In the lead up to finals time our latest podcast could be really useful for your practical sessions
In it we discuss how you will get the best out of presenting findings to an examiner in a medical student final OSCE or VIVA situation
These situations can be stressful and if you dont think about your presentation [...]
This package will teach you about the recognition and management of the critically ill patient. It is aimed to equip the medical student with the knowledge and skills to allow them, without feeling intimidated, to catch ill patients at an early stage to prevent further deterioration. Covers topics such as ABCDE assessment, SBAR, MEWS and basic initial management options.
Many medical students struggle with revising effectively. Often this is not due to a lack of effort or time but rather a lack of knowledge of how to study. Although effective learning is personal to each individual this guide was created to encourage other students to think about what works for them. It also provides step by step guidlines to create more efficient revision tools such as concept diagrams and flash cards with advice on how to maximise their use. It proved a popular guide with many students requesting further copies.
There are so many sources for advice out there for potential medical students. So many books, so many forums, so many careers advice people, and so many confusing and scary myths, that I thought it might be useful to just put up some simple guidelines on what is required to become a medical student and a short book list to get your started.
I am now in my 5th year at university and my 4th year of actual medicine. Since getting into Medical School in 2009 I have gone back to my 6th form college in South Wales at least once a year to talk to the students who wanted to become medical or dental students, to offer some advice, answer any queries that I could.
This year, I tried to to do the same sort of thing for high achieving pupils at my old comprehensive, because if you don't get the right advice young enough then you won't be able to do everything that is required of you to get into Medical school straight after your A-levels. Unfortunately, due to some new rules I wasn't allowed to. So, since I couldn't give any advice in person I thought that a blog might be the easiest alternative way to give young comprehensive students a guide in the right direction. So here goes...
How to get into medical school:
You must show that you have the academic capacity to cope with the huge volume of information that will try to teach you and that you have the determination/tenacity to achieve what you need to. To show this you must get good grades:
a. >8A*s at GCSE + separate science modules if possible = you have to be able to do science.
b. >3A’s at A-Level = Chemistry + Biology + anything else you want, as long as you can get an A.
2. You must have an understanding of what Medicine really involves:
a. Work experience with a doctor – local GP, hospital work experience day, family connections, school connections – you should try to get as much as you can but don’t worry if you can’t because you can make up for it in other areas.
b. Work experience with any health care professional – ask to see what a nurse/ physio/ health care assistant/ phlebotomist/ ward secretary does. Any exposure to the clinical environment will give you an insight into what happens and gives you something to talk about during personal statements and interviews.
c. Caring experience – apply to help out in local care homes, in disabled people’s homes, at charities, look after younger pupils at school. All these sorts of things help to show that you are dedicated, motivated and that you want to help people.
3. Be a fully rounded human being:
a. Medical schools do not want robots! They want students who are smart but who are also able to engage with the common man. So hobbies and interests are a good way of showing that you are more than just a learner.
b. Playing on sports teams allows you to write about how you have developed as a person and helps you develop essential characteristics like team work, fair play, learning to follow commands, learning to think for yourself, hand-eye co-ordination etc. etc. All valuable for a career in medicine.
c. Playing an instrument again shows an ability to learn and the will power to sit and perfect a skill. It also provides you with useful skills that you can use to be sociable and make friends, such as joining student choirs, orchestras and bands or just playing some tunes at a party.
d. Do fun things! Medicine is hard work so you need to be able to do something that will help you relax and allow you to blow off some stress. All work and no play, makes a burnt out wreck!
4. Have a basic knowledge of:
a. The news, especially the health news – Daily Telegraph health section on a Monday, BBC news etc.
b. The career of a doctor – how does it work? How many years of training? What roles would you do? What exams do you need to pass? How many years at medical school?
c. The GMC – know about the “Tomorrow’s Doctor” Document – search google.
d. The BMA
e. The Department of Health and NHS structure – know the basics! GP commissioning bodies, strategic health authorities.
f. What the Medical School you are applying to specialises in, does it do lots of cancer research? Does it do dissection? Does it pride itself on the number of GPs it produces? Does it require extra entry exams or what is the interview process?
