Making the Most of Phase II:
A Guide for Students by Students
Edited by
Adrian Hayes
With
Kate Gallagher
Emily Rawle
Siobhan Reilly
Chris Roughley
Sarah Watson
Rebecca Woodside
Thanks to all those who contributed tips:
Aoife Abbey
Divya Mathew
Afiniki Akanet
Alexandria Morgan
Amy Attwater
Sanjena Mithra
Mark Bailey
Oliver Morgan
Jack Bambrough
Miranda Mylne
Liz Barnfield
Mona Neuvonen
Harald Bjorndalen
Katie Parker
Sarah Chard
Poppy Roberts
Hafsatu Ciroma
Emily Robinson
Amy Crookston
Jeremy Royle
Calum Davis
Harjeet Sahota
Stephanie Dizon
Bhavna Sharma
Caroline Ellison
Sarah Sharp
Imogen Foster
Philip Slack
Rosalind Gould
Martin Slattery
Sun Mi Ha
Nicholas Tyrell
Jack Jouanny
Fiona Vas
Rebecca King
Christopher Waller
Katie Lyne
Jo Webb
Hannah Mason
James Webster
2
Foreword
Welcome to Phase II - it’s a real achievement to have made it through ESA 3 so many
congratulations!
Phase II is so different from Phase I that it can be a difficult transition. The familiar structure
of lecture-groupwork-lecture is replaced with great expanses of time with little guidance as
to what to do with it. This can be really daunting and there will be occasions when you feel
as though you’re not getting anything out of a block. The best learning opportunities in
Phase II are often those you organise yourselves, or which you weren’t expecting. It’s up to
you to make the most of these as there is nobody checking up on you for a lot of the time.
This guide came about because my friends and I often found ourselves complaining that we
had wasted time in blocks doing things that weren’t too useful, and would have organising
things very differently if we were to do it again. I discovered that everyone had their own
tips for getting the best out of their placements, but unfortunately only learned these by
about Week 6 of that block. This became more important as the blocks went on and exams
began to loom again. This document is a compendium of everyone’s best advice for making
the most of Phase II so you can benefit from our mistakes!
An important caveat – the information in this guide does not represent the views of
Warwick Medical School. Ultimately you must do anything and everything that the
university requires of you. This guide is meant to help you in the grey areas, where it’s not
clear how best to proceed – but if in doubt, ask (Jane Padfield). Furthermore, every
consultant is different in terms of what they expect of you – so if they say you should be
with them 8-6 every day then you’ll have to do it or take the consequences. Don’t blame us!
All the quotes included here are from tips written by individual students. For each one,
there are bound to be people who disagree. You should know by now that everyone has
different learning styles and what is useful for one person may be the most boring thing in
the world for another. One of the benefits of this part of the course is to become more
independent in your learning, so try to find your own way.
This guide was compiled in February 2011. We intend to add to it in a year’s time when we
have experience of the Senior Rotation. We also hope to include some advice from
consultants. Hopefully some of you will also want to add your own tips and experiences
after you’ve been through the placements yourself. For any suggestions, tips, or to get
involved in redrafting this guide, email me on A.Hayes@warwick.ac.uk.
All the best for Phase II and enjoy yourselves!
Adrian Hayes
3rd year medical student
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Contents
Hospital Stuff ............................................................................................................................... 5
Dealing with Consultants .................................................................................................................... 5
Seeing Patients.................................................................................................................................... 8
Portfolios ........................................................................................................................................... 11
Clinics ................................................................................................................................................ 14
Ward Rounds .................................................................................................................................... 16
MDTs ................................................................................................................................................. 18
Free Time .......................................................................................................................................... 19
Junior Rotation Stuff .................................................................................................................. 22
General Practice ................................................................................................................................ 22
Psychiatry .......................................................................................................................................... 25
Surgery .............................................................................................................................................. 29
Orthopaedics & Anaesthetics ........................................................................................................... 33
General Medicine Blocks................................................................................................................... 35
Senior Rotation Stuff.................................................................................................................. 38
Obstetrics and Gynaecology ............................................................................................................. 38
Acute Medicine ................................................................................................................................. 39
Paediatrics ......................................................................................................................................... 40
Extra Stuff ................................................................................................................................. 41
Teaching ............................................................................................................................................ 41
Exam Preparation.............................................................................................................................. 41
General.............................................................................................................................................. 43
4
Hospital Stuff
Dealing with Consultants
In most blocks, every clinical pairing is allocated to two consultants from different
specialties. The first meeting with your consultant is important, so don’t put it off! Meet
them as early as possible in the block (first day if possible), so you can make a good
impression, find out their timetable, when they expect to see you, how many portfolios you
can do, etc. It is better to spend as much time with them as possible in the first few weeks
as it will make them a lot more tolerant of absences later in the block! Visit the secretaries
and get some contact details – sometimes consultants can be hard to find in person. It’s also
important to be on time – some consultants won’t mind if you’re late and you’ll get to know
this. Others hate it – your marks and their attitude to teaching you can go down the pan.
“Meet with consultants early on and discuss what they expect of you during the block regarding attendance, portfolios, reading, opportunities for additional teaching etc. saves any nasty surprises come end-of-block assessment forms”
“If possible, ask previous students what consultants expect of you. Also, arrange a
meeting with the consultant in your first week to arrange when you can present portfolios
/ which clinics etc they want you to attend”
“Have talks early on about what they expect of you and what you are hoping to gain from
the block. Discuss attendance (how often they expect to see you) discuss any timetabled
teaching you have, discuss how portfolios will be marked and how many they expect you
to do for them. But also it’s really important to tell them what you want to get out of the
block - do you want lots of time on the wards? How to learn best? How will you reach the
targets set out in the Phase II booklet and whether they would be willing to give bedside
teaching?”
Most of the consultants are trained as examiners. Take advantage of this – get them to
observe you practising for exams and ask for bedside teaching. Many of them won’t do this
unless you ask. They can also give you a good guide as to which extra clinics/procedures it
will be worth seeing. Do not underestimate how useful an on-call can be! Consultants are in
general really interested in their specialty, so they are happy to share knowledge
(sometimes more that you can cope with). For this reason try to appear interested – don’t
offend them by saying you hate their specialty or find it boring! NEVER feel guilty for asking
questions/ taking up their time – they are paid to teach you, teaching forms part of their
appraisals too (the same goes for the rest of the team). Don’t panic if they start asking you
more questions. They are used to students getting it wrong – try to think of a logical answer,
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but if you really don’t know then say so – now is the time to learn. Of course some days they
may be too busy, so be prepared to wait for another opportunity at a more suitable time.
“You’re not supposed to know everything your consultant knows, don’t forget they have
had years more training than you. At the start of phase II it can be stressful not knowing
what your consultant is going to quiz you on and when; don’t get stressed out, if it isn’t in
the blue book chances are it won’t be in finals!”
“Don’t be afraid of answering questions and looking stupid. See these as teaching
opportunities, you will get more benefit if you have a go at answering (they often don’t
expect you to know the answer anyway)”
“Try to get your consultant to suggest topics to read up on each week – it gives you a
focus and might keep impossible questions on random subjects to a minimum”
“Even if you are not interested in their topic, pretend to your consultant that you are
because ultimately s/he is marking your attitude”
“Remember that your consultant is human too and if he/she doesn't have time for you
that is because they have a busy job too. Don't just rely on them, use their team too, they
usually know which patients will be able to give you good histories and have good signs”
Consultant partnerships often change from block to block. A consultant may not be aware of
clashes within the timetable, so it is important to let them know your other commitments.
They should not monopolise your time – if you feel they are then talk to them. If that
doesn’t work have a quiet word with the Phase II secretaries at your respective hospitals.
Some consultant pairings don’t work very well, so let the secretaries know for the next pair
of students if you have difficulties. If you are having trouble with clashes, try to alternate
weeks between one clinic and another, or split your pair so a student can go to each clinic.
