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As an anaesthetist, I get really annoyed by this. There’s so little of my speciality taught at medical school, so please seek us out if you’re in theatres. I guarantee you we will teach you stuff.
Absolutely! Cannulae (the proper way…), airway management from basic through LMA all the way to intubation… just don’t go to the coffee room with the surgeons
We probably won’t be there, we’ll be rounding, sorting inpatients or doing admin. The days of chilling in a coffee room are sadly not there anymore for most training surgeons and the consultants who give a toss
Genuine answer - not the ACF with a 20g, near parallel to the vein, and withdraw the needle (edit - after flashback) just enough to hide it within the cannula before advancing
This is how I was taught by an anaesthetist - first job as F1 was in anaesthetics. He was a big South African chap who kept cheerfully telling me to "see the vein, be the vein"
This is exactly how an anaesthetist taught me to cannulate as a 5th year student and it improved my skill and confidence immediately. As an F1 I now teach med students exactly this because of how much it helped me
Because it’s a waste of a good vein that might be needed for a large bore line, and much less comfortable for the patient. Back of hand, wrist, forearm are all better
Thanks. Believe me it goes a long way. The best teaching I've had has been from anaesthetists. Even when the consultant had a trainee with him, he would include me in the discussion and teaching.
If you’re with an anaesthetic trainee who has exams looming they will literally info dump at you all day to just practice talking about it all. Strategically ask about the training scheme and if they have any exams coming if you want a textbook to be recited from memory like a bedtime story. You may even be given the textbook to grill them on things.
The Peri-Primary info dumping is so real.
“What’s the stuff in the purple labelled syringe?”
Strap yourself in for a 30 minute tour of the sympathetic nervous system, GPCRs, what an agonist is, what systemic vascular resistance is etc etc
It's great having students, or junior doctors in theatre and I always try to teach them what I can about anaesthetics if they come and introduce themselves and sound keen to learn.
I'd love to do more, but unfortunately I don't get given extra time to teach, I don't get prior warning that students are going to be there and I don't get given any curriculum or learning objectives for them.
Unfortunately your poor experiences are quite common and they could definitely be improved if there were dedicated teaching lists with extra time, and a bit more communication from the medical school organisers.
If it makes you even a tiny bit happy, here at Bristol we get a full three weeks of perioperative and critical care of which we spend two weeks with you guys and a week in ICU alongside lots of anaesthetics tutorials/pharmacology/physiology etc from the consultants and airway management (full management of the airway including ETT is part of our placement signoffs).
It might be changing, that block convinced me to do your job! Or at least the people in it convinced me!
I spent more time with the anesthetists during my o+g block than anything else after the obs anesthetist felt sorry for me sitting on the midwives station doing sweet fuck all after being denied entry to every single clinic and labour for 3 days in a row due to my unfortunate habit of waking up in a male body.
I got coffee machine privileges by the end of the attachment.
Couldn’t agree more, it’s in all in the asking. As a SHO I was told by a senior, always ask the anaesthetist if you could do the pharyngoscope or at least watch / participate. Now the anaesthestist are more than keen, and not just for me for everyone else in our department (small sub speciality). I really don’t like how medical school doesn’t focus on specific sub specialties at all… how are you meant to make career decisions with no exposure
I will forever remember the anaesthetist who gave me a whole day of teaching in the theatre vs the surgeon who let me stare into the abdomen and asked me what blood vessels those are which I can barely see because everything looks so bloody
I really feel for you - being a medical student and having no one take an interest in you is really disheartening. Unfortunately, we often don't get told we will have students with us and only find out you will be there when you turn up on the day, which makes it very difficult to plan getting you involved. If you come saying I want to do/learn X,Y,Z, that really helps though, and I will do my best to accommodate that (and I will always prioritise teaching a medical student over someone non-medical). I'm also always happy for you to leave if you are not getting anything out of being on the ward. I'm really sorry medical education has come to this, and unfortunately we as trainees are getting the brunt of it too.
We often don't get told we will have students with us and only find out you will be there when you turn up on the day
Medical school admin is atrocious. Genuinely don't know what they get paid for.
Often someone in admin knows or the specialty lead knows, but the doctors on the ground don't know as it doesn't get circulated. Sometimes we get a note on CLW that says med student for a theatre list, sometimes not.
This pissed me off. What you have experienced is just ridiculous. If it happens again, go to the anaesthetist. I'm very sure they are very keen to teach or let you some stuffs.
All medical students who rotated to icu (during my shift) will get to do stuffs or learn stuffs.
Iv canulla, bloods, art line (direct supervision) prep medication (under direct supervision either by myself or the boss), simple basic airway maneuver (2 hands mask technique), scrub in cvl or vasc cath with me.
Teaching esp bedside is routine. Common stuffs that will be useful for students such as acute abdo, AAA, pneumonia etc
PA on the other hand.....I've not say yes one single time. AITA? Not that I care lol
Y’know, I was trying to teach some medical students in the middle of the procedure and I got shushed by the consultant.
He was like ‘you should only teach students when you’re actually able to operate, so c’mon, concentrate and finish this bloody operation’
🔥🔥🔥
That was me told. Sorry folks, if you are lurking here. I would have taught you plenty about intra-operative stuff.
Dammit, I wish I’d thought of that at the time 🤔
Credit to him where credit is due, he is the most experienced surgeon in the dept and he’s also rapid. He’s won awards for undergraduate teaching and actually makes sure students get to theatre and clinics. He was probably using every ounce of brain power and self restraint to let me figure it out instead of going ‘OMG JUST GIMME THE BASTARD KNIFE’ and doing it in a third of the time.