These 4 points are very basic and are just a very rough guide to consider for anyone applying to become a medical student. There are many more things you can do and loads of useful little tips that you will pick up along the way. If anyone has any great tips they would like to share then please do leave them as a comment below!
My final thought for this blog is;
READ, READ and READ some more.
I am sure that the reason I got into medical school was because I had read so many inspiring and thought provoking books, I had something to say in interviews and I had already had ideas planted in my head by the books that I could then bring up for discussion with the interview panel when asked about ethical dilemmas or where medicine is going.
Plus reading books about medicine can be so inspiring that they really can push your life in a whole new direction or just give you something to chat about with friends and family. Everyone loves to chat people – how they work, why they are ill, what shapes peoples' personalities etc and these are all a part of medicine that you can read into!
Final Final Thought:
Just go into your local book shop or library and go to the pop-science section and read the first thing that takes your interest! It will almost always give you something to talk about.
There are loads of survival guides out there to help medical students adapt well to university life but which ones should you be taking notice of? I’ve put together a list of my top 6 must reads - I hope you find them useful.
1. BMJ’s Guide for Tomorrow's Doctors
If you don’t read anything else, read this. It covers everything from the pros and cons of using the library to essential medical websites (check out number 6 on the list :D).
2. Money Matters
Ok, this isn’t the most exciting topic but definitely a stress you could do without. The Money Saving Expert gives some great advice on how to make money and manage your finances.
This guide includes 4 simple but essential study tips relevant throughout your years at university.
4. Dos and Don’ts
Some great advice from Dundee University here on the dos and don’ts of surviving medical school.
5. Advice to Junior Doctors
Karin shares some of her hospital experiences and gives advice to junior doctors.
6. Looking after yourself
To get the most out of university it’s important that you look after yourself. The NHS provide some great tips from eating healthily on a budget to managing stress during exam time.
If you know of any other useful survival guides or would like to create your own please send them across to me firstname.lastname@example.org.
Because of the snail's pace that education has developed at, most of us don't really know how to study because we've been told lectures and reading thousands of pages is the best way to go, and no one really wants to do that all day.
That's not the only way to study. My first year of medical school... You know when you start the year so committed, then eventually you skip lectures once or twice... then you just binge on skipping? Kinda like breaking a diet "Two weeks in: oh I'll just have a bite of your mac n' cheese... oh is that cake? and doritos? and french fries? Give me all of it all at once." Anyways, when that happened in first year I started panicking after a while; but after studying with friends who had attended lectures, I found they were almost as clueless as I was.
I'm not trying to say lectures are useless... What my fellow first years and I just didn't know was how to use the resources we had– whether we were keen beans or lazy pants, or somewhere in between. I still struggle with study habits, but I've formed some theories since and I'm going to share these with you.
While reading should not be the entire basis of your studying, it is the best place to start. Best to start with the most basic and detailed sources (ex.Tortora if it's a topic I'm new to, then Kumar and Clark, and Davidson's are where I usually start, but there are tons of good ones out there!). I do not feel the need to read every section of a chapter, it's up to the reader's discretion to decide what to read based on objectives.
If you do not have time for detailed reading, there are some wonderful simplified books that will give you enough to get through exams (ICT and crash course do some great ones!). I start with this if exams are a month or less away.
Later, it's good to go through books that provide a summarized overview of things, to make sure you've covered all bases (ex. Flesh and Bones, the 'Rapid ______" series, oxford clinical handbook, etc.). These are also good if you have one very specific question about a subject.
After all that reading, you want the most laid back studying you can find. This is where Meducation and Youtube become your best friend. (I can post a list of my favourite channels if anyone is interested).I always email these people to thank them. I know from the nice people that run this website that it takes a tremendous amount of effort and a lot of the time and it's just us struggling students who have much to gain.
Everyone should use video tutorials. It doesn't matter if you're all Hermione with your books; every single person can benefit from them, especially for osce where no book can fully portray what you're supposed to do/see/hear during examinations.
