Patients: not sign offs

 Written by Abbie Tutt, JASME.

abbie tutt photo

Abbie Tutt

Twitter: @abbietutt

I looked at my timetable this week. Some self-directed learning (result!), a day on labour ward and a scattering of clinics. Not too much then, should be able to cope, might even get some studying done this week. I had just finished a GP placement where I was commuting for a full hour and a half every day and was consequently shattered. I am relieved now to only be travelling 20 minutes up the road.

As a final year student I can feel exams breathing down my neck. There’s pressure to perform at a finals standard despite it being over 2 years since I stepped foot on a labour ward. I’m determined to get sign offs completed early and attend all teaching, but time is precious, so I need to recognise when I am no longer learning and return home to revise.

As a medical student, it’s all too easy to see patients as textbooks or opportunities for sign offs. You are constantly torn between staying on the wards to develop clinical experience and going home to study textbooks (because that is what is what I will be examined on). As much as I enjoy scrubbing in and assisting in theatre, I don’t think it’s likely to be an OSCE station. Though that would be fun to think about:

“Mr Jones is a 45-year-old male who broke his ankle last Tuesday. You are the Med Student who is assisting his ankle surgery. Please demonstrate ankle traction for 5 minutes without getting out of breath or sweating”.

However, this week during placement, I just stopped. It hit me just how lucky we are to study what we do. I was observing a c-section - I had never seen one before - and suddenly there’s a tiny baby in front of me taking their first breath and letting out their first cry…. I got to witness this because it was part of my degree. It was on my timetable to be at the very beginning of someone’s life.

Can you name another degree like this? As a Neuroscience undergrad, I remember being timetabled for 9am statistics lectures and 2pm lab sessions, not 11am ‘see someone take their first breath’. I look back over my degree now and wish I had been scheduled to see things just to experience them, without worrying about a looming exam or a sign off deadline.

As medical students we remain uniquely privileged in comparison to other healthcare students. Paramedics are limited to the ambulance, Midwifery to labour and nurses to their designated specialty. Physician Associate training is somewhat similar in breadth to medicine, but it is limited to two years which may reduce the depth of clinical experience. Even as doctors, we are unlikely to ever see the range of patients and specialties we do now.

It’s easy to become de-sensitised to the incredible opportunities of our degree. For example, I have previously moaned about my placement in trauma surgery because of the 7:30am starts. Additionally, the demand for sign offs can take the enjoyment and inspiration away from clinical exposures, turning us into the signature hunting machines that consultants hide away from. 

Our recent JASME conference featured Dr Amie Burbridge as a Keynote speaker. I am a bit of a fan of Dr Burbridge as she supervised me during my first ever patient encounters as a medical student. Dr Burbridge mentioned keeping a book of lessons you learn every day; for me, that would be my revision notes. Instead, I would like to invite medical students to keep a record of their experiences that will stay with them throughout their careers.

We all remember the enthusiastic pre-meds we once were. Gushing over a simple clinic or in my case (very luckily) visualising a brain during neurosurgery for the first time. Perhaps from time to time we need to re-kindle that pre-med spirit to remind ourselves why we are studying medicine and that, despite the pain and frustration they can cause, 7:30am trauma meetings are a privilege to attend.

Abbie Tutt

Communications Team, JASME Committee

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