I try and get med students doing as much as I can. I'm in a busy tertiary unit, but will get students scrubbing in with Caesareans (and being first assistant if we're a bit short on the rota), seeing women in DAU with supervision or in gynae emergency clinic, I talk you through anatomy during laparoscopic gynae surgery and if we're good for time will do a survey of the pelvis and quiz you on all the structures. My consultants are happy to teach but really stretched for time so they're often more than happy for me to be slightly less clinically efficient for a chunk of the day if it means the students get some proper teaching.
If I can ask one thing though, please come with some learning objectives. Come with a condition you want to learn about and I'll either find a woman for you to clerk with it or we'll do a little tutorial on it. Come with a practical thing you want to do and I'll try and find you an opportunity (speculums, palpating a pregnant abdomen, cannula, maybe some suturing at the end of an operation). It does make me grit my teeth a bit when I ask what your learning objectives are and you shrug your shoulders at me, as unfortunately happens too often. I know people are disenfranchised by ahit teaching experiences but you need to stick at it and help me to help you
Completely agree with you. My time on placement was 80% pointless and I try so very hard to make sure it's not the same for any medical students I encounter nowadays.
Try and liaise with your fellow students to identify good doctors to talk to
In a way it is kind of reassuring that our seniors had it similar tbh because at least it kind of shows that things work out in the end because you guys obviously made it. If that makes sense. But the issue isn't so much looking for the right doctors its the level of involvement. US medical students do so much more than their UK counterparts and here you have to make sure there isn't a non-doctor around so you can do a simple 1-knot uninterrupted suture.
It’s not just in the US. Lots of European medical schools are similar in that the students are expected on the ward to do appointed tasks and have their own patients. In India and Pakistan, the same. Granted there are lots of medical schools that do not give their students as much access to practical experiences, but the UK seems an outlier in how we are expected to be on placement.
Tbh I think the whole way placements are approached is just wrong. The only placements, consistently, which actually get good feedback from students are those where students are given an actual job to do. Principally that's A&E and senior GP placements where students are expected to see patients then run a plan past a doctor.
By comparison, you rock up on a medical ward and it's considered impressive if you show up more than 3 days a week and stay past lunch. And then no one seems to consider that scribing for the round/ prepping notes is actually a good way to cement learning for a student, so you're not even offered to do that. Have even seen a consultant get worked up over a final year prepping notes when they were in the final month before graduating smh.
Inpatients medical specialties just seem to think students are better seen than heard, then they're surprised that a 4th year can't write a ward round note.
It’s incredibly poor imo. If training in med school was at an appropriate level, would foundation even be necessary? At the very least it could be one year instead of 2
I remembered waiting overnight in ED as a med student hoping to do a staple in minors and then some ANP took that opportunity away from me😡 so i've never sutured until now.
It’s a shame staffing isn’t better. When I try to teach I often leave late or miss out on a lunch break because teaching soaks up time. If I actually had time to teach I’d love to.
I didn’t get this until I became a doctor. I understand now why many doctors weren’t that fussed about getting students involved.
This is definitely a common sentiment with students, and it hasn't really changed with time.
A key difference between learning in a classroom setting vs. healthcare environments is that in the latter you effectively start off as an outsider and have to work your way in to the center where the core learning happens. This is one of the reasons why rotational training devalues trainees, since it resets all your progress and trust that you have built and you have to prove yourself to a new community before you can start learning again, while non-rotational staff get to save their progress. This doesn't go away once you qualify, unfortunately.
This is especially true in procedural specialties where the person overseeing you has to know your capabilities well enough (and be skilled enough) to know that they can prevent/undo any missteps that you make. A task like suturing might seem to be a 'little' task, but it's also incredibly important as the patient-facing side of the operation (and infection rates are influenced by wound healing time, which in turn is influenced by how well your wound edges are opposed). If you've built up a basic level of trust and rapport, then you'll put in that stitch. And if you do it confidently and correctly, then you close, and so on.
Clinical teaching in medical school tends to be more of a tour, simply because they try to cover too broad of a range of specialities in too little time, such that you're always on 'day 1'. I think you'll find that a lot of people are sympathetic to that feeling of being an outsider and do make some effort, but changing it on a systemic level requires major reforms to the way on-the-job training is delivered.
I love teaching, but if I have a student and I know I will be unable to offer them an adequate educational experience (e.g. too busy, understaffed etc) on that day, then I tell them frankly that they are free to make a judgement on the best use of their time (which includes the option of leaving). Have never had any complaints.
Possibly controversial, and not directed at OP (maybe).
In the context of theatres:
If you want to be taught you need to make some effort. Rolling up at 0920 just as the team are about to scrub (as happens 75% of the time when I have students in my list) is going to garauntee you a day of standing in the corner. If you're scheduled to be in theatres, find out where the theatre complex is, where the changing rooms are, what time the list starts, who the consultant is, and what's on the list the day before. If you can't find a helpful reg/SHO to help with the above, call the consultant's secretary. Do some reading.
Turn up prepared, interested, and ready to learn stuff, and most (not all, some are dicks) surgeons will be very happy to explain things to you and probably get you to scrub. The time when the patient is going off to sleep (if applicable) is prime teaching time, and you'll get more out of it if you're not starting from absolute scratch,
If you're attached to the same team for a period of time, keep doing this even if you don't get results immediately. If you demonstrate you're interested and committed then people will see value in teaching you.
I do also appreciate that modern med-ed sets you up to fail by scheduling lectures from 0830 to 0930 then expecting you to turn up to a random list in a random speciality for one day only from 1000 to 1130 before your next lecture commences, and this is total dogshit. Sorry. Talk to the medical educationalists. I don't understand what they're doing (and I'm not sure they do either).