Some youtube channels I like
We're all thinking it, lectures can be boring. Especially when the speaker has text vomited all over their slides (seriously, If I can't read it from the back of the lecture hall, there's too much!. It's even worse when they're just reading everything to you, and you're frantically trying to write everything down. Here's the thing, you're not supposed to write everything down. If you can print the slides beforehand or access them on your laptop/ipad/whatever you use and follow along, do that.
You're meant to listen, nod along thinking (oh yes I remember this or oooh that's what happens? or Oh I never came across that particular fact, interesting!). It's also meant to be a chance for you to discuss interesting cases from the a doctor's experiences. If you're lucky to have really interactive lecturers, interact! Don't be shy! Even if you make a fool of yourself, you're more likely to remember what you learned better.
If you happen to be in a lecture you're completely unprepared for (basically 70% of the time?). Think of it as "throwing everything at a wall and hoping something sticks." Pull up the slides on your smart phone if you have one, only take notes on interesting or useful things you hear the speaker say. If all else fails, these lectures where tell you what topics to go home and read about.
My university has gradually increased its use of tutorials, and I couldn't be happier. Make the most out of these because they are a gift. Having the focused attention of a knowledgeable doctor or professor in a small group for a prolonged period of time is hard to lock down during hospital hours. Ask lots of questions, raise topics you're having trouble understanding, this is your protected time.
In group study activities, this is particularly hard to make the most of when everyone in your group varies in studying progression, but even so, it can be beneficial. Other people's strengths might be your weaknesses and vise versa– and it's always helpful to hear an explanation about something from someone at your level, because they will neither under or over estimate you, and they will not get offended when you tell them "ok I get it that's enough."
Myself and 3 of my medic friends would meet once a week the month or two leading up to exams at one of our houses to go through OSCE stations and concepts we didn't understand (food helps too).
Besides peer discussions, you should take advantage of discussions with doctors. If the doctor is willing to give you their time, use it well.
I am a practice question book hoarder. Practice questions book not only test and reaffirm your knowledge, which is often hard to find if your exams are cumulative and you have little to no quizes/tests. They also have concise, useful explanations at the back and, they tell you where the gaps in your studying are. For my neuro rotation, the doctor giving the first and last lecture gave us a quiz, it was perfect for monitoring our progress, and the same technique can be used in your studies.
Practical Clinical Experiences
If you freeze up during exams and blank out, and suddenly the only forms of text floating around your brain are Taylor Swift lyrics, these are bound to come to your rescue! "Learn by doing."
Take as many histories as you can, do as many clinical exams in hospital, and on your friends to practice, as you can, see and DO as many clinical procedures as you can; these are all easy and usually enjoyable forms of studying.
Have you ever had an experience where one of your peers asks you about something and you give them a fairly good explanation then you think to yourself "Oh wow, I had no idea that was actually in there. High five me."
If there is ever an opportunity to teach students in the years below you or fellow students in your year, do it! It will force you to form a simplified/accurate explanation; and once you've taught others, it is sure to stick in your head.
Even if it's something you don't really know about, committing yourself to teaching others something forces you to find all the necessary information. Sometimes if there's a bunch of topics that nobody in my study group wants to do, we each choose one, go home and research it, and explain it to each other to save time. If you're doing this for a presentation, make handouts, diagrams or anything else that can be used as an aid.
As part as my paediatrics attachment, I was having peripheral nervous system bed side teaching. We had spoken over the examination and I was first up to practice on 4 year old Jake. One consultant and 3 other medical students looked on as I worked my way through the examination.
My general inspection and impression of the child got approving nods from my colleagues. Phew! Next up was actual exam “two people can’t resist…” I recalled in my head.
First up, tone. I assessed this correctly and nothing had gone majorly wrong yet. Relief. Power was next.
“ok, so put out your arms up like this and resist me…ok, no, not like that..erm..oh god…I don’t know how to explain it”.
My colleagues looked on.
The consultant chipped in “tell him to touch his shoulders”.
It did the trick and I was able to get through the rest of the examination without too many hiccups.
When we had finished, in classic med school fashion I had to reflect on what had just happened and then say something I did good and something I could have done better.
My good thing was “I got through it..I mean I remembered everything”. My bad thing was “I wasn’t good at explaining power to him”.
