I may type my anecdotes and impressions of my Clinical School so far in a disjointed manner.
I have just completed my 1st Block (Neurology/Ophthalmology/ENT) for Clinical School. In my previous entry regarding starting Clinical School, I said that the 2 weeks felt like it went for a really long time, perhaps due to the very stressful incident that occurred then (which I’m not allowed to further discuss for legal reasons), which seemed to slow down my perception of time, like undergoing massive Adrenaline rushes for several days or being under the influence of Cannabis. On the contrary, the remaining weeks of this block seemed to pass by rather quickly, and I’m feeling both stressed out and slightly relieved about it.
A Criticism of my Clinical School (--> Relatively Insufficient Patient Contact)
My impression is that each Block isn’t long enough, and that 6 weeks is definitely not enough time to see enough patients and learn the knowledge required to pass exams unless you spend the vast majority of your spare time outside Clinical School exhaustively studying and reviewing notes as compensation. This issue is exacerbated by the idiosyncrasies of my Clinical School, of which I was initially impressed by, but subsequently partially disappointed. It was supposedly the most didactic of all Clinical Schools (for Melbourne Uni MBBS), but it’s didactic in the “wrong” style.
For further explanation of being didactic in the “wrong” style, I mean that there’s technically more structure as there are more planned tutes and lectures throughout the week, but many of them are for topics that aren’t directly relevant to my current Block. While it’s true that many aspects of medicine crossover into each other (eg Pneumonia involves both Respiratory System and Infectious Diseases), the topics that are discussed are hard for me to apply on in terms of student-patient interactions, and don’t particularly benefit me in understanding the topics of my current block, ie “adding extra food to my plate” when I’m already overloaded with other stuff to learn.
For example, on Monday 7:30 AM, we always have a lecture relating to Orthopaedics and how different arm and leg fractures occur, and how it gets managed. Sure, this lecture would be beneficial to the students who are doing their Orthopaedics Block, but it’s not very helpful for students outside of that Block, and furthermore it’s even less helpful when they don’t even provide any preliminary anatomy lectures so everyone could at least have a general idea of what is going on. I think it’s asking too much of the medical students (outside of Orthopaedics Block) to study bone/joint/muscle anatomy when they’re really busy studying other things. I don’t gain much out of these lectures as I haven’t done the preparation beforehand, and I hate waking up really early to go to it (yes, lectures are compulsory to attend at my Clinical School). IMO they should only make the lecture compulsory for the students doing Orthopaedics, and only make “irrelevant lectures” compulsory for everyone if the medical condition is very common among Australian patients, eg Type II Diabetes.
Now, consider this and add in the following factors that are/aren’t intrinsic to my Clinical Hospital:
- “Irrelevant lectures” x 5 /week
- 1 or 2 “wishy-washy” tutes / week (ESPECIALLY the Empathic Practice ones which isn’t being examined on and doesn’t didactically teach polite bedside manners / professional etiquette)
- Often being unable to speak to a patient and/or do physical exams on them coz they just happen to be sleeping/with relatives or other doctors/away to undergo extra investigations/tired of speaking to medical students.
- Lectures/tutes/clinical visits often running overtime and being placed and spaced out on the timetable in an inconvenient fashion, occupying the “best times” to speak to a patient, and you often don’t have enough time in between to sufficiently interview them, if you even manage to get one in the first place.
- A curfew in which you’re not supposed to stay at the hospital after 6:30 PM (absolute latest) on weekdays, and not allowed to visit the hospital on the weekends or during holidays if you wanted extra patient contact. I understand that many patients are tired and want to rest on the weekend, but isn’t it possible to at least allow a 3 hour time-slot for students who want to visit the hospital on Saturday/Sunday as compensation for reduced spare time during weekdays? I didn’t think it’d be too overwhelming.
All of this results in SIGNIFICANTLY REDUCED OPPORTUNITIES FOR PATIENT CONTACT (COMPARED TO OTHER CLINICAL SCHOOLS) given the unpredictability of the ward setting and the nature of the patients, and is extra frustrating coz I’m compelled to go to lectures and tutes that don’t benefit me directly when I could be using that time to be in the library reading relevant books, or on the wards seeking/speaking to patients. Typically due to the circumstances, there are about 2 weekdays/week in which I don't speak to any patients at all. It feels a bit disorganized, and I feel like I’m being restrained, and I feel further anxiety and “injustice” due to the fact that we are required to log in a minimum amount of “long case quality” patient data by the end of Semester 9 but they didn’t provide a conducive environment for conveniently doing so .