“When you first meet your consultant ask for their timetable, and then ask when they
expect you to see you, that way you don't have to guess if you are expected to attend
things. Also make it clear when you are not available”
“Work out the consultants’ timetable and draw up a weekly plan for yourself from that,
eg Monday ward round, followed by finding portfolios and PM clinic”
“Don’t take it personally – your consultant is only human, they have bad days too. If a
consultant says something that makes you feel bad try to ignore it. Often it’s just
unfortunate that you were in the wrong place at the wrong time. Even if you feel you
don’t get on with a consultant for a whole block, don’t worry too much. They are
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professionals and will mark you fairly, even if there is a personality clash. Remember,
even if you don’t get on, try to be tactful!”
“They seem much better if you get in early, put the time in their diary and look proactive
but what you're doing is telling them what to teach you and making sure they make time
for it (ie go into your first meeting with your own agenda for the block and tell your
consultant - in a nice way!)”
“Halfway through the block, check with your consultant if you’re doing everything they
expect, and if there’s anything else you should be doing – always helps for the end of
block assessment forms”
You need to maintain a professional relationship with your consultant – you might work for
them later in your career! However they are still people (honest!), so you can still show
your personality. A light hearted chat and the odd joke can really help to get you through a
long clinic or theatre. This is also important if you are having personal problems during the
block. They will understand if you cannot attend for certain personal or educational reasons,
but you should be honest about them. If you just stop turning up with no explanation,
expect them to be put out.
“Make a good impression on consultants by being around as much as possible in the first
week of your placement (makes it easier if there are days you can't come in later)”
Some consultants are more demanding than others. Some will seem worse-tempered. Don’t
panic!! Often, the ‘harsher’ consultants are actually the ones who mark most generously –
they actually have an idea of what you know! It’s also a great learning opportunity as the
more they push you the more you learn. The odd embarrassment in clinic/ward
round/theatre should be expected- nothing like it to help direct and motivate your learning.
“If you have a consultant that seems very harsh and critical... who asks you random
questions and also questions you know you know the answer to but you just freeze up
when they ask because they are just so intimidating and you generally feel like an idiot
when you are around them... DON'T WORRY ABOUT IT, just do your best and try not to
beat yourself up about it – some consultants are just like that and it is probably the same
for every clinical pair that have that consultant!”
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Seeing Patients
Time to get out there and meet patients...
Phase II is the time to perfect your history-taking and examination skills, without an
examiner breathing down your neck. The wards offer an informal environment to meet,
take histories from, and examine patients. Not every patient you meet needs to be
approached systematically – if you just want to ask a patient a few questions without taking
a full history there is nothing stopping you.
“At first if you are not confident taking histories, just start off with the aim of ‘having a
chat’ with the patient - you are far more relaxed, and you will be surprised how much
information patients will give you without you trying. After seeing a few patients you will
start to find yourself asking all the right questions without thinking about it”
“See patients!! Set yourself a target, eg take 40 histories during the block (that's only one
a day). This will really help you pass exams and dramatically increase your confidence.
Don't be afraid of taking histories from people (particularly on call) who you have no idea
what to ask/what signs might accompany the presenting complaint - you will be surprised
how much they tell you themselves, and how logical more questions begin to seem”
Do not fall into the trap of only taking a full history when you need a portfolio. The more
histories you take the easier the whole process will become. Once you’ve taken a history
and conducted an examination, present the case to a doctor or fellow student; a very
important skill for both exams and your future as a junior doctor.
“Don't be shy - take as many histories and examine as many patients as possible... not
just when you need a portfolio case! And then practice presenting the case to your
consultant, or at least to your clinical partner”
“After talking to/examining a patient find a willing F1/F2 who will listen to you present
your findings and give you feedback”
“If you’ve spoken to one of the patients being seen on the ward round, ask if you can
present them to your consultant or the team”
The structure and the formulation of questions to ‘rule in’ and ‘rule out’ differential
diagnosis will become easier the more histories you take. This will be an invaluable skill
when IPE and finals rear their ugly heads.
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“Think about differentials when asking questions in the history, try to put a line through
them systematically”
“...as soon as I know the presenting complaint, I scribble down the major differentials that
need to be excluded as I feel this ensures that I ask one or two extra questions that will
exclude simple obvious differentials. If I don't write these down I get stuck on one train of
thought and forget to exclude obvious things...eg chest pain....I would write down....MI,
PE, GI, MS. This would remind me to ask two extra questions that I may otherwise have
forgotten”
Patients are your learning tools in Phase II. They are suffering from and living with the
conditions you need to learn about for exams. You can start putting faces to all the illnesses
you learnt about in Phase I; many people find this is an easy way to remember things like
how the illness presents, investigations and management. Ultimately, you are preparing for
your clinical examinations, so use your time with patients to practice.
“Note down interesting conditions and patients you see on ward rounds - if they have
interesting examination findings or a good history go and see them later if there is no
time during ward round. Read about conditions at end of each day”
“Go and speak to patients as much as possible as soon as possible with your clinical
partner and time each other - try and do it like exam conditions ...while your partner
watches and then gives feedback at the end ...go through presenting it back with your +ve
findings, -ve findings and a differential list then look it up in the oxford handbook and ask
each other questions about it - the more you do it in the time the easier it will be and it
doesn't matter if you're rubbish at first ...It really is the best way to practice for IPE and
finals and the sooner you start the less you need to do each week”
If a patient has clinical signs of disease have a goosy gander; it may be the only opportunity
you will get to see the sign before you qualify. Even if it’s not rare, the more times you
see/hear it the better chance you will have of being able to identify it in the future.
Auscultation of heart and lung sounds is not always easy at first – get your stethoscope out!
“Venture out onto the other wards....ask the F1s if there are any interesting cases....be
always on the lookout for signs ie liver flap, heart murmurs, crackles etc”
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Patients offer limitless learning opportunities - take advantage of this! Some patients will be
difficult to take histories from, others will do all the work for you; but all of them will teach
you something.
“SEE MORE PATIENTS! Each patient will teach you something even if you don't think they
do - it may just boost your confidence with patients, or teach you how to interrupt
particularly chatty patients politely (a much needed skill!)”
Do not underestimate the importance of your communication skills and this is the perfect
time to fine-tune these skills. Patients will tell you time and time again that a ‘good doctor’
in their eyes is one that listens to them. So it’s not always about getting the diagnosis, there
is a lot more to taking a good history.
“Be nice to the patient!!! They will forgive you even if you have multiple failed blood
taking attempts, and will still be delighted to see you at tomorrow’s ward round”
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Portfolios
“Do portfolios really early in the block. Everyone says it but nobody does it!”
A big part of Phase II is completing portfolios. These are in-depth case studies written under
specified headings with a strict word limit. At the moment you’re expected to complete 20
in the Junior Rotation and another 16 in the Senior Rotation. It is really important you stay
on top of these as not doing the right amount will get you straight to extended IPE – and
there isn’t really anyone checking you’re on track until the very end. Some blocks are harder
to get portfolios (GP can be variable, Psych portfolios are longer) so think about how many
you need in each placement.
Loads of students complain about portfolios and they can be a massive pain, but they can
also be the most effective work you do. The worst scenario is leaving them all until the end
of the block, then you’re struggling to find patients and haven’t got time to write them.
Remember that consultants also need time to mark portfolios and might also be short of
time, or get shirty that you’ve left them late. The first few you write will take absolutely ages
but they do get quicker, so dive in!