My feedback wasn’t the same as my bad thing though. My feedback was “be more confident. You did everything correctly and didn't forget anything. I think it’s a girl thing. You doubt yourselves more than the boys”.
Next up was a male medical student’s turn. He did the examination just fine but there were things that I could pick out that he could have done better and being totally objective my examination was better. But there was a major difference. His confidence.
He seemed like he knew what he was doing and when he went wrong or missed something out, he just added it to the end of his examination. If I were his examiner, I would have found it difficult to fault him.
He appeared confident and as a patient that inspires confidence and a happy patient makes for a happy examiner and good marks.
After the session, I got to thinking: am I really incompetent or am I just underestimating my own ability which is making me lack confidence?
The fact that a paediatric consultant and all my colleagues told me that my examination was fine, good even, answers the first part. I am not incompetent. So I must be underestimating my own ability. And if I am, is that something that is unique to me? Or are other medical students doing that too? And more interestingly to me, is this something that the female medical students are doing more than their male colleagues?
All stages of essay writing can be tricky, from the choice of a proper topic to the organization of the paper to the actual writing. Moreover, you also have to edit and proofread the paper in order to make sure it’s clean of all spelling errors and logical gaps. The content has to be free of plagiarism, and all sources you have used need to be properly referenced. When you have all those rules in mind, essay writing can become really confusing.
However, there are online resources that can help you through every stage of the process, and we will list some of the most useful ones in the continuation.
Help with your topic and thesis
The first stage of the process can often be the most troublesome one. However, there are online tools that offer great topic ideas, which you can later turn into thesis statements with the help of thesis generators.
Writinghouse is citation generator that will create the needed bibliography entries and in-text citations in your paper.
How to write a college application essay – 10 practical ninja tips by Ninja Essays. This simple guide offers practical tips for writing impressive application essays. Paying attention to this advice will relieve you from the stress of college applications.
Thesis Generator 1.0 is a great tool for drafting clear thesis statements for argumentative and persuasive essays. In order to get a suggestion for your thesis statement, you will need to enter the topic and main argument of your paper, along with two reasons that support the main argument.
Thesis Statement Creator is also requires you to enter all components of the thesis statement, after which you will get a suggestion for a thesis statement that you can directly use into your essay.
Understand the types of essays
All types of essays have different requirements, so you need guides that will help you understand their principles.
Roane State Online Writing Lab provides clear information about various types of essays, as well as samples that will help you get an impression of how great academic writing is done.
Writing Detective provides a useful online lesson that will teach you how compare/contrast essays are written, after which you can take a quiz to test your abilities.
The organization of your paper
Proper essay organization isn’t difficult to achieve, but many students struggle with it. These are the tools that will improve the structure of your papers:
Essay Map by ReadWriteThink will help you organize your paper through an interactive guide.
From outline… to essay by iCivics is a lesson with side-by-side examples of appropriate organization.
Essay Organizer is an app for smartphones, which you can use to go through the detailed steps of essay writing and take notes at any time.
Great essays don’t come without proper grammar and syntax!
These tools will help you make sure your paper is error-free:
PaperRater will not only provide you with suggestions on how you can improve your paper in terms of style and vocabulary, but will also check it for plagiarism.
Purdue OWL offers any information about essays you could possibly need. It will teach you about proper grammar and syntax, as well as the general requirements for different types of essays.
UNLV Writing Center provides practical tips on essay writing that will teach you how to avoid the most common mistakes.
Check the uniqueness of your paper!
Professors don’t forgive plagiarism issues, so you better use these tools to make sure your paper is unique before you submit it:
PlagTracker is a simple, but very effective tool that provides links to articles and webpages of duplicate content.
Viper is another effective plagiarism checker, but this one requires a download.
Education is an aspect of life that has been particularly transformed due to the remarkable digital changes. Now that you have practical tools within reach, essay writing doesn’t have to be a struggle. Online tools will make this activity less stressful and less time-consuming!
Book of the week (BotW) = The Darwin Economy by Prof Frank
Being a medical student and wanna-be-surgeon, I am naturally very competitive. I know exactly where I want to end up in life. I want to be a surgeon at a major unit doing research, teaching and management, as well as many other things. To reach this goal in a rational way I, and many others like me, need to look at what is required and make sure that we tick the boxes. We must also out-compete every other budding surgeon with a similar interest.
