The Jump from Preclinical Medicine to Clinical Medicine

I have alluded to the vast differences in life during third year, as compared to the first two years of university, in my previous posts but now is the time to delve into the nitty gritty details of third year. I know this comes on the background of weeks of inactivity on my blog, after specifying how proud I was for keeping it up while starting up university. Still, amidst a global pandemic and going back to university life, I am lucky and blessed to be here at all to share my thoughts. Let’s talk about the jump from the preclinical years of medical school to the clinical years.


Everyday Life

Life is just different! And I have to be honest, I’m not sure how positive the differences are.

To tell you the truth I’m nostalgic for university life; for Oxford road in the torrential autumn/winter rainfall, for Morrison’s meal deals in Stopford library, for breaks in between lectures spent laughing the whole time and trying to fill in stuff you missed. I mean, I know this whole year has been a very different year and I think preclinical students actually got the short end of the stick having to do traditional university during the pandemic, but that doesn’t detract from the fact that I miss it.

Going into hospital three or four times a week was such a novel concept at the start and I felt totally incapable of being a “proper” medical student but it’s something I’ve gotten used to. Also, it’s not always going on wards or to clinics and we do have specific teaching sessions still, which are a little bit more reminiscent of preclinical medicine, though we don’t have a whole lot of these sessions.

One thing that’s been a stark change for me this year is making lunch for myself every day. If you knew me in first and second year, you’d know that I ran on chocolate bars and meal deals and Sainsbury’s pizza rolls. With the lack of extensive food choices at many of the hospitals I’ve been to, I’ve resigned to taking my own food. My body and bank account thank me for it every single day, but I’m not convinced.

Clinical Practice

The whole point of clinical years means getting clinical practice. And boy, have I been clinically challenged these past three months.

Firstly, speaking to patients has become a lot more clinical as opposed to the more abstract conversations we used to have about feelings. Not that abstract conversations were bad, because the stuff we’ve learned now really compounds on top of the things we were previously taught, but now the focus is on diagnosing. This has been fun for me. It’s truly a form of detective work going through the clinical reasoning and understanding why you’re asking the questions you’re asking.

Beyond that, every history should be reinforced with an examination. Gone are the days of distinctly separated histories and examinations because they come as a package deal now. It makes complete sense, of course, just threw me off a little bit. I will say, the more you do examinations, the better you get at them and the slicker they become. It’s blatantly obvious to everyone when I do an examination I’ve practised a lot vs one that I always avoid.

Having the opportunity to do procedural skills has been one of the more exciting aspects of this year. This is the classic hands-on stuff we’ve been dreaming of for years. I would say one of the most fun skills to do is venepuncture because taking blood is such a thrilling concept. It’s almost always a challenge so it’s satisfying when you get it, and when you don’t, you can comfort yourself with the knowledge that you’re only in third year.

The last point I wanted to make in this section was about being grilled by consultants…

This one is a sticky one. In all my experiences so far, I really don’t think it’s been that bad. This was one of the things I was dreading coming into third year, but I believe the idea of it is scarier than being in practice and experiencing it. All the doctors that I’ve been grilled by have been very friendly and not made me feel ashamed if I don’t know something, which is all I can really ask for. On that note, I also feel a lot more comfortable saying I don’t know now. Something about the challenges we’ve faced this year has made me a little bit less worried about being honest.

However, the one point at which it really is hard being grilled by doctors is when you truly have no clue what’s going on. Normally you can wing it in most cases, slip in a cheeky FBC if they ask what investigations you want to do next or go for a safe imaging option (X-ray, CT, ultrasound, etc.) but when they’re asking very specific questions about a niche disease you’ve not even seen on those medicine-related Instagram pages, you know you’re screwed. Still, honesty is the best policy and it’s okay to not know the answer!

Forms

Now, I’m not sure how other medical schools measure attainment in clinical years, but at Manchester we have a set number of forms to fill out per block, on patient assessments, physical examinations, clinical experiences and procedural skills. Some of them need to be signed off by clinicians who watch you while you do certain things and sign you off and give you feedback to improve, while others you can fill out yourself.

This year, forms are formative (i.e., they do not need to be completed in order to let you progress to next year) due to the pandemic making it more difficult to see patients, but obviously you need to show that you’re still achieving things and trying skills. Even despite all that, it can still be stressful trying to fill forms out and find the right people who can sign you off, which is less of a problem at the big base hospitals but can be more difficult at District Generals.

Also, I’m sure this is not just my experience, but with forms I feel like I can get a bit of tunnel vision. Sometimes I start prioritising signs offs more than the actual experiences so I’ll spend all my time trying to get one thing signed off, while simultaneously shunning three other good opportunities that I don’t necessarily need signed but would be good anyways. It’s not a major concern honestly, and I’m glad forms are formative this year, so there’s no worry with certain blocks where there’s less of a chance to get things signed off.

Travel and Commuting

Me and my car have become very accustomed to each other this year. We’ve conquered motorways together, multiple dark nights driving home from the hospital and sticky parking situations.

I’ve been very blessed this year that I have a car and I can get to hospitals quickly and easily. I also think I’ve been quite lucky with the placements I’ve gotten because they’ve not been too far from me and it hasn’t taken me too long to get around. I was commuting for much longer during preclinical years because it took me just over an hour to get to university from my house and that really did have an effect of my university experience. Overall, this has been a huge plus for me this year, and it’s only hit me recently how drained the commuting was making me these past two years.


I’ve rambled on enough for today, I think. I’m excited to be back on the blog and I hope to be posting a little bit more regularly once again in the new year. Life really just has the habit of getting in the way.

How has this academic year been for you so far? What has changed and what are your thoughts on the changes?

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