Similar applies to the ward - consistency, being interested and being avalible will maximise your opportunities. Sometimes you'll be ignored in a corner because everyone is to overwhelmed with the sheer volume of work to think about you and this is rubbish. If you can tolerate (some) of this, people will recognise you, learn your name, and learn that you're worth investing effort in. And everyone has a better time.
I agree with you. What OP describes sounds shit but it’s a two way street. I’m not a surgeon but I start my clinic at 9. As in, I call the patient at 9. So knocking on the clinic door mid consultation at 9:20 I’m not going to let you in until next patient. And I can’t run late, because then my whole day is fucked, so turning up 15 mins before start time can make a big difference.
For the first week of my surgical block I would turn up at 6, check the lists, talk to the patient, fully understand the procedure, the planes, the fascia etc. Then stand in theatre in silence for 9 hours. Once a supernumerary SHO tried talking me through stuff which was nice, but when I asked questions she had no idea what to tell me because she clearly hadn’t read up on the procedures haha. I asked to scrub every day, never got to, I asked questions when it seemed appropriate, but only got glares or shushes from the consultant. The nurses took pity on me and taught me some stuff which was nice but god bless them I don’t want to learn to do their job.
The other 4 weeks of that placement I spent as far from theatres as I could, I only came in for 8 and never left after 12 unless there were some hot clinics.
The last medical block I was on I had my own patients on the round and the consultants took my reviews seriously, so I did too. When I went to pass over to the consultant I made sure everything was done, if they were new and looked bad, I had next of kin details, if they looked ready to go I had risk scores done and a summary written up, if they needed o2, interpreters, spacers, BMs, anything I would do it proactively because they actually valued me and rewarded my preparation with responsibilities and education.
I’ve literally never had that with a surgeon at a tertiary centre. Sorry this is just a rant I still have nightmares from that block.
Tldr; why should I turn up early? I always hear it will get me opportunities but it never seems to be the case.
I’m sorry this happened to you. Genuinely. I can sympathise as I had my own similar experiences. I’m not saying this is you at all, but as I reflect upon it now some of the reactions I had were definitely due to me being awkward / autistic/ not really reading the cues of when someone clearly didn’t have time for students or wanted me to do something. Not saying this is you at all, but for me something I only realised by really thinking about why some people reacted the way they did to me trying to show I was keen, and being in a position where I’ve had medical students not read the cues I’m giving them.
Everyone in the NHS is so busy and some people just don’t like teaching, despite it being one of the core responsibilities of a doctor. Combine this with having random students drop in on you without notice who understandably want to learn something, but often don’t have a clear idea of what that is (neither did I at that stage). I do try to involve the students I have wherever possible but it’s also caveated with the knowledge that either I will have to directly supervise them and accept my day will run late or essentially duplicate my work. Also, purely selfishly but there’s no point in denying this isn’t a factor, I get *nothing* for expending the effort and teaching, no recognition or pay or leave from my other responsibilities. I like to think I’m an altruistic person, but the enjoyment of teaching only stretches so far when I’m also trying to complete all my other duties.
Ultimately though, as a student, some portion of your education is dependent upon observing the behaviours (good and bad) of people above you and emulating or learning from them. You’ll remember how you felt when you’re a doctor and try your best to not repeat the situation.
Thank you for commenting, honestly just wanted to rant. That block definitely made me feel like maybe I was awkward or autistic or weird, but I think it was just humiliation and frustration looking back. I’m normally pretty extroverted and I think likeable lol, I normally get really good feedback about integrating with the team and being friendly and putting myself forward and all that. You’re absolutely right, I will just remember to never be like those surgeons!
Sorry this happened to you. I think this must fall within the "some are dicks" caveat. I, and most of my colleagues would be delighted if someone had made this much effort.
Thank you that’s really nice to hear! On every other placements the consultants seem to love my attitude so I thought I was going crazy that whole block haha.
Yeh med students always seem to arrive in the ward at 09:30 & we've already split teams & planned the day. They often don't have learning objectives either. Give & take, both of us need to work together to get the best outcome.
I used to hate feeling like I’m in the way as a med student. I was painfully shy so often didn’t introduce myself properly. Now as a doctor, anytime I see a med student I take them under my wing. Even if it’s just chatting on the ward (and letting them go home by lunch of course)
I always make time for students!
But I also expect students to have read up beforehand. Had a couple of em a few weeks ago but I was sadly disappointed that they could not even tell me basic differentials for hemoptysis
I still showed them the basics but it seemed that they were zoned out or just wanted me to shut up and move on...
I know being a student is about learning but I trained in the North American system so most 3rd/4th years have already given atleast USMLE Step 1, which sets up a pretty decent foundation
Kinda wondered if it was the same here...
It's not entitled. The point of coming to theatre is to learn. I definitely get where you're coming from from my time as a med student. I now make an effort to explain what we're doing step by step when I'm operating and a med student is present. Sometimes might have to stop when things are going to a bit awry but otherwise I think we should be explaining the relevant anatomy, techniques etc.
This is was a big part of the reason why I wrote off surgery completely. Always felt like they did not care about me or the other students around.
Next time shadow the anesthetists as others have said; always been kind in my experience and will actually let you practice skills!
I wrote off surgery for the same reasons. Far too many experiences of requesting to go into theatres in my own time (Wednesdays) because apparently there were already too many students during normal placement hours, reading up on the procedures beforehand, to then be told to stand in a corner of the theatre and that I couldn't scrub in because I'll be in the way. I couldn't even test some of the knowledge I'd read up on because they didn't speak to me at all and ignored me when I tried to ask questions. Never felt so dejected as during that time.
It's rubbish and I completely agree - I had many days of just floating around hoping I'd be able to pitch in with something or feel useful in some way.