Medicine is also a dog-eat-dog world when it comes to getting the job you want. Luckily you can head off into almost any field you find interesting, as long as you have the points on your CV to get access to the training. In recent years, the number of med students has increased, but so has the competition for places. The number of FY1 jobs has increased but so has the competition for good rotations. The number of consultant posts has increased, but so has the competition for the jobs.
To even be considered for an interview for a consultant surgeon post these days a candidate (hopefully my future self) will have to demonstrate an excellent knowledge of anatomy, physiology, pathology and demography. They will need to have competent surgical skills and have completed all of the hours and numbers of procedures. To further demonstrate this they will need to have gone on extra-curricular courses and fellowships. They will also need to show that they can teach and have been doing so regularly. They must now also have an understanding of medical leadership and have a portfolio of projects. Finally, they will have had to tick the research box, with posters, publications, oral presentations and research degrees.
That’s a long list of tick boxes and guess what? It has been getting longer! I regularly attend a surgical research collaborative meeting in Birmingham. Many of those surgeons didn’t even get taught about research at medical school or publish anything until they were registrars. Now even to get onto a good Core Training post you need to have at the very least some posters in your chosen field and probably a minimum of a publication. That’s a pretty big jump in standards in just 15 years.
In two generations the competition has increased exponentially. Why is that?
Prof Frank explains economic competition in Darwinian terms. His insights apply equally well to the medical training programme. It’s all about your relative performance compared to your peers and the continual arms race for the best resources (training posts). However, the catch is, if everyone ups their performance by the same amount then you all work harder for no more advantage for anyone, except for the first few people who made the upgrade. The majority do not benefit but are in fact harmed by this continual arms race.
I believe that this competition will only get worse as each new year of med students tries to keep up and surpass the previous cohort. This competition will inevitably lead to a greater time commitment from the students with no potential gain. Everything we do is relative to everyone else. If we up our game, we will outperform the competition, until they catch up with us and then relatively we are no better off but are working harder.
Why is this relevant?
I know everyone will want to select “the best” candidate, but in medicine the “best” candidate doesn’t really exist because we are all almost equally capable of doing the role, once we have had the training. So there is no point us all working ourselves into the ground for a future job, if all our hard work won’t pay off for most of us anyway. But we can’t make these choices as individuals because if one of us says that “I am not going to play the game. I am going to enjoy my free time with my friends and family”, that person won’t get the competitive job because everyone else will out-perform them. We have to tackle this issue as a cohort.
How do we ensure that we don’t work ourselves into the ground for nothing?
Collectively as medical students and trainees we should ask the BMA and Royal Collages to set out a strict application process that means once candidates have met the minimum requirements, there is no more points for additional effort. For instance, the application form for a surgical consultant post should only have space to include 5 peer-reviewed publications. That way it wouldn’t necessarily matter if you had 5 or 50 publications.
This limit may seem counter-intuitive and will possibly work against the highly competitive high achievers, but it will have a positive effect on everyone else’s life. Imagine if you only had to write 5 papers in your career to guarantee a chance at a job, instead of having to write 25. All that extra time you would have had to invest in extra-curricular research can now be used more productively by you to achieve other life goals, like more time with your family or more patient contact or even more time in theatre perfecting your skills.
If you were selecting candidates for senior clinicians, would you rather pick an all round doctor who has met all of the requirements and has a balanced work-life balance or a neurotic competitor who hasn’t slept in 8 years and is close to a breakdown?
Being a doctor is more than a profession, it is a life-style choice but we should try to prevent it becoming our entire lives.
My fellow medical students, interns, residents and attendings:
I am not a medical student but an emeritus professor of Obstetrics and Gynecology at the University of Miami Miller School of Medicine, and also a voluntary faculty member at the Florida International University Herbert Wertheim College of Medicine. I have a great deal of contact with medical students and residents. During training (as student or resident), gaining confidence in one's own abilities is a very important part of becoming a practitioner. This aspect of training does not always receive the necessary attention and emphasis. Below I describe one of the events of confidence building that has had an important and lasting influence on my career as an academic physician.
