Clinical Rotations: Expectations vs Reality
Published on Jul 19, 2021. Updated on Jul 19, 2021.
Most pre-clinical students have a familiar yet foreign idea of how a hospital works. In this blog, Kieren talks through what he expected going into a hospital for the first time and how this matched with what actually happened during his first week.
The ideas and expectations of what actually happens in a hospital are largely shaped by medical dramas and what other people tell you. What we see and what we’re told are both daunting and exciting. Is the hierarchy really that prevalent? Are bullying and pimping as common as I think? Is there a team of McDreamys floating around or are most people like JD and Turk?
I am a 2nd-year medical student about to head into the hospital for the first time. My first rotation is with the surgical team, a close interest of mine. I am very eager to see and learn, but I'm also worried about being useful, whether or not I’ll be a nuisance, or that I will just plain embarrass myself. I am going to document my expectations prior to starting and provide a day-by-day blow of my experience in the first week of a hospital.
- I will be very lost: The layout of the hospital is confusing and I have no idea where to go. The only thing I have been told is to go to C6 West (how do I get to C6 west?) and find the resident (how do I do that?).
- There will be a hierarchy: I have prepared to be at the bottom of the food chain and to be of very little use to anyone on the team. I predict that any individual at the top of the pecking order will have very little time for those below them and that it is expected that all juniors show respect and speak when spoken to.
- Surgery will be organized chaos with an etiquette I have no idea about: I have assumed that operating theatres will be well set out with everything in place except for me. I also have no idea what to do with my hands or what I can touch.
Reality, Day One: Getting lost and Introductions
I was right—I had no idea where I was going and ended up on the wrong ward asking for my team. At least I gave that nurse something to laugh about. After finally finding the right place (only 35 minutes late!) I was able to locate the team with the assistance of another friendly nurse. I very quickly learnt that nurses truly are absolute gold and the perfect people to go to for assistance. My team was very friendly and happy to see me but introductions were short and brief because everyone had lots of pressing tasks that were a higher priority. (Called it.)
Throughout the day I learnt that it was important to stay out of the way when they were doing tasks and to keep myself busy when I wasn’t directly involved.
Hot tip - having an iPad with flashcards is an excellent tool to fill in time!
Day Two: Early ward rounds and my first surgery
I had been told that surgeons like to start their day early and that was completely true. Rounds started at 7 am sharp. I was prepared to move quickly to keep up with the team, but I totally underestimated it. 25 patients across 6 different wards seen in 48 minutes flat!
They absolutely flew, making me feel like a bug on a speeding car’s windscreen, trying to absorb information and write notes. Be sure to be prepared and have a method down pat on how to take brief notes.
I was fortunate enough to head to the theatre and observe a perianal abscess drainage and a laparoscopic cholecystectomy. The theatres looked exactly like you see on TV and the etiquette was very similar. Write your name on the board and make sure everybody in the room knows who you are and why you are there. Doesn’t mean they will stop to chat though. The scrub nurse watched me like a hawk, the surgeons didn’t acknowledge me and the anesthetists were very friendly. Due to the nature of each of their roles, I made sure not to touch anything, stand out of the way and speak only when spoken to.
I would recommend making friends with the nurses and anesthetics team because they are extremely friendly and helpful.
Day Three: How do I get someone to sign off my requirements?
I was still very much riding the wave of excitement and was absolutely loving the constant stimulation of seeing new and interesting things. However, I realized that I couldn’t keep immersing myself in just watching and that I had tasks that I needed to get signed off.
But, how do I approach pulling someone away from their pressing tasks to watch me perform tasks, give me feedback and sign me off?
My way in was to offer coffee in exchange for signatures and it worked! Coffee makes the hospital run and is a great way in with the interns and residents. Similarly, I had found myself spending long hours on placement which was compromising my theory study. It is important to inform your supervisors of the tasks you would like to complete for the day and what time you are aiming to leave by.
It also helps if you have a timetable of your tutorials so that they know why you aren’t on the wards / in theatre. I have slowly been developing the skill of informing the doctors that I am leaving to go study. It’s easier said than done.
Day Four: Missed my first venepuncture and the intern’s expectations of me
I went into the hospital with pretty low expectations of myself. I knew I had to fine-tune examinations, definitely didn’t have the clinical knowledge on how to appropriately interpret investigations and so much more.
That being said, it still stung when I missed my first venepuncture and later on the intern opened up to me saying that she expects nothing of me and knows I provide very little utility to the team. Reflecting upon this, she was right and fair but I recognized that I want to progress rapidly so that I can be trusted and useful for the team.
I think it’s important to be realistic about yourself and set clear and achievable goals that promote development.
Day Five: Consultants are scary and the hierarchy of medicine
Seeing a consultant surgeon on rounds or on the wards was a little like playing ‘Where’s Waldo.’ I struck gold when a consultant rounded with us, learning lots about bedside manner and how to pick up on the small things.
That being said, his presence further exacerbated the hierarchy of medicine. Throughout the week I learned to try and be useful where possible, to pick the most appropriate times to ask questions, and try not to get in the way of my seniors. It was an unspoken law to stand up and offer a senior a seat when they walk in the room and to walk at the back of the group.
How my expectations and goals have changed moving forward
Overall, I absolutely loved my first week in the hospital. The exposure to clinical cases is invaluable and I have learned so much so quickly. It was enjoyable to play out a slightly less dramatic Grey’s Anatomy while feeling more like a first day JD and seeing doctors that thought they were Dr. House. The stereotypes are there for a reason and I found that hospitals are definitely organized chaos that takes time to learn.
I definitely recommend going in with an open mind, getting exposed to as many things as possible and grabbing any opportunity to learn! I am excited about the next year in the hospital and am eager to reflect on this in months and years ahead.
Kieren is a 2nd-year medical student from Wollongong, Australia (an hour south of Sydney). In his spare time, he enjoys running, cycling, adventuring and video games.
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