“Try and get portfolio patients as early as you can. Don't leave it until the last minute the evidence base and commentary sections always take longer to write up than you
think they will. Leave enough time at the end of each block to hand in your portfolios and
have your consultant mark them (generally try and get them in in week 5 - 7 of the block),
and remember to check whether your consultant is away on holiday during your
placement. Also ask your consultant when you can present your portfolios - they may
have a certain day of the week they do paperwork etc in their office”
“Try to get portfolios done in the first 5 weeks or so, so that in the last 3 weeks you can
explore other specialities...It’s a pain to chase consultants in weeks 7 & 8”
“Do your portfolios early especially in blocks that have exams at the end (surgery and
ortho/anaes) otherwise you are spending time on the portfolios instead of revising!”
“Don't leave all your portfolios until the last block”
“Present your portfolios to consultants as early as possible otherwise you will end up
chasing them around to get them signed off!”
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A useful approach is to get good patients with basic, common conditions which we’re
expected to know (as set out in the handbook). That way, portfolios can be used as revision
and you’ll remember the topic much better than reading it from a textbook. You can ask
consultants for advice on choosing a patient, but be aware they may go for one they find
interesting and that might be overly complex for your stage. Junior doctors (especially
Warwick graduates) will have a good idea of what is suitable.
“Go for easy, "bread and butter" conditions/presentations like abdo pain or chest pain.
These are the ones you will probably learn most from and are also what is most likely to
come up in exams”
“Look in the Phase II handbook for the 17 suggested key cases that the medical school
thinks we should know before finals...always try to do the recommended portfolio cases in
the handbook”
“Avoid "interesting but complicated" cases for portfolios, always pick classic
presentations of common conditions, it makes them much better revision for exams and a
more useful learning tool, and much less hassle. In my experience consultants always
suggest the difficult cases, so just tell them you already have something else in mind.
“As soon as possible and try to get portfolio cases that you are actually interested, that
aren't too complicated or perhaps cover a topic which is important for your learning so
that you will know the pathology, prognosis and management which will help you at a
later date.
“Ask the F1/SHO or nurses or anyone around for decent patients for portfolios in week 1
or 2 and get them written up and out of the way as soon as you can so that the rest of the
block can be focused on what you want or need to do without the pressure of portfolios
hanging over you”
Consultants mark portfolios in different ways. Many will ask you to present them, which
basically involves reading them out and answering questions as you go. Be warned, some
will take them off you before you do this, so make sure you can present the case without
your notes. Some will take them away and mark them, and others will read them through
while you’re waiting. It’s a good idea to find out at the start of the block how they want to
go through portfolios as it might make a difference to the way you write them (eg wellwritten or lots of information in note form).
“Be prepared when presenting portfolios . Consultants have different approaches, some
will quiz you on what you have written”
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“Don’t put things in portfolios that aren't relevant and you don’t want to be asked about”
The quality of your portfolios and presentations help form your consultant’s opinion of you.
However the marks for these don’t [currently] go towards your final grading directly. One
student recommended the following, but others may disagree:
“Don't spend too long on portfolios, they need to be satisfactory but ultimately they won't
help you pass your exams”
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Clinics
Clinics are where you will encounter a large number of patients, from new cases to those
with well established diagnoses. You’ll see histories, examinations and management here so
make the most of it. They are an excellent opportunity to see a wide variety of conditions as
you can see as many patients in one day as there are on a ward. It can a brilliant opportunity
to see patients by yourself and present them back to the consultant – but you may need to
ask for this as not all consultants suggest it themselves.
“Go to all new patient clinics and use follow-up clinics to familiarise yourself with the
most common drugs that are used for different conditions, their doses, side-effects, and
alternatives”
“Ask your consultant to see patients on your own and present back to him/her. This is the
only way to maximise your experience in clinics, otherwise, you find yourself sitting in the
corner of the room not doing much for 3 hours”
Always get your consultants’ timetables and endeavour to see them in clinic as soon as
possible – however, it is wise to branch away from their clinics as well and experience other
(sub-) specialities. This is particularly true of general medicine and surgery blocks where you
are expected to gain a breadth of knowledge, not just becoming a urological expert for
example. They understand this is what you need to do and will often encourage you to do
so. It is a good idea to inform your consultant what you have been up to, however, so s/he
doesn’t think you’re slacking. It is also worth doing this early on in the block as it means
you’ve reached your targets early and you can spend more time with your consultant as it
draws close to sign-off.
“Don't go to eg 10 endoscopy clinics when you could've gone to one. Just arrange to
do something else so you have a chance to see the maximum amount of different
investigations / clinics / patients during each attachment. Consultants don't mind as
long as you tell them what you have been up to.”
“Make the most of the wide variety of outpatient clinics at UHCW, you don’t need to
stick to your specialities if there is a clinic without students ask to go so you see a
wide variety in gen med.”
You often see the same types of patients week in week out if you remain with one
consultant so to achieve the necessary breadth it is important to be organised. Switch clinics
with other pairs and/or ask when they may not be attending one that you could instead. It
14
may help to listen to what other students say about certain consultants too. Some are much
more effective and enthusiastic teachers than others, so try and push yourselves to make
time for them. On some blocks you may gain assistance with this, eg sign-up sheets for
particular clinics. Feel free to speak with other secretaries too in order to see what’s
available elsewhere.
“If you are not in one of the major specialties like cardio, respiratory, gastrointestinal
or renal in general medical blocks: Go to some clinics with consultants in these
specialities. Either you could swap with someone for a week or ask a consultant that
doesn't have medical students to sit in on his clinic one day”
“If you don't get allocated a cardio consultant it can still be tested in IPE. Make use of
other peoples’ specialties”
Some consultants ask what you want to gain from the time you spend in clinic with them
and so this is something you should consider before attending. It is a useful tool anyway in
trying to give you focus and gain the most from a session. If there is an aim that you have
conveyed to the consultant he is more likely to be receptive to your enthusiasm and take
the time to cover it with you. You commonly see that consultants do not do full
examinations so if it’s something you wish to see you’re probably going to have to ask.
“Have an aim in mind for each clinic you attend, eg an examination you want to
improve or disease you want to understand better”
“Prepare a little in advance for each clinic/block as it will help you when being
questioned by consultants and if you know a little they are more likely to teach as it
shows enthusiasm”
“If you are due to have a clinic the next day, ask beforehand what cases are likely to
be encountered eg in obs & gynae some clinics are specifically 'menopause' or
'infertility', then read about the topics before you attend”
“Always read a chapter on the relevant topic before clinic. It stops you looking
stupid, and if you impress a consultant at the start they will be more lenient on you in
weeks to come”
The attitude and preparation with which you approach clinics can really affect what you
take from them.
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Ward Rounds
Ward rounds are one of the mainstays of hospital life, and are often the thing that
consultants plan your weeks around and think is most useful for students. However, this is
often not the case, especially if you don’t know any of the patients being reviewed. They
may also be very early (especially in surgery...). Knowing how to get the most from them is
definitely an important tool.
Ward rounds are a good place to get to know the patients on the wards to which you are
attached and in particular those that are good for the all-essential portfolios. Alternatively if
you see and get to know the patients between ward rounds they will be much more
valuable. This is a good opportunity to get to know the team with whom you are attached
and offer them help with any of the tasks that have arisen during the round. The FY1s will be
really grateful for the help and it actually gives you chance to practice tasks like cannulation,
venepuncture and catheterisation. You may even free up time for some impromptu
teaching!
“Ward rounds can be variable in their learning opportunities, so chose what you attend.
Some teams will allow you to act as part of the team and be involved in writing in the
notes. Take these opportunities as these team members are likely to help support you in
your teaching and provide you with more opportunities to practice your skills.”
“I found few ward rounds really helpful, but sometimes they are unavoidable as many
consultants think it’s really useful for you to attend. Use them to note any patients who
are potential portfolio cases that you can go back and see later – they are also a time to
get to know the juniors at the start of a block.”
“Get the handover sheet before the ward round if possible so you have an idea of the
patients on the ward.”