I graduated from medical school in Belgium many years ago. I came to the US to do my internship in a small hospital in up state NY. I was as green as any intern could be, as medical school in Belgium at that time had very little hands on practice, as opposed to the US medical graduates. I had a lot of "book knowledge" but very little practical confidence in myself. The US graduates were way ahead of me. My fellow interns, residents and attendings were really understanding and did their best to build my confidence and never made me feel inferior.
One such confidence-building episodes I remember vividly. Sometime in the middle part of the one-year internship, I was on call in the emergency room and was called to see a woman who was obviously in active labor. She was in her thirties and had already delivered several babies before. The problem was that she had had no prenatal care at all and there was no record of her in the hospital. I began by asking her some standard questions, like when her last menstrual period had been and when she thought her due date was. I did not get far with my questioning as she had one contraction after another and she was not interested in answering. Soon the bag of waters broke and she said that she had to push. The only obvious action for me at that point was to get ready for a delivery in the emergency room. There was no time to transport the woman to the labor and delivery room.
There was an emergency delivery “pack” in the ER, which the nurses opened for me while I quickly washed my hands and put on gloves. Soon after, a healthy, screaming, but rather small baby was delivered and handed to the pediatric resident who had been called. At that point it became obvious that there was one more baby inside the uterus. Realizing that I was dealing with a twin pregnancy, I panicked, as in my limited experience during my obstetrical rotation some months earlier I had never performed or even seen a twin delivery. I asked the nurses to summon the chief resident, who promptly arrived to my great relief. I immediately started peeling off my gloves to make room for the resident to take my place and deliver this twin baby. However, after verifying that this baby was also a "vertex" without any obvious problem, he calmly stood by, and over my objections, bluntly told me “you can do it”, even though I kept telling him that this was a first for me. I delivered this healthy, screaming twin baby in front of a large number of nurses and doctors crowding the room, only to realize that this was not the end of it and that indeed there was a third baby.
Now I was really ready to step aside and let the chief resident take over. However he remained calm and again, stood by and assured me that I could handle this situation. I am not even sure how many triplets he had delivered himself as they are not too common. Baby number three appeared quickly and also was healthy and vigorous. What a boost to my self-confidence that was! I only delivered one other set of triplets later in my career and that was by C-Section. All three babies came head first. If one of them had been a breech the situation might have been quite different.
What I will never forget is the implied lesson in confidence building the chief resident gave me. I have always remembered that. In fact I have put this approach in practice numerous times when the roles were reversed later in my career as teacher. Often in a somewhat difficult situation at the bedside or in the operating room, a student or more junior doctor would refer to me to take over and finish a procedure he or she did not feel qualified to do. Many times I would reassure and encourage that person to continue while I talked him or her through it. Many of these junior doctors have told me afterwards how they appreciated this confidence building. Of course one has to be careful to balance this approach with patient safety and I have never delegated responsibility in critical situations and have often taken over when a junior doctor was having trouble.
Those interested, can read more about my experiences in the US and a number of other countries, in a free e book, entitled "Crosscultural Doctoring. On and Off the Beaten Path" can be downloaded at this link.
I read an article recently that 90% of surgical trainees have experienced bullying of one form or other in their practice. That’s 90%. That’s shocking. Worryingly it is highly likely that this statistic is not purely isolated to surgery. This is evidence of a major problem that needs to be addressed. We don’t accept bullying in schools and in the workplace policies are in place to stop bullying and harassment– so why have 90% of trainees experienced bullying? I can relate to this from personal experience, as I am sure most of us can.
Prior to intercalating I had always had the typical med student ambition of joining the big league and taking on surgery. I had a keen interest in anatomy, I had decided to intercalate in anatomy, I did an SSC on surgical robotics, presented at an undergraduate surgical conference and had a small exposure to surgery in my first couple of years that gave me enough drive to take on a competitive career path. I took it upon myself to try and arrange a brief summer attachment where I would learn as a clinical medical student what it is like to scrub in and be in theatre. At the beginning I was so excited. At the end every time someone mentioned surgery I felt sick.