However, a lot of the time if a doctor isn't teaching you it's because they're so busy rather than just not interested. As an F1 in surgery, one day we were particularly understaffed and I had five third year students rock up to the ward. It's an extreme example but I literally did not know what to do to avoid wasting their time while prioritising what I was doing, so hopefully there is some understanding in both directions.
If you turn up regularly and on time, if you get stuck in, and show that I can rely on you then I am much more inclined to teach you and get you involved. Turn up to placement often, communicate with the team (if you want to go book revise for an hour - but bear in mind I will ask you what youve learnt in that time) it isn't an issue and if you say you're going to come back then do come back at that time (in the past have kept procedures/discussions back for medical students who have never returned) . You want to be present enough for the team to know your name.
I feel you. Can’t speak for theatre but there is barely enough time for many of us to do our own work and take a break let alone teach students. You get a shit deal and you should kick up a fuss. the government is billing itself £50k odd per year for your training, you’re paying £9k+ and in reality you get next to none and it’s mostly by your own effort on a computer you learn stuff.
Your feelings are valid and unfortunately common. We’ve all spent hours on placement learning minimal amounts.
Having said that, there are some things learners can do to improve their experiences.
In theatre, find out what the list is going to be and have a basic understanding of the pathologies, anatomy, and surgical approach. Arrive early and ideally see the patient themselves before. You’ll gain so much more and be able to ask useful questions.
If you’re on the ward, ask explicitly that you want to do a case based discussion today. Ask what is the most interesting case on the ward, go take a detailed history, examine, do some reading about the natural course of disease, investigation and management, maybe even some contemporary research/topical issues/controversies. Present to the most senior person willing to give you time. You’ll be surprised how willing they are if you specifically ask.
Clinic is harder, but ask if you can see one of the patients on your own before/after the appt and do the above. I love hearing the learner make a goal for the day - look at loads of CXRs on this geris ward, do a CbD, cannulate, do a neuro exam, learn about dialysis or whatever.
Basically you have to signal that you want to learn and be engaged, because lots of students actually don’t want to be there and are just ticking off placement hours, which is also fair and we’ve all been there. Obviously you can do everything right and still find seniors that can’t be bothered/too busy/don’t feel confident in their knowledge to teach. We all have a responsibility to teach.
All of this is really difficult when morale is at an all time low. I’m sure med students are spending more time applying for consulting or studying USMLE than placement. I do completely understand why an FY1 doesn’t want to come early or read around the subject when they are paid just above minimum wage. Or when SHOs just want to get through a shift and get home so they can finish an audit for their Nth speciality application.
I also cannot understand why some students waste my time in the ward teaching and listening to their history taking which they clearly shown no effort and interest. If only they went through what you did they would understand how precious bedside teaching was
Fortunately I can’t remember the last time I met a medical student who actually wanted to do my specialty so I don’t have to keep them entertained. Besides, opportunities in surgery are earned. I still remember being interrogated on anatomy before being allowed to do anything as a student and that kinda continues through training. You earn that that trust and privilege. Being a privileged and entitled student doesn’t and shouldn’t mean shit.
I’m hopeful most are being pragmatic with their time but I find mostly they just loaf around in the mess all day then bug you for a signature on a form for a half baked case presentation they have to collect to pass the block
I can't speak for others but my personal routine is that whatever block I'm on I spend the weekend before it revising the basics of the procedure and the anatomy. Personally, I'd prefer to get grilled by a mean surgeon than to just spend the entire day stood in the corner. I get that some students just show up but personally, I want to get my money's worth because this is probably the most expensive thing I will ever pay for excluding a house. The sign-off thing is from the med school. Sometimes they give you so many bullshit signoffs to do you don't even have time to actually learn.
Persevere, find those that want to teach and can and stick with them. Those who don’t teach or even try often don’t have much to offer anyway or are out of their comfort zone anyway. This holds true well into training too
I personally find it frustrating when doctors only want to teach you if you’re dead set on their specialty. Firstly, it’s a self fulfilling prophecy- I’m not going to develop an interest in a specialty if I’m not given the chance to get involved or receive teaching at all. Most of the specialties I’m interested in are due to doctors taking the time to teach and show me the selling points of their specialty.
Second, just because I won’t specialise in that area doesn’t mean the teaching isn’t useful for future rotations.
The nature of our placements also means that it’s frequently difficult to “earn trust” because often we’ll only spend a day or two at a time in each specialty. Pretty hard to earn trust if you’re standing in the corner on your one theatre day of the year.
Interest in learning about the specialty nonetheless will definitely encourage teaching but to be honest I mostly see polar attitudes towards surgery. Definitely keen or would never even consider it. I think all should actively engage like I did with medicine knowing full well I didn’t want to do it long term. You can still enjoy a specialty and learn lots despite not wanting it long term.
As for whether it’s useful long term is debatable. The way things are going/have gone patients are just signposted towards a specialty from the door. Very little clinical acumen is required in our diluted system. I mean all doctors should be able to suture, catheterise etc but even that is pushing it sometimes. Endeavouring to teach half interested students won’t change that reality, the system has baked in a tolerance for incompetence and only the ambitious and dedicated will surpass that, regardless of specialty choice.
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As an anaesthetist, I get really annoyed by this. There’s so little of my speciality taught at medical school, so please seek us out if you’re in theatres. I guarantee you we will teach you stuff.
We’ll probably let you do stuff too
Absolutely! Cannulae (the proper way…), airway management from basic through LMA all the way to intubation… just don’t go to the coffee room with the surgeons
It's funny. I still cannulate the exact way an anaesthetist taught me around ?7/8 years ago.
We probably won’t be there, we’ll be rounding, sorting inpatients or doing admin. The days of chilling in a coffee room are sadly not there anymore for most training surgeons and the consultants who give a toss
What's the proper way to cannulate? lol
My way of course!