You find that many consultants do not actually attend ward rounds but they may have a
dedicated week in which they are on take and will be more likely to show up. It’s a good
idea to get to know all of their patients on the ward so that you can present them to
him/her if asked. It’s often easier to do than you think, particularly if you’ve already been
trying to get portfolio cases and practise your histories (very advisable). If you are proactive
in this way you are more likely to receive some teaching from the consultant.
“Practice reporting x-rays, CT scans or ABGs”
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“Keep a note of when you have impressed consultant or said/done something that has
altered a patient's management for the better - will come in handy later!”
“Ward rounds - ask the F1 or SHO if you could present a patient to your consultant at the
ward round. You may have to get there a bit earlier to read the notes and speak to the
patient. This would be an excellent opportunity to get a full picture of the patient,
understand the role of investigations, and explore management options. You could also
use these opportunities for scooping up portfolio cases”
It is good to attend a range of ward rounds whilst on the general medicine/surgery
placements to help give you better insight into the types of patients that you may find in the
hospital. Many ward rounds occur with great haste and therefore leave very little chance for
you to gain teaching. It is important to arrive punctually and it’s always a good idea to
introduce yourself to those running the ward round. It may feel daunting to ask questions as
you move quickly from patient to patient but don’t be afraid to. Jot down any questions as
you go and ask the FY1 or Reg at the end if it hasn’t already been answered. If the Reg
hasn’t been teaching you much they may start if you have been questioning them and
showing interest.
“During ward rounds get involved; ask the house officers to let you write in the notes
during rounds or present the patients to your consultants. Good practice for when you
become a HO and also improve presentation skills for the clinical exams.”
You may get lucky and the Reg will tell you if they’re particularly busy and it’ll be better to
attend on another day. If they’ve bothered to tell you this, remember who they were and
try to see them again as they are probably more interested in teaching than others. Ward
rounds can be tricky and tiresome but prepare and pay attention to get the most from it.
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MDTs
It’s probably a good idea to go to the odd Multi-Disciplinary Team meeting just to see what
goes on. You’ll get to see radiologists and pathologists in their element, and you can watch
management decisions being made. On the whole, however, discussion of each case is very
swift and unless you know the patients it can be a blur. Show your face when your
consultant is going to be there for possible brownie points.
“MDTs are good for finding interesting portfolios and for potential cases that can be
written up as a case report and published. Don't go to too many though, as they can be
long, drawn-out and boring”
“Go to MDTs which consider patients you know about, especially if they are your portfolio
case. You can still learn if you don't know the patients, as it's a great opportunity to pick
up histology and imaging knowledge - radiologists love to tell students what they can
see!”
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Free Time
In between ward rounds, clinics and formal teaching you’ll also find that you have some
time with nothing organised. This is really useful time to do whatever you’re interested in or
feel that you need to improve - from looking for portfolio cases, getting teaching from the
F1s or going home to do reading, it’s very much your decision on how your time is best
spent.
Many students find that the ward is a productive place to go if they want to do something
useful. It’s helpful if you introduce yourself to the people working on the ward. The junior
doctors and nurses know which patients have clinical signs or are good historians and can
let you know if anything interesting is going to happen on the ward. Some of the best
teaching and experience of working life comes from tagging along with the junior doctors.
“Go and find the junior doctors attached to your consultant in the first couple of days and
introduce yourself. Tell them you’d like to help them out with any ward jobs, and see if
there’s a good time to see them – they’re often inspired to teach you if you show some
early interest. They will also report back to the consultants on your attendance and
attitude”
“Do spend time with the F1s. They are the most recent people to sit finals and know
exactly what you need to know. Also you can learn a little more about the job you will be
doing”
“Make friends with the F1s. This will make your life so much easier! They will point you in
the direction of good patients to interview and examine. They may give you teaching, and
help you brush up on your clinical skills”
“Grab any F1 or F2 who isn't too busy and is keen to teach and ask them if they could
watch you taking a history and examining a patient and give you feedback - this is
invaluable (you can also do this with your clinical partner regularly through the blocks)”
“Go to the ward, find a junior doctor and ask them if there are any interesting patients on
the ward that you could talk to and present to them. If not, they might have some jobs
that need to be done, like cannulas, bloods, etc, which are good practice”
Time spent on the wards is the best place to gain some practical, hands-on experience and
the better you are at these skills now will make the first couple of weeks being an F1 less
stressful.
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“Aim to do as much cannulation, venepuncture, reading ABGs and ECGs as possible”
“Offer to help them (F1s) with their jobs: taking blood, cannulating (also useful for you!),
TTOs, blood request forms (hey, we are going to have to do them some day, why not learn
how now while scoring points with your F1?). And also they may put in a good word for
you to the consultant!”
“If you want to practice blood-taking skills there are usually requests put out for the
phlebotomists, grab a handful and have a look to see who has good-ish veins. Patients are
very accommodating if you are honest”
It’s understandable to feel apprehensive before trying procedures on patients for the first
time. Here are some tips to get over initial nerves:
“If you don't feel confident doing a venflon/catheter/other- ask someone to watch you, or
show you how it's done, instead of just saying no”
“If it is your first time taking blood from a real live patient and you are feeling tremulous take a blue conti sheet with you to protect the bed (unless you have one of those sterile
packs in GEH - does the same thing). Not only will the nurses be pretty narked if you get
blood on the sheets, it doesn't look proficient to the patient”
“I find it easier to keep chatting to the patient whilst I am taking blood or putting
cannulae in, it puts them at ease and distracts them if you are a bit shaky at first!”
You may also find free time when you didn’t expect it, with cancelled clinics or consultants
held up elsewhere. Although waiting around can be frustrating, it’s also a good opportunity
to do things that you wouldn’t otherwise have had time for.
“Bring work along. On numerous occasions you may be stuck between waiting for the
consultant without a way of contacting him and not being able to leave because you need
to make up ‘face time’. It is very useful if you bring some work to do so that you make use
of the time”
“Find an empty room with your clinical partner and practise examination techniques on
each other”
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“When in senior rotation (surgery/medicine), use your down time to do mock exams with
your clinical partner. Mimic the format of the actual clinical exam: 10 mins history, 5
mins examination, 15 mins thinking time, and 10-15 mins presenting/questions!”
So, there are loads of things that you can do on the wards in your free time, and remember
to fit time in for the books at some point as well. But also consider that there really isn’t
much point hanging around just for the sake of it – if it’s not a good day to be on the wards,
you don’t need to be there. The fact that you are now the master of your own time is one of
the biggest and most empowering changes compared to Phase I.
“I think it's worth mentioning that people should be sure to timetable time at
home/library reading and learning about whatever it is they are doing”
“When there REALLY isn't anything going on: Go home. Work on portfolios. Do some
revision. It is easy to waste time in Phase II waiting around for things to happen. Often a
lot more learning could be done at home”
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Junior Rotation Stuff
General Practice
The GP block is a bit different depending on when in the rotation you do it. If early, it is a
great time to practice communication skills and dealing with patients. Later on, it might be
more useful for revising conditions you’ve come across in the hospitals and learning to
identify these in their early stages - as well as getting your history taken in the most efficient
time. Either way, it’s worth making the most out of the placement as it’s the only general
practice we do at Warwick.
How is the block structured?
GP Placements
You’ll be asked to choose a practice for your placement. It’s hard to know how to choose
based on the information given, so ask around other people who have done the block
before you. Don’t be fooled into automatically choosing the practice at the end of your
street – many of those further afield are extremely motivated towards teaching and
providing experience. If you’re away from home, you’re also more likely to make good use
of time between clinics which can be four hours or more. This is a good time to get on with
some reading and, depending what is going on at your practice, to get involved in some of
the other activities such as nurse-led clinics or home visits.
