ensure that you are familiar with local protocols. Remember that once in the public domain online, these comments and images remain discoverable in the foreseeable future. The GMC has issued guidance on Doctors’ use of social media to help with complying with good medical practice in these channels. Not complying can create serious implications and call your professionalism into question.