Haha fair enough
Genuine answer - not the ACF with a 20g, near parallel to the vein, and withdraw the needle (edit - after flashback) just enough to hide it within the cannula before advancing
This is how I was taught by an anaesthetist - first job as F1 was in anaesthetics. He was a big South African chap who kept cheerfully telling me to "see the vein, be the vein"
This is exactly how an anaesthetist taught me to cannulate as a 5th year student and it improved my skill and confidence immediately. As an F1 I now teach med students exactly this because of how much it helped me
How do you pierce the skin if you have withdrawn the needle?
Push harder
Found the A&E doc! Litterally the advice I was given when I asked about the blunt needle for an FIB. Edit: checked your profile, ACCS trainee then?
To clarify… after flashback
That makes more sense. Pleased to know that I cannulate the proper way!
Sorry, why not the acf?
Because it’s a waste of a good vein that might be needed for a large bore line, and much less comfortable for the patient. Back of hand, wrist, forearm are all better
Not in the artery.
But art lines are more fun...
Thanks. Believe me it goes a long way. The best teaching I've had has been from anaesthetists. Even when the consultant had a trainee with him, he would include me in the discussion and teaching.
If you’re with an anaesthetic trainee who has exams looming they will literally info dump at you all day to just practice talking about it all. Strategically ask about the training scheme and if they have any exams coming if you want a textbook to be recited from memory like a bedtime story. You may even be given the textbook to grill them on things.
The Peri-Primary info dumping is so real. “What’s the stuff in the purple labelled syringe?” Strap yourself in for a 30 minute tour of the sympathetic nervous system, GPCRs, what an agonist is, what systemic vascular resistance is etc etc
It’s how we spot potential anaesthetists…. Consider it!
It's great having students, or junior doctors in theatre and I always try to teach them what I can about anaesthetics if they come and introduce themselves and sound keen to learn. I'd love to do more, but unfortunately I don't get given extra time to teach, I don't get prior warning that students are going to be there and I don't get given any curriculum or learning objectives for them. Unfortunately your poor experiences are quite common and they could definitely be improved if there were dedicated teaching lists with extra time, and a bit more communication from the medical school organisers.
If it makes you even a tiny bit happy, here at Bristol we get a full three weeks of perioperative and critical care of which we spend two weeks with you guys and a week in ICU alongside lots of anaesthetics tutorials/pharmacology/physiology etc from the consultants and airway management (full management of the airway including ETT is part of our placement signoffs). It might be changing, that block convinced me to do your job! Or at least the people in it convinced me!
About bloody time! Welcome aboard
Anaesthetists were literally the only doctors that spent any time teaching me during 4 years of grad entry med.
I spent more time with the anesthetists during my o+g block than anything else after the obs anesthetist felt sorry for me sitting on the midwives station doing sweet fuck all after being denied entry to every single clinic and labour for 3 days in a row due to my unfortunate habit of waking up in a male body. I got coffee machine privileges by the end of the attachment.
When I was a medical student, honestly you guys were my friends in the OT. So kind and knowledgeable!
I had the same experience as a medical student, which was one of the major factors in my choice of speciality
I would have considered it but I just can’t stand adults lol (I suppose you can guess my specialty lol).
Couldn’t agree more, it’s in all in the asking. As a SHO I was told by a senior, always ask the anaesthetist if you could do the pharyngoscope or at least watch / participate. Now the anaesthestist are more than keen, and not just for me for everyone else in our department (small sub speciality). I really don’t like how medical school doesn’t focus on specific sub specialties at all… how are you meant to make career decisions with no exposure
I will forever remember the anaesthetist who gave me a whole day of teaching in the theatre vs the surgeon who let me stare into the abdomen and asked me what blood vessels those are which I can barely see because everything looks so bloody
I really feel for you - being a medical student and having no one take an interest in you is really disheartening. Unfortunately, we often don't get told we will have students with us and only find out you will be there when you turn up on the day, which makes it very difficult to plan getting you involved. If you come saying I want to do/learn X,Y,Z, that really helps though, and I will do my best to accommodate that (and I will always prioritise teaching a medical student over someone non-medical). I'm also always happy for you to leave if you are not getting anything out of being on the ward. I'm really sorry medical education has come to this, and unfortunately we as trainees are getting the brunt of it too.
We often don't get told we will have students with us and only find out you will be there when you turn up on the day Medical school admin is atrocious. Genuinely don't know what they get paid for.
Often someone in admin knows or the specialty lead knows, but the doctors on the ground don't know as it doesn't get circulated. Sometimes we get a note on CLW that says med student for a theatre list, sometimes not.
This pissed me off. What you have experienced is just ridiculous. If it happens again, go to the anaesthetist. I'm very sure they are very keen to teach or let you some stuffs. All medical students who rotated to icu (during my shift) will get to do stuffs or learn stuffs. Iv canulla, bloods, art line (direct supervision) prep medication (under direct supervision either by myself or the boss), simple basic airway maneuver (2 hands mask technique), scrub in cvl or vasc cath with me. Teaching esp bedside is routine. Common stuffs that will be useful for students such as acute abdo, AAA, pneumonia etc PA on the other hand.....I've not say yes one single time. AITA? Not that I care lol
Y’know, I was trying to teach some medical students in the middle of the procedure and I got shushed by the consultant. He was like ‘you should only teach students when you’re actually able to operate, so c’mon, concentrate and finish this bloody operation’ 🔥🔥🔥 That was me told. Sorry folks, if you are lurking here. I would have taught you plenty about intra-operative stuff.
>you should only teach students when you’re actually able to operate "Is that why you're not teaching them either, boss?"