“If you have a practice with v long lunch breaks then either bring something to do, like
JAHD lectures from that week to write up, or read about some of the patient's conditions
you've seen in the morning clinic...or ask to go on house calls, to sit in with the nurse or
other clinics (mid-wife, weight loss clinic, diabetes clinic, minor surgery etc). Ask about
going out with the health visitor and doing jabs and bloods in clinic (to get some clinical
skills practice in)!”
You may have one main GP or rotate around several. Your time is technically divided into
basic sessions (where you are observing) and professional sessions (where you are leading
the consultation). In practice this may be less clear cut, so make sure you are getting enough
experience of direct patient contact (even though it may be scary at first).
“Try to get as many professional sessions as possible. You will get the most out of GP
block if you do as many consultations as possible. When you are in a basic (nonprofessional) session, ask the GP if you could do the consultation and most of them are OK
with it”
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Make the most of sessions where you are observing by paying attention to conditions and
medications you are not familiar with.
“Take a notepad, copy of GP textbook (oxford guide is good) and BNF and learn any
tradenames/side effects etc as mentioned during consults”
“Get out a copy of the oxford handbook of general practice - then you can look up
conditions and management, signs and symptoms etc in between patient - this can be
quite productive and can give you lots of ideas for questions to ask (which will make you
seem v keen and interested)”
The GP block is one of the only parts of the junior rotation which focuses on management.
You will start advising patients and deciding how best their condition should be treated. It’s
best to jump into this headfirst even if you’re not sure.
“When practicing management, don’t worry about saying the wrong thing - just give it a
go and say something like ‘the doctor will correct me if I’m wrong, but what I’m going to
suggest is...’, rather than running scared and asking the GP to take over”
Teaching
There are lectures on (for us) Tuesdays and Wednesdays on various topics in primary care.
Some of these topics will be new and incredibly useful (eg dermatology), while others will
be...revision. Remember to attend sufficiently (see below).
Communication Skills
These are all-day sessions conducted in small groups with a tutor. This is where you learn
how to structure a consultation and take a focused history in a short time. It also includes
interviewing actors, and reviewing videos of your own consultants taken in the placements.
While all this sounds slightly horrendous and terrifying, it’s one of the most valuable parts of
the block. You’ll get to know your small group extremely well and it will really affect your
interview technique. Make sure you turn up to all of these sessions – they’re well
worthwhile.
Portfolios
Portfolios are not compulsory in the GP block. Nevertheless, it’s worth asking your lead GP if
you can do any – some will be happy whereas others won’t want you to. It can be a good
opportunity to write up conditions you wouldn’t necessarily see in hospital as an inpatient,
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particularly the chronic conditions which are managed within primary care. Make sure you
submit these to the University once marked otherwise they won’t know you’ve done them
(there is no space for portfolio submission on the GP end-of-block assessment sheet). If GP
is your last block, don’t leave any portfolios to do as you may not be able to.
How is the block assessed?
Attendance
Attendance on the GP block seems to be more strict that any other because we are doing
the minimum requirement of general practice for a medical school. Remember that
attendance at each of the three components described above is calculated separately – so
you can’t attend all communication skills sessions and slack off the other teaching. There is a
register you need to get signed as you go.
“Make sure you take your register to EVERY SINGLE teaching session – it can be a big
problem if you don’t have the right forms with the right signatures at the end”
End of Block Examination
There is an MCQ exam in the last week which is quite hard to revise for as the questions are
very varied. Still, it’s rare for people to fail this so don’t get too stressed about it.
“Read up on the list of primary care illnesses listed in the GP handbook in your own time –
they will come up in the exam, but might not be taught specifically”
Performance
Your lead GP and communication skills tutor will each grade your performance. These two
marks are taken with your exam mark to give you an overall grade. At the moment you have
to pass two out of the three to pass the block.
Reading
The Oxford Handbook of General Practice is a great reference to have to hand in
consultations.
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Psychiatry
“In psychiatry, try to see as many different patients as possible. It might be tiring to do 1
hour histories but seeing the symptoms/signs of psychiatric conditions is the best way to
understanding the condition itself. This is true for in medicine and surgery too, but I think
it is especially true in psychiatry. You wouldn't really know what mania is until you have
talked to a manic patient”
“Psychiatry may seem to be going at a slower pace, but just use the opportunity to talk to
people and try to understand the different symptoms in psychiatry”
“Just try to enjoy your Psychiatry block – try not to feel daunted having to take histories
etc – Psychiatric patients are often keen to talk to students and their stories can be really
mind-blowing”
How is the block structured?
Introductory lectures
Psychiatry block usually starts with a few days of lectures, at which time you will be
bombarded with information on the full array of psychiatric conditions. Don’t worry if by the
end of this you are feeling overloaded, you will have time in the block to get to grips with
the main conditions. The most important lectures to look over before you head off the
wards are Psychiatric History and Mental State Examination.
Weekly lectures
Usually you will have one day of lectures per week, though there are specific weeks for
child/adolescent and old age psychiatry.
Small group sessions/Supervision
During the block there is a program of weekly small group meetings with your assigned
psychiatrist supervisor. Usually you will discuss one topic in psychiatry each week (e.g. mood
disorders) with time left to ask any questions about patients you’ve seen or something
you’ve read that you’re not sure about. In other locations, these sessions are all about
discussing portfolios which can provide very useful feedback before you finally hand them in
(see below).
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Specialist psychiatry sessions
Apart from spending time with your consultant and their team at clinics, on ward rounds etc
you will do:
 1 week on old age psychiatry with a different consultant
 (at least) 1 child psychiatry clinic with CAMHS
 1 ECT (electro-convulsive therapy) session
On calls
You will be expected to do one weekend morning or afternoon and one weekday evening
with the on-call SHO.
“On calls can be a bit hit and miss – for some they are hectic with multiple incidents and
admissions, for others it can be very quiet – for the later take the opportunity to ask your
SHO lots of questions, go and interview an inpatient (and ask the SHO to give you
feedback) or do some work in the library”
Optional speciality placements
During the block you can take the opportunity to arrange (for yourself) time in other
psychiatry sub-specialities e.g. forensic psychiatry, eating disorders clinic, community drugs
team clinic, community alcohol advisory service, perinatal psychiatry etc. Contact details can
be found in the psychiatry handbook.
How is the block assessed?
Portfolios
You have to complete at least 2 portfolio cases using a special psychiatry proforma. Check
your psychiatry handbook for word limits and tips on what to include in each section and
common pitfalls as they’re a bit different to those in other blocks.
“Start your portfolios early - they take such a long time, definitely don't leave it to the last
couple of weeks!“
“Ask the ward staff, they know the best people to talk to”
“Don't be worried if you find a portfolio patient and you don't get all the information you
need in your first interview.. that's normal, usually they aren't going anywhere quickly so
you have plenty of chances to speak to them again, and look in their notes”
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“In writing portfolios remember to include predisposing, precipitating and perpetuating
factors (you’ll know about this then!!) and also think about risks of self harm, harm to
others and whether they may be vulnerable to exploitation by others”
Case presentations
You will have to do 2 case presentations, one by week 4 and one by week 8 of the block.
Only the second one counts towards your overall assessment (so the first one is like a
practice). You can present any patient but normally people present their two portfolio
cases.
“You will need to present cases to your consultant. These pretty much follow the portfolio
template so it’s a good idea to use these patients as portfolio cases and write them up
before presenting.”
Clinical workbook
You will have to complete a set of patient cases in the clinical workbook.
“Carry your clinical work book around with you, especially on call and to ECT and
speciality placements/clinics. You have to get the cases signed off so it’s easier to do it at
the time you see that patient”
End of Block Examination
This is a mixture of MCQs (majority), Best-of-5s and EMQs.
“Use the introductory lectures and psychiatry handbook as the main tools for revision.