It became apparent very quickly that I was an inconvenience. I think medical students all get this feeling – ‘being in the way’ - but this was different. This was being made to feel deliberately uncomfortable. I asked if I could have some guidance on scrubbing in and this was met with a complete huff and annoyance because I didn’t know how to do it properly (thank goodness for a lovely team of theatre nurses!). I even got assigned a pet name for the week – the ‘limpet’ (notable for their clinging on to rocks) that was frequently used as a humiliation tactic in front of colleagues. By the end of the week I dreaded walking into the hospital and felt physically sick every morning. Now some people might say ‘man up’ and get on with it. Fair enough, but I’m a fairly resilient character and it takes a lot to make me feel like I did that week. This experience completely eradicated any ambition I had at the time to go into surgery. Since then I’ve focused elsewhere and generally dreaded surgical rotations until very recently where I managed to meet a wonderful orthopaedic team who were incredibly encouraging.
Bullying can be subjective. Just because a consultant asks you a difficult question doesn’t mean they’re bullying you. By and large clinicians want to stretch you and trigger buttons that make you go and look things up. If it drives you to work and develops you as a professional then it’s not bullying, but if it makes you feel rubbish, sick or less about yourself then you should perhaps think twice about the way you’re being treated.
Of course bullying doesn’t stop at professionals. Psychological bullying is rife in medical schools. We’ve all been ‘psyched out’ by our peers – how much do you know? How did you know that when I didn’t? Intimidating behaviour can be just as aggressive. Americans dub these people ‘Gunners’ although we’ve been rather nice and adopted the word ‘keen’ instead.
Luckily most medical schools have a port of call for this sort of behaviour. But a word of advice – don’t let anyone shrug it off. If it’s a problem, if it’s affecting you – tell someone. Bullying individuals that are trying to learn and develop as professionals is entirely unacceptable.
If you would like to share similar experiences, drop them in the comments box below.
In the USA the issue of indiscriminate use of expensive, sophisticated, and time consuming test in lieu of, rather than in addition to, the clinical exam is being much discussed. The cause of this problem is of course multifactorial. One of the factors is the decline of the teaching of clinical skills to our medical students and trainees.
Such problems seem to have taken hold in developing countries as well. Two personal anecdotes will illustrate this.
In the early nineties I worked for two years as a faculty member in the department of ob & gyn at the Aga Khan University Medical School in Karachi, Pakistan. One day, I received a call from the resident in the emergency room about a woman who had come in because of some abdominal pain and vaginal bleeding. While the resident told me these two symptoms her next sentence was: “… and the pelvic ultrasound showed…” I stopped her right in her tracks before she could tell me the result of the ultrasound scan. I told her: “First tell me more about this patient. Does she look ill? Is she bleeding heavily? Is she in a lot of pain and where is the pain? What are her blood pressure and pulse rate? How long has she been having these symptoms? When was her last menstrual period? What are your findings when you examined her ? What is the result of the pregnancy test?”. The resident could not answer most of these basic clinical questions and findings. She had proceeded straight to a test which might or might not have been necessary or even indicated and she was not using her clinical skills or judgment.
In another example, the resident, also in Karachi, called me to the emergency room about a patient with a ruptured ectopic pregnancy. He told me that the patient was pale, and obviously bleeding inside her abdomen and on the verge of going into shock. The resident had accurately made the diagnosis, based on the patient’s history, examination, and a few basic laboratory tests. But when I ran down to see the patient, he was wheeling the patient into the radiology department for an ultrasound. "Why an ultrasound?" I asked. “You already have made the correct diagnosis and she needs an urgent operation not another diagnostic procedure that will take up precious time before we can stop the internal bleeding.” Instead of having the needless ultrasound, the patient was wheeled into the operating room.
What I am trying to emphasize is that advances in technology are great but they need to be used judiciously and young medical students and trainees need to be taught to use their clinical skills first and then apply new technologies, if needed, to help them to come to the right diagnosis and treatment. And of course we, practicing physicians need to set the example. Or am I old fashioned and not with it?
Medico legal and other issues may come to play here and I am fully aware of these. However the basic issue of clinical exam is still important.
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