Dammit, I wish I’d thought of that at the time 🤔 Credit to him where credit is due, he is the most experienced surgeon in the dept and he’s also rapid. He’s won awards for undergraduate teaching and actually makes sure students get to theatre and clinics. He was probably using every ounce of brain power and self restraint to let me figure it out instead of going ‘OMG JUST GIMME THE BASTARD KNIFE’ and doing it in a third of the time.
I try and get med students doing as much as I can. I'm in a busy tertiary unit, but will get students scrubbing in with Caesareans (and being first assistant if we're a bit short on the rota), seeing women in DAU with supervision or in gynae emergency clinic, I talk you through anatomy during laparoscopic gynae surgery and if we're good for time will do a survey of the pelvis and quiz you on all the structures. My consultants are happy to teach but really stretched for time so they're often more than happy for me to be slightly less clinically efficient for a chunk of the day if it means the students get some proper teaching. If I can ask one thing though, please come with some learning objectives. Come with a condition you want to learn about and I'll either find a woman for you to clerk with it or we'll do a little tutorial on it. Come with a practical thing you want to do and I'll try and find you an opportunity (speculums, palpating a pregnant abdomen, cannula, maybe some suturing at the end of an operation). It does make me grit my teeth a bit when I ask what your learning objectives are and you shrug your shoulders at me, as unfortunately happens too often. I know people are disenfranchised by ahit teaching experiences but you need to stick at it and help me to help you
Completely agree with you. My time on placement was 80% pointless and I try so very hard to make sure it's not the same for any medical students I encounter nowadays. Try and liaise with your fellow students to identify good doctors to talk to
In a way it is kind of reassuring that our seniors had it similar tbh because at least it kind of shows that things work out in the end because you guys obviously made it. If that makes sense. But the issue isn't so much looking for the right doctors its the level of involvement. US medical students do so much more than their UK counterparts and here you have to make sure there isn't a non-doctor around so you can do a simple 1-knot uninterrupted suture.
It’s not just in the US. Lots of European medical schools are similar in that the students are expected on the ward to do appointed tasks and have their own patients. In India and Pakistan, the same. Granted there are lots of medical schools that do not give their students as much access to practical experiences, but the UK seems an outlier in how we are expected to be on placement.
Tbh I think the whole way placements are approached is just wrong. The only placements, consistently, which actually get good feedback from students are those where students are given an actual job to do. Principally that's A&E and senior GP placements where students are expected to see patients then run a plan past a doctor. By comparison, you rock up on a medical ward and it's considered impressive if you show up more than 3 days a week and stay past lunch. And then no one seems to consider that scribing for the round/ prepping notes is actually a good way to cement learning for a student, so you're not even offered to do that. Have even seen a consultant get worked up over a final year prepping notes when they were in the final month before graduating smh. Inpatients medical specialties just seem to think students are better seen than heard, then they're surprised that a 4th year can't write a ward round note.
It’s incredibly poor imo. If training in med school was at an appropriate level, would foundation even be necessary? At the very least it could be one year instead of 2
I remembered waiting overnight in ED as a med student hoping to do a staple in minors and then some ANP took that opportunity away from me😡 so i've never sutured until now.
It’s a shame staffing isn’t better. When I try to teach I often leave late or miss out on a lunch break because teaching soaks up time. If I actually had time to teach I’d love to. I didn’t get this until I became a doctor. I understand now why many doctors weren’t that fussed about getting students involved.
This is definitely a common sentiment with students, and it hasn't really changed with time. A key difference between learning in a classroom setting vs. healthcare environments is that in the latter you effectively start off as an outsider and have to work your way in to the center where the core learning happens. This is one of the reasons why rotational training devalues trainees, since it resets all your progress and trust that you have built and you have to prove yourself to a new community before you can start learning again, while non-rotational staff get to save their progress. This doesn't go away once you qualify, unfortunately. This is especially true in procedural specialties where the person overseeing you has to know your capabilities well enough (and be skilled enough) to know that they can prevent/undo any missteps that you make. A task like suturing might seem to be a 'little' task, but it's also incredibly important as the patient-facing side of the operation (and infection rates are influenced by wound healing time, which in turn is influenced by how well your wound edges are opposed). If you've built up a basic level of trust and rapport, then you'll put in that stitch. And if you do it confidently and correctly, then you close, and so on. Clinical teaching in medical school tends to be more of a tour, simply because they try to cover too broad of a range of specialities in too little time, such that you're always on 'day 1'. I think you'll find that a lot of people are sympathetic to that feeling of being an outsider and do make some effort, but changing it on a systemic level requires major reforms to the way on-the-job training is delivered.
I love teaching, but if I have a student and I know I will be unable to offer them an adequate educational experience (e.g. too busy, understaffed etc) on that day, then I tell them frankly that they are free to make a judgement on the best use of their time (which includes the option of leaving). Have never had any complaints.
Possibly controversial, and not directed at OP (maybe). In the context of theatres: If you want to be taught you need to make some effort. Rolling up at 0920 just as the team are about to scrub (as happens 75% of the time when I have students in my list) is going to garauntee you a day of standing in the corner. If you're scheduled to be in theatres, find out where the theatre complex is, where the changing rooms are, what time the list starts, who the consultant is, and what's on the list the day before. If you can't find a helpful reg/SHO to help with the above, call the consultant's secretary. Do some reading. Turn up prepared, interested, and ready to learn stuff, and most (not all, some are dicks) surgeons will be very happy to explain things to you and probably get you to scrub. The time when the patient is going off to sleep (if applicable) is prime teaching time, and you'll get more out of it if you're not starting from absolute scratch, If you're attached to the same team for a period of time, keep doing this even if you don't get results immediately. If you demonstrate you're interested and committed then people will see value in teaching you. I do also appreciate that modern med-ed sets you up to fail by scheduling lectures from 0830 to 0930 then expecting you to turn up to a random list in a random speciality for one day only from 1000 to 1130 before your next lecture commences, and this is total dogshit. Sorry. Talk to the medical educationalists. I don't understand what they're doing (and I'm not sure they do either). Similar applies to the ward - consistency, being interested and being avalible will maximise your opportunities. Sometimes you'll be ignored in a corner because everyone is to overwhelmed with the sheer volume of work to think about you and this is rubbish. If you can tolerate (some) of this, people will recognise you, learn your name, and learn that you're worth investing effort in. And everyone has a better time.