‘Lecture Notes in Psychiatry’ is also good for revision too”
General advice from previous students
“Don't feel as though you need to be in for ages everyday; a history can take over an
hour/hour and a half and you are mentally drained by the end”
“All in all, you get quite a lot of free time on psych, use it well - especially before IPE!!”
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“You're in for a full day of lectures once a week so it's just 4 days a week in the
various hospitals. Aim for a full psychiatric history (inpatient preferably) once a week and
that'll be enough”
Books
Get a few basic text books out from either the CSB library or the library at the Caludon
centre. The Caludon centre library also have some interesting psychiatry-related DVDs to
borrow (eg Good Will Hunting etc) if you fancy a way to relax, whilst doing something
educational.
“If I were to recommend one book for psychiatry it would be Lecture Notes in Psychiatry –
it gives a great overview of all the common conditions, and is clear and simply written”
“Oxford Handbook of Psychiatry can be useful to take to clinics – you can look up things
like management, symptoms, conditions etc between patients (this is also a good idea in
GP block)”
“Don’t bother getting out one of those huge heavy Psychiatry texts books (unless you are
super interested in psychiatry) – I did and I didn’t even open it at all during the 8 week
block!”
Safety
At induction, in addition to the usual fire and IT lectures, you will be given a talk about
personal safety, and be given a personal alarm to carry at all times on placement. It is
unlikely you will need to use it but it is worth remembering the following:
“Always let staff know who you're talking to and NEVER take a history in a patient's
room, always in an interview room or common area”
“If you don’t feel confident or safe taking a history from a patient alone, see patients in
pairs, or ask one of the staff to accompany you”
“Trust your instincts when interviewing the patient, and if you feel uncomfortable or
unsafe at any time tell the patient that that’s all you have time for at the moment but
perhaps you can talk to them again later”
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Surgery
There are surgery blocks in both the junior and senior rotation of Phase II. These can be
some of the busiest blocks you will experience. Whilst you are assigned to two consultants,
you will also be expected to attend clinics and surgery in all other surgical specialties. This
means that you need to be a bit more organised and proactive about your learning
experience.
How is the block structured?
The surgical block can be quite different to your previous placements. Theatres are usually
the best place to find your consultants, so that’s usually a good place to go on your first day!
The prospect of attending surgical procedures can be exciting for some, but quite daunting
for others. It is a completely new experience and environment for most students. Here’s
some practical advice to get you started:
“I had no idea what I was meant to do when I was on surgery in terms of where you get
scrubs from, if you have to sign in, what shoes you are meant to wear, what you are
meant to do, how to scrub in, so that could also be useful to find out”
“Girls - do not leave handbag in locker room. Leave in anaesthetics room”
“In theatres, it is best not to turn up and stand in the corner - introduce yourself to one of
the scrub nurses and ask politely if they mind you being there to watch. Enquire about
theatre - who's who, where to stand, times to show up etc”
“Introduce yourself as Mr Blah's medical student to anybody that looks at you strangely,
or everybody if you're really friendly... the surgery lot are (understandably) very protective
of their turf!”
The important thing about the surgery block is that you can spend as much or as little time
in theatre as you like, subject to your consultants’ instructions. The tips we received from
students were the most polarised for surgery, with some recommending spending as much
time as possible in theatre, and others as little time as possible. It depends on what you’re
interested in and what you get out of being there - don’t feel like you need to stand there
and watch all day! The best way to get the most out of being in theatre is to get involved by
scrubbing in to procedures - getting up close helps you learn a lot more! However, you will
need some help initially to learn how to scrub in properly.
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“If you are unsure about scrubbing in - make sure you have someone to supervise you and
walk you through the process, don't feel like any question is too stupid, the smallest
things make a difference with scrubbing in”
“Scrub in whenever you can! Always ask if you can as many of the consultants won’t even
say! “
“Ask if you can scrub in at every opportunity you get, as you won't learn much standing
10 feet away from the surgical site. Another tip is that registrars (in my experience) are
much more likely to let you do small parts of an operation (suturing, drilling, sawing, etc)”
“For surgery I think for those people who aren't that interested in watching surgery, it's
important to watch enough to not offend your consultant but to make it more interesting
revise the anatomy beforehand and always ask if you can scrub in - that way at least you
can see what's going on”
“Expect to be quizzed on the pathophysiology behind the cause for the operation
during/before/after the operation by the registrar/consultant”
There are often long periods of time between surgeries, so be organised and take a text
book along with you to read between cases. Alternatively, be more involved in surgeries by
meeting the patient beforehand so you know exactly what’s going on.
“It may seem obvious but go and take a history and examine the patient before they have
their surgery either the afternoon before theatre or early that morning. The examination
especially is more useful before they have their surgery in terms of clinical signs – eg
hernias, masses etc! It makes watching surgery more interesting if you saw the patient
beforehand and helps for picking up portfolio cases”
“During your surgical block, try to see the patients before theatre, as an F1 you will not be
doing operations but will be doing pre-operative clerking!”
For some students, surgery is a passion and a professional goal so these people will naturally
want to spend as much time in theatre with their consultants as they can. If however
watching surgery isn’t so much your thing, there are plenty of other opportunities to learn
in clinic or on the wards, by attending morning ward rounds and getting involved with the
junior doctors. Time spent here is a better reflection of your job as a junior doctor as you
certainly won’t be the one performing the surgery! Surgical patients are really useful for
practicing many of your clinical examinations with lots of clinical signs. However, if your
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consultant is adamant that you should spend much of your time in theatre, you’ll have to go
with it (or negotiate).
“Don't spend all your time in theatre. It's gory and interesting but ultimately you'll
get far more from ward work / clinics...”
“Don't spend your day standing in theatres if your consultant/registrar isn't teaching
you or letting you scrub in. Probably a better use of time to make notes/see patients
on wards etc.”
“If you can't see ask to scrub in, or cut your losses and leave (providing your
consultant is ok with this) - nothing worse than wasted hours.”
The junior surgery block, including teaching and exams, is organised by Mr Wong who most
students agree is an absolute legend. Throughout the block, you will have lectures about the
common topics in surgery. Most of these are really enjoyable and interactive, and there are
more lecture slides on the surgery website. They won’t unfortunately cover all the topics
you need to know about, so it’s worth getting a book to read. The two that come most
highly recommended by Warwick students are ‘Surgical Talk’ and ‘Surgery at a Glance’.
How is the block assessed?
At the end of the 8 weeks’ junior rotation, there is exam with three components:
1. Written exam with short answer and multiple-choice questions
2. Viva
3. Clinical examination
Whilst this may seem like a lot, it’s actually really useful! The practical and the viva are
based around the IPE exams that you have at the end of the junior rotation of phase II. They
are an excellent opportunity to become familiar with the exam format and improve your
clinical skills, especially as this format is very different to your phase I exams. What makes
these more enjoyable is that they are formative and so don’t count towards final ranking at
the end of the medicine course. If you fail them, you will simply be offered extra support
with your studies.
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Senior Surgery
Senior surgery does not have an end of block assessment and you should have covered most
of the topics in your junior rotation. Your learning experience is therefore going to be quite
different.
“I am on senior surgery at the moment at George Elliot. There are no exams. It is a great
opportunity to get quite a few portfolios done and revise what was covered in junior
surgery. There is quite a bit of teaching which is good to attend for revision. I am finding
it a good opportunity for learning about pharmacology”
“Don’t bother doing ward rounds, ward work, chatting up the F1s. You did all that (?) in
junior surgery. The team won’t expect you back. Instead concentrate on making sure all
your surgical examinations are up to scratch, and you cover all the key aspects. This
means being firm with consultants, only see one of each type of surgery in theatre,
politely say having enjoyed the first cholecystectomy you now wish to ensure you study
etc etc”
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Orthopaedics & Anaesthetics
This block is a bit of a hybrid, and the amount of time you spend in either orthopaedics or
anaesthetics will very much depend on your consultants.
How is the block structured?