It has reached the extent, where I feel like I need to spend every bit of spare time scavenging for the “good patients” who aren’t confused, have English as a 1st language, aren’t sleeping or away for investigations, and are willing to talk to medical students. The number of “good patients” on the ward (out of around 30 Neuro patients) vary each week due to patients being admitted into the ward and being discharged later on, but there’s this drive in me to want to be the earliest student to speak to them for fear of them being “sick of speaking” to medical students later on. I apologize for my behaviour which may be perceived to be selfish and even “gunner-ish”, but I’ve noticed that if I don’t be proactive to a degree, the patients will just be “taken” by other medical students and it’ll be harder for me to get a suitable patient to speak to so I have good data to log in. It also doesn’t help that the total [students : ward patients] ratio is around [10 - 18 : 30] , which means that saturation of the “good patients” occurs pretty quickly during each week.
It feels like there’s an extra competition not directly mentioned by the Clinical staff, where you have to “fight” to get “good patients” to speak to. The closest game analogy I can make to this is MUSICAL CHAIRS but with some basic rule variations:
- The music “plays” when everyone doing a certain Block is in a lecture/tute (compulsory).
- The music “stops” when there’s spare time so students can go onto the wards to seek/speak to patients.
- The chairs in one pile represent the “total” amount of willingness/tolerance that a patient has to speaking to medical students. This can range from 0 chairs for patients that are confused/in a coma, to perhaps 10 for patients that happen to be very chatty and in a good/optimistic mood (despite their medical condition).
- Students may work in pairs/triplets and speak to a patient while the other (1 or 2) student/s listen and write notes on what the patient is saying. Once a single chair is occupied (via student/s interviewing a patient), no other chairs may be occupied during that time.
- After a "significantly long" conversation with a patient has been completed, remove 1 chair. If several physical exams and systems reviews have been conducted, remove another chair.
- Total number of chairs may be replenished or reduced overnight depending on the progression of patient’s medical condition, and how much undisturbed time (by medical students) they have.
- Once number of chairs reach 0, patient is no longer accessible to students for conversations/physical exams.
- A “spare chair” for a specific patient as back-up may be provided for a medical student (even if main total is 0 chairs) if he previously engaged in a very engaging and enjoyable conversation with a patient and the patient thoroughly appreciated his company.
I have also created a few terms to describe the phenomena of this competition:
Stealing/Miss: When other medical students had conversations with a patient (especially a “good” one) and you were unable to speak to him because he has become “saturated” already.
Saturated/Depleted: When a patient has spoken to enough medical students up to his tolerated level, and can’t/no longer wishes to speak to any students anymore. Ie chairs --> 0.
Occupied: When a patient is currently being spoken to by a medical student, doctor, nurse etc.
Penetrating/"being popular": When a patient is being seen by multiple medical students throughout most/all spare time during the day. In most patients, their chairs would’ve decreased a lot by evening. "Penetrating" supposedly has an alternative meaning, so I would use "being popular" in public.
Quickie/Mini: A short conversation with a patient, lasting around 15 minutes or less, just to get a basic idea of his history of presenting complaint. A Quickie/Mini minimizes the chances of the conversation being considered “significantly long”, and thus minimizes the chances of 1 chair being deducted.The term "Quickie" has another meaning, so I tend to use "Mini" in public.
Kara (空): Empty, mainly in reference to an empty bed (ie patient isn’t there).
Ikki (一気): In one go, mainly in reference to having a long conversation with a patient covering the presenting complaint and general medical history, along with performing 1 or 2 physical exams with their consent.
Renzoku (連続): Continuous, mainly in reference to searching for a suitable patient to speak to, moving in a consecutive order around the ward.
Tenpai (聴牌): “Fishing”, when you conduct a significantly long conversation with a patient, and perhaps performing 1 physical exam as well, but you’re still missing out on a few medical details (that you forgot to ask or the patient doesn't remember), ie a small step away from having sufficient amount of patient data to log in.
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