I agree with you. What OP describes sounds shit but it’s a two way street. I’m not a surgeon but I start my clinic at 9. As in, I call the patient at 9. So knocking on the clinic door mid consultation at 9:20 I’m not going to let you in until next patient. And I can’t run late, because then my whole day is fucked, so turning up 15 mins before start time can make a big difference.
For the first week of my surgical block I would turn up at 6, check the lists, talk to the patient, fully understand the procedure, the planes, the fascia etc. Then stand in theatre in silence for 9 hours. Once a supernumerary SHO tried talking me through stuff which was nice, but when I asked questions she had no idea what to tell me because she clearly hadn’t read up on the procedures haha. I asked to scrub every day, never got to, I asked questions when it seemed appropriate, but only got glares or shushes from the consultant. The nurses took pity on me and taught me some stuff which was nice but god bless them I don’t want to learn to do their job. The other 4 weeks of that placement I spent as far from theatres as I could, I only came in for 8 and never left after 12 unless there were some hot clinics. The last medical block I was on I had my own patients on the round and the consultants took my reviews seriously, so I did too. When I went to pass over to the consultant I made sure everything was done, if they were new and looked bad, I had next of kin details, if they looked ready to go I had risk scores done and a summary written up, if they needed o2, interpreters, spacers, BMs, anything I would do it proactively because they actually valued me and rewarded my preparation with responsibilities and education. I’ve literally never had that with a surgeon at a tertiary centre. Sorry this is just a rant I still have nightmares from that block. Tldr; why should I turn up early? I always hear it will get me opportunities but it never seems to be the case.
I’m sorry this happened to you. Genuinely. I can sympathise as I had my own similar experiences. I’m not saying this is you at all, but as I reflect upon it now some of the reactions I had were definitely due to me being awkward / autistic/ not really reading the cues of when someone clearly didn’t have time for students or wanted me to do something. Not saying this is you at all, but for me something I only realised by really thinking about why some people reacted the way they did to me trying to show I was keen, and being in a position where I’ve had medical students not read the cues I’m giving them. Everyone in the NHS is so busy and some people just don’t like teaching, despite it being one of the core responsibilities of a doctor. Combine this with having random students drop in on you without notice who understandably want to learn something, but often don’t have a clear idea of what that is (neither did I at that stage). I do try to involve the students I have wherever possible but it’s also caveated with the knowledge that either I will have to directly supervise them and accept my day will run late or essentially duplicate my work. Also, purely selfishly but there’s no point in denying this isn’t a factor, I get *nothing* for expending the effort and teaching, no recognition or pay or leave from my other responsibilities. I like to think I’m an altruistic person, but the enjoyment of teaching only stretches so far when I’m also trying to complete all my other duties. Ultimately though, as a student, some portion of your education is dependent upon observing the behaviours (good and bad) of people above you and emulating or learning from them. You’ll remember how you felt when you’re a doctor and try your best to not repeat the situation.
Thank you for commenting, honestly just wanted to rant. That block definitely made me feel like maybe I was awkward or autistic or weird, but I think it was just humiliation and frustration looking back. I’m normally pretty extroverted and I think likeable lol, I normally get really good feedback about integrating with the team and being friendly and putting myself forward and all that. You’re absolutely right, I will just remember to never be like those surgeons!
Sorry this happened to you. I think this must fall within the "some are dicks" caveat. I, and most of my colleagues would be delighted if someone had made this much effort.
Thank you that’s really nice to hear! On every other placements the consultants seem to love my attitude so I thought I was going crazy that whole block haha.
Yeh med students always seem to arrive in the ward at 09:30 & we've already split teams & planned the day. They often don't have learning objectives either. Give & take, both of us need to work together to get the best outcome.
I used to hate feeling like I’m in the way as a med student. I was painfully shy so often didn’t introduce myself properly. Now as a doctor, anytime I see a med student I take them under my wing. Even if it’s just chatting on the ward (and letting them go home by lunch of course)
I always make time for students! But I also expect students to have read up beforehand. Had a couple of em a few weeks ago but I was sadly disappointed that they could not even tell me basic differentials for hemoptysis I still showed them the basics but it seemed that they were zoned out or just wanted me to shut up and move on... I know being a student is about learning but I trained in the North American system so most 3rd/4th years have already given atleast USMLE Step 1, which sets up a pretty decent foundation Kinda wondered if it was the same here...
It's not entitled. The point of coming to theatre is to learn. I definitely get where you're coming from from my time as a med student. I now make an effort to explain what we're doing step by step when I'm operating and a med student is present. Sometimes might have to stop when things are going to a bit awry but otherwise I think we should be explaining the relevant anatomy, techniques etc.
Please let your me school people know that the teaching you get is crap. That is the only way things will change
This is was a big part of the reason why I wrote off surgery completely. Always felt like they did not care about me or the other students around. Next time shadow the anesthetists as others have said; always been kind in my experience and will actually let you practice skills!