You will usually be allocated to one anaesthetist and one orthopaedic consultant with a
timetable to suit both. There is teaching on a set day for orthopaedics, and at regular
intervals for anaesthetics. There is also some teaching on rheumatology which is well
worthwhile for exam purposes as it’s the only exposure you’ll get to this specialty in the
junior rotation. There are also a few practical sessions including plastering and suturing.
Orthopaedics
Your surgeon will be a lower or upper limb specialist, but you need to make sure you get
experience in both, as well as fracture, spine, and paediatric clinics. The latter two are best
arranged with the block organisers, but you can swap between upper/lower limb and
fracture clinics with other clinical pairs. The time spent in surgery/clinics will depend on your
consultant, but try to spend more time doing the things you’re interested in (while keeping
the consultants happy). One of the main difficulties in this block is getting practice of taking
orthopaedic histories and doing examinations. If you’re not getting much chance at this, ask
your consultants – but failing that practice on each other. Don’t forget the histories – you
might not see much of it in the clinics but it is a feature of the OSCEs at the end of the block.
“Go to lots of different upper/lower limb clinics...Swap clinics and theatres with
coursemates- it's great to be able to name 15 different hip replacements, but you need to
get some upper limb teaching too”
“When allocated to a consultant he/she will have a very narrow specialist interest. It’s
important to make sure that you spend time with other consultants or at clinics where a
variety of problems may be seen. There are only so many hip replacements you need to
see!”
“Try to ask as many questions as possible in theatres and if you're still not really getting
anything out of it then tell your consultant (politely) that you're leaving to do something
else!”
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Anaesthetics
There is an online handbook for anaesthetics which contains all the information you will
need. Your experience will probably vary depending on your consultant. Lots of them do
good individual teaching so make the most of that, and try to get as much practical
experience as you can.
“I really enjoyed anaesthetics but there can be lots of time after induction and before
they bring the pt round where you’re at a loose end....bring some revision notes with you,
it’s much better than standing around pretending not to be bored”
Your mileage from the anaesthetics placement may depend for a large part on how
interesting you find the area. To maximise your enjoyment, find out what other roles your
consultant (and other anaesthetists) have and try to get involved – this may include trauma
on-calls, as well as maternity cover or fertility treatment.
End of Block Assessment
For orthopaedics, there are three aspects; the usual assessment form plus written exam and
OSCEs. For us, only the OSCEs were summative, meaning that if you failed you had to sit
extended IPE. These were four stations of five minutes each, with a specific task to do – eg
taking a hip history, examining an elbow (yes, an elbow), screening for red-flag spine
pathology etc. The patients were actors (or more likely Unitemp workers) so it’s important
to ask their age at the beginning as they may be ‘playing’ an elderly person with OA. The
anaesthetic written exam for us was short-answer questions but formative.
There is also a multiple choice exam for anaesthetics, which for us was formative.
Everything you need to know is in the handbook.
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General Medicine Blocks
How is the block structured?
It’s not. Well, it is, but not as much as all the other blocks, and varies enormously between
any student pair. These are the blocks where you really need to keep an eye out for learning
opportunities within your placement and crucially in other specialties.
You will usually be allocated two consultants from separate specialties. Each of these will
have a timetable with a rough idea of what you’re expected to attend during the block.
However, it’s up to you to make your own timetable which keeps your consultants happy
while allowing you to do all the other things you need to do. See Chapter 1 for how to do
this.
Your Allocated Specialties
You’ll work out quite quickly how much you personally get out of ward rounds, clinics and
MDT meetings and there are separate sections in this guide to help. It’s important in your
medical blocks to spend time doing things most useful to you, but balancing this with what
your consultant expects you to do. The Phase II handbook provides the best guide to what
you should be learning from each area.
“When you're doing your general medicine block especially look at the objectives that are
the same subject as your placement firm - if you work through them throughout the block
you'll have some good knowledge under your belt (which will not only make you more
knowledgeable during the block in front of consultants etc, but will prepare you for IPE by
providing you will some revision notes for later)”
During these blocks you may find you get just as much (or even more) teaching from the
junior doctors attached to your firm as the consultants. When you identify a nice helpful
doc, make sure you spend lots of time with them and arrange to help them out with tasks
around the ward in exchange for teaching or letting you present cases to them. If you end
up spending a lot of time with the team, it will get back to your consultant and will reflect
well on you.
“Find out when the registrar or junior doctors in your team are on call and ask to follow
them for the day, or get a bleep and ask them to bleep you when something interesting
happens”
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“Perhaps use these blocks if you are not enjoying them to brush up on your venepuncture
and cannulation skils with the junior doctors on the ward because they will feed back your
attendance to your consultants. And don't get too bogged down in the details, if you don't
know what is important for you to know then - ask!!”
Other Specialties
Make it a priority to find out what specialties the other students in your stream have. It
usually means that when there are specialties within one block to which you aren’t
allocated, you will never have a placement in this specialty. Most probably you have to get
experience of these disciplines in addition to what you’re already doing and no one will tell
you to do so. I can’t emphasise enough how important this is, especially if it’s a block like
Respiratory, Renal or Cardiology which are hard to teach yourself. Missing GI is not the end
of the world as you’re quite likely to get it in the Surgery block – but even then, consider the
non-surgical GI conditions and read up on these. You can get experience of other specialties
by reading about them, by joining other consultants’ ward rounds and clinics, and by seeing
patients on those wards. A mix of these techniques is probably recommended. Swap around
with other clinical pairs to get experience of everything that is going on and everything that
sounds useful.
“During Gen med try not to stick to just your speciality...try and find a nice F1 who will
watch you do histories and examinations and critique them”
“If you are on a general medical or surgical block and are with a specific specialty, don't
be afraid to ask about other clinics to broaden your knowledge and experience - it is
pointless just doing 8 weeks of cardiology clinics and never go to a renal or respiratory
clinic. Ask about specialties' functionality clinics, such as lung function, audiometry,
retinopathy photography or exercise ECGs, etc”
“For senior surgery and senior medicine, try to spend this time concentrating on medicine
topics you haven't had an attachment with, cos you don't do a lot!”
How is this block assessed?
There is no formal assessment, which makes it difficult to judge how much you’ve learned.
Test yourself with practice exam questions – there are plenty of these books in the library.
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Reading
There are so many textbooks to choose from and everyone will have a different preference,
but many students have been recommending ‘Medicine at a Glance’ and the ‘Oxford
Handbook of Clinical Medicine’. The ‘Oxford Handbook of Clinical Specialties’ is also useful
to work out what is essential to know and what is super-specialised for our stage. Case
books (eg Clinical Cases Uncovered or USMLE Cases) are also useful to have up your sleeve
for any waiting times – use them to test yourself or quiz your clinical partner. Don’t forget to
focus your reading using the Phase II Handbook objectives.
“Try to look up or read up on every new thing you see or hear in hospital. This will help
solidify the knowledge so that you are learning as you go along in small chunks. It only
takes five minutes to find the meaning of 'ileus', for example, but saves you a lot of
embarrassment on the ward round if you actually know what the consultant is talking
about when he asks you a question! Besides, you will also feel that your knowledge is
increasing and you will have less anxiety for exams, which is the period when you might
not even remember or have time to look up those 'little things' you always meant to”
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Senior Rotation Stuff
[Ed: Hello, this guide has been compiled by third year students so, although we got lots of
tips from the fourth years, it’s hard for us to make proper sense of them. I’ve included the
tips here in their raw form, but we will update this guide next year when we’ve done this
rotation for ourselves.]
Obstetrics and Gynaecology
“Do a few night shifts on labour ward to see/assist with deliveries. There will be less
students and more women in labour, could save you a lot of time hanging around in the
daytime! Turn up for the midwife's handover meetings (8am and 8pm at UHCW) then all
the midwives on that shift will know you are there and hopefully will let you know when
anything interesting is happening. And try to get assigned to multips!“
“You have a different schedule every week - make sure you talk to the people in your
stream who did the placement in the previous week, otherwise you miss monday because
you're trying to organise yourself (usually by running around the hospital signing up for
clinics)”
“Sign up for labour week shifts early (you are competing for the 'good slots' with other
med students AND midwifery students)”
“Do a night shift as it is much easier to observe the mandatory 5 deliveries than battling
with midwife students during the day time”
“Make friends with the midwife you are following - and ask her lots of questions!! I
learned a lot of 'hands on' information from them (ie. apgar scores, common
complications, fetal monitoring during labour with CTG...)”
“Plan your learning (attendance at clinics, theatre, ante natal clinics, labour ward
experience, gynae clinics) from the beginning - there is a lot you need to see and have
signed off”
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Acute Medicine
“The teaching sessions organised at each trust, be it xray teaching or general clinical stuff,
is usually pretty good so make sure you attend. Ask your clinical team specifically to give
you and your clinical partner some one-to-one teaching on the speciality you are in. They
have a duty to do so”
“For the acute block, resus is a great place to just hang out. You get to see acute
presentations of anaphylaxis, asthma, trauma etc and is great practise for meeting the
end of block objectives”
“My personal experience of Acute Medicine - you work shifts, nights and weekends - it is
therefore difficult to get into a routine and therefore difficult to do any additional work
during the block. That might just be a personal experieince. I thought it was the best
block - you get to practice being a real doctor and interpret symptoms without having
notes to confer with”
“A&E is a great place to learn especially in the smaller hospitals. You can usually find a
junior doctor who is willing to let you follow them and coach you on your history and
examination techniques. It’s also a great place to practice clerking patients in”
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Paediatrics
“Paediatrics has some conditions you've never heard of before - take some time in the
first weeks of the block to read about common ones (bronchiolitis, croup, respiratory
distress syndrome, transient tachypnoea of the newborn, febrile seizures/convulsions,
etc...)”
“Take advantage of great teaching (and watch out - if you're not there, they WILL know
and call you)”
“Find social case early as it can be difficult to find one”
“There is quite a lot to learn - start learning from beginning of block as the last week of
exams is quite intense”
At George Eliot:
“Some people feel a bit left out because the Children’s Emergency Department (CED)
exposure isn’t as intense and you can be left waiting around for pts to come in, which isn’t
very time effective. When you start paeds at GE, go to the switchboard office across the
way from WH Smith and get yourself a student bleep. You can share the bleep between
the four pairs placed there, giving it to whoever hasn’t got clinic or ward round and then
get the reg covering CED to bleep you if and when something comes in....much more time
effective”
At Redditch:
“Placement at Redditch is actually a good thing as it is one of the few times you will have
more consultants than medical students on a block! book accomodation for the block - it
means you can stay at redditch if you have an early/late/weekend shift. It's free!”
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Extra Stuff
Teaching
Apart from the compulsory teaching on many of the blocks described above, there are a lot
of additional sessions at all the hospitals. Those at Warwick Hospital and George Eliot are
particularly good so make the most of these as you never know if you’ll be placed there
again. Make a point of finding out what teaching is going on during your block – including
asking others at the same hospital but in a different stream as some teaching is only
advertised to specific groups. Most of it is extremely good and invaluable for specialties you
might not get to experience. Don’t ignore neurology, rheumatology or specialties which
seem to be more geared towards the Senior Rotation as the IPE exam will still expect
knowledge of these areas. Whenever you see bedside teaching being advertised, sign up
immediately!
“All of the hospitals have additional teaching sessions at lunchtimes – most of these are
really good, so make sure you cover them all during the year (especially renal at UHCW,
even though it’s slightly terrifying)”
“Make the most of the bedside teaching at Warwick - it's great practise for IPE/FPE”
Exam Preparation
Everyone has their own preferred method of revision, but we asked the fourth years for
their top tips on passing ICE (as was)/IPE. There were a few common areas that came up.
The first was about making notes during the blocks, and using the handbook objectives as a
guide.
“Getting the objectives done: It helps to have comprehensive typed out notes for each of
the objectives in the phase II blue book but there are so many that it is very difficult to get
this done on your own. Get a small group of two or three friends and agree to share you
notes. If you make sure you trust the work of whoever you pick and that there is
agreement nobody outside the group will get the notes everything should run smoothly.
You will have to start this very early in phase II (block one preferably!) or else there just
won’t be time, but it will be worth it when you get to finals”
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“Write notes which you can use before finals - you will thank yourself later (this goes for
all specialty blocks...)”
“Go through the handbook objectives as you go and make notes - if you cover material in
JAHD, lectures, etc write a page to revise from and tick it off your objectives”
“Make lists for causes of each of the presenting complaints at the beginning of each
chapter of the handbook – it’s good practice for exams and also when consultants
randomly quiz you about haemoptysis...”
“For every condition you study, make sure you have a snappy answer to the question
‘and what’s the pathophysiology of that condition?’ – this is needed for IPE clinical exams
but isn’t really covered by the handbook objectives”
It appears that patient contact is just as important as written work for the IPE exams
(Deborah Markham would argue that it’s more important). You have to be confident and
efficient when talking to and examining patients – the examiners will be able to tell when
you haven’t had much practice.
“When preparing for ICE/finals take histories with your clinical partner, take it in turns to
do history and examination, present the case to each other (or a helpful F1) and come up
with some differentials. Then ask each other questions on pathophysiol/management
etc. Stick to the appropriate time you will get in the clinical exams for Hx/Ex (e.g. finals
10 mins Hx, 5 mins Ex)”
“Just talk to patients, check the objectives, don't just sit (re-)writing your own textbook,
just try and get a picture in your head about what someone might look like with
disease/condition”
Finally, time-planning seems to be the most important factor in the written papers.
“Most people in my [4th] year who didn’t do great on the MCQ paper just messed up the
timing. Get a subscription to onexamination.com at the beginning of phase II (the one
called “Medical student years 2 to 3 is what I used for IPE) and start practicing questions
early whenever you have time (while watching Eastenders is fine!). By the time IPE
written comes around you will be so relaxed about MCQs you will sail through”
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General
Here are some more general points which didn’t fit into any of the above sections:
“Be punctual”
“Be enthusiastic, you will get out of a placement what you put in”
“BE PROACTIVE! :) don't just do the stuff your consultant does!”
“On day one of the block, chat up the secretaries. Make them feel appreciated, and make
them remember you. Handy in so many ways”
“Always say thank you if someone helps you, manners cost nothing - this includes patients
and staff. You are now a part of the NHS and as such will be remembered by patients make sure it is for the right reasons!”
“Always look professional, because you never know who you might meet and first
impressions matter even in medicine. Do not try to see what you can get away with in
terms of dressing. Looking smart helps your confidence and influences the way patients
and staff perceive you”
“For the wards etc - girls.. get a little over the shoulder bag big enough to put the pocket
OHCM, your stethoscope, pen torch, small note pad and paper.. and a drink!! it can be
difficult to find time to get to a tap/canteen etc especially in clinics so take a drink around
with you.. keep hydrated!”
“If you need to find out which hospital you are going to be in the next block, the
Undergraduate Coordinators at each site know provisional placements well in advance of
us being told...“
“Own your space. You may feel when you start Phase II that you are always in the way
and be shoved around from one corner to another. So, own your space. We are medical
students, we have paid to be there. Yes, more often than not we will be in the way and
consultants/doctors may think you are a bit of a pest, but by being there is the only way
we will learn. So stand there with pride, offer to do things and be confident. The more
confident you come across, the more you will be asked to do something and the less you
will be in the way”
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“Oh also just a general heads up that the first block is gonna be a bit weird and med
students will get in the way and will become experts on loitering in the corridors”
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