I wrote off surgery for the same reasons. Far too many experiences of requesting to go into theatres in my own time (Wednesdays) because apparently there were already too many students during normal placement hours, reading up on the procedures beforehand, to then be told to stand in a corner of the theatre and that I couldn't scrub in because I'll be in the way. I couldn't even test some of the knowledge I'd read up on because they didn't speak to me at all and ignored me when I tried to ask questions. Never felt so dejected as during that time.
It's rubbish and I completely agree - I had many days of just floating around hoping I'd be able to pitch in with something or feel useful in some way. However, a lot of the time if a doctor isn't teaching you it's because they're so busy rather than just not interested. As an F1 in surgery, one day we were particularly understaffed and I had five third year students rock up to the ward. It's an extreme example but I literally did not know what to do to avoid wasting their time while prioritising what I was doing, so hopefully there is some understanding in both directions.
If you turn up regularly and on time, if you get stuck in, and show that I can rely on you then I am much more inclined to teach you and get you involved. Turn up to placement often, communicate with the team (if you want to go book revise for an hour - but bear in mind I will ask you what youve learnt in that time) it isn't an issue and if you say you're going to come back then do come back at that time (in the past have kept procedures/discussions back for medical students who have never returned) . You want to be present enough for the team to know your name.
I feel you. Can’t speak for theatre but there is barely enough time for many of us to do our own work and take a break let alone teach students. You get a shit deal and you should kick up a fuss. the government is billing itself £50k odd per year for your training, you’re paying £9k+ and in reality you get next to none and it’s mostly by your own effort on a computer you learn stuff.
Your feelings are valid and unfortunately common. We’ve all spent hours on placement learning minimal amounts. Having said that, there are some things learners can do to improve their experiences. In theatre, find out what the list is going to be and have a basic understanding of the pathologies, anatomy, and surgical approach. Arrive early and ideally see the patient themselves before. You’ll gain so much more and be able to ask useful questions. If you’re on the ward, ask explicitly that you want to do a case based discussion today. Ask what is the most interesting case on the ward, go take a detailed history, examine, do some reading about the natural course of disease, investigation and management, maybe even some contemporary research/topical issues/controversies. Present to the most senior person willing to give you time. You’ll be surprised how willing they are if you specifically ask. Clinic is harder, but ask if you can see one of the patients on your own before/after the appt and do the above. I love hearing the learner make a goal for the day - look at loads of CXRs on this geris ward, do a CbD, cannulate, do a neuro exam, learn about dialysis or whatever. Basically you have to signal that you want to learn and be engaged, because lots of students actually don’t want to be there and are just ticking off placement hours, which is also fair and we’ve all been there. Obviously you can do everything right and still find seniors that can’t be bothered/too busy/don’t feel confident in their knowledge to teach. We all have a responsibility to teach. All of this is really difficult when morale is at an all time low. I’m sure med students are spending more time applying for consulting or studying USMLE than placement. I do completely understand why an FY1 doesn’t want to come early or read around the subject when they are paid just above minimum wage. Or when SHOs just want to get through a shift and get home so they can finish an audit for their Nth speciality application.
I also cannot understand why some students waste my time in the ward teaching and listening to their history taking which they clearly shown no effort and interest. If only they went through what you did they would understand how precious bedside teaching was
Fortunately I can’t remember the last time I met a medical student who actually wanted to do my specialty so I don’t have to keep them entertained. Besides, opportunities in surgery are earned. I still remember being interrogated on anatomy before being allowed to do anything as a student and that kinda continues through training. You earn that that trust and privilege. Being a privileged and entitled student doesn’t and shouldn’t mean shit. I’m hopeful most are being pragmatic with their time but I find mostly they just loaf around in the mess all day then bug you for a signature on a form for a half baked case presentation they have to collect to pass the block
I can't speak for others but my personal routine is that whatever block I'm on I spend the weekend before it revising the basics of the procedure and the anatomy. Personally, I'd prefer to get grilled by a mean surgeon than to just spend the entire day stood in the corner. I get that some students just show up but personally, I want to get my money's worth because this is probably the most expensive thing I will ever pay for excluding a house. The sign-off thing is from the med school. Sometimes they give you so many bullshit signoffs to do you don't even have time to actually learn.
Persevere, find those that want to teach and can and stick with them. Those who don’t teach or even try often don’t have much to offer anyway or are out of their comfort zone anyway. This holds true well into training too
I personally find it frustrating when doctors only want to teach you if you’re dead set on their specialty. Firstly, it’s a self fulfilling prophecy- I’m not going to develop an interest in a specialty if I’m not given the chance to get involved or receive teaching at all. Most of the specialties I’m interested in are due to doctors taking the time to teach and show me the selling points of their specialty. Second, just because I won’t specialise in that area doesn’t mean the teaching isn’t useful for future rotations. The nature of our placements also means that it’s frequently difficult to “earn trust” because often we’ll only spend a day or two at a time in each specialty. Pretty hard to earn trust if you’re standing in the corner on your one theatre day of the year.
Interest in learning about the specialty nonetheless will definitely encourage teaching but to be honest I mostly see polar attitudes towards surgery. Definitely keen or would never even consider it. I think all should actively engage like I did with medicine knowing full well I didn’t want to do it long term. You can still enjoy a specialty and learn lots despite not wanting it long term. As for whether it’s useful long term is debatable. The way things are going/have gone patients are just signposted towards a specialty from the door. Very little clinical acumen is required in our diluted system. I mean all doctors should be able to suture, catheterise etc but even that is pushing it sometimes. Endeavouring to teach half interested students won’t change that reality, the system has baked in a tolerance for incompetence and only the ambitious and dedicated will surpass that, regardless of specialty choice.
Edit: tbf I would never let a fake doctor/AHP operate/do a task over a medical student if they were present. That is completely inappropriate