Electives at Home: A Vote of Confidence
When I was a first‐year medical student, and heard that in our final year we had an elective placement that could be taken ANYWHERE in the world, my imagination ran wild. I had grand ideas about going to a tiny village in a developing country, where medical care was scarce and I could really make a difference to people. Fast‐forward five years, and unfortunately life (and finances) get in the way of even the best laid plans. So it was with some regret that I decided to stay in Australia for my elective. However, from the first day of my elective in the Emergency Department of the Epworth Hospital in Richmond, any regret I had melted away, and I knew I had made an excellent choice.
From the minute I began my elective placement, I immediately felt like part of a team. The doctors treated me like one of their own, and the nurses were happy to have me there and help me out. If I had a difficult patient there was always a senior doctor available to ask questions, run through differential diagnoses and discuss complex treatment issues. As a medical student, I have at times become used to feeling like I am in the way, with doctors being too busy to teach or listen to me. At Epworth, I never once felt like this. I was treated like an equal member of staff whose inputs were relevant and valuable.
This does not mean, however, that I did not receive any teaching. I was surrounded by consultants, most of whom love to teach, but who, working in a private hospital, see relatively few medical students. Indeed, I was the only medical student for the entire four week elective period. Thus, I had a virtual smorgasbord of Emergency specialists all eager to teach me. Consultants had time to listen to a long case, to run through my differential diagnoses, or to sit down with me and give me a one‐on‐one tutorial on ECG interpretation or arterial blood gases. I also got personalised tutorials on common emergency presentations such as syncope and chest pain. I doubt I will ever receive such personalised and comprehensive teaching again in my degree or career, and feel so lucky to have had this opportunity.
Despite working within a supportive team and receiving teaching, I was still given a good degree of independence at Epworth. I was allocated patients to clerk and examine, to select appropriate investigations, and to formulate a management plan. I then discussed the case with a consultant and made additions or alterations as required. The best aspect of this was that the consultants would actively listen to me and give me real feedback. They gave me criticism when it was due, but for the most part this was constructive and followed up with a mini‐tutorial or written guidelines. And for one of the first times in my degree, I received positive feedback. Consultants would actually take the time to congratulate me on my skills, my records or management plan. For the first time in this course, I began to have confidence in myself. Just maybe I could actually be okay at this doctor thing?
Furthermore, I gained confidence and competence in a variety of clinical skills. On my first day, I assisted a consultant in suturing a scalp laceration. Later that day, I was suturing the same type of laceration alone. My IV cannulation success rates increased from around 30% to close to 100% within the first week, and inserting a urinary catheter became an everyday practice. The mantra “watch one, do one” became real to me as I learnt to quickly adapt my skills to the technique I had seen. The doctors trusted me to perform these procedures alone. It was a responsibility that was perhaps a little daunting on the first day, however it was also a vote of confidence. As the doctors placed their trust in my skills and judgements I gained new confidence in my abilities. These may seem like minor procedures that any student will get to practise at some stage, however I was also lucky enough to be involved in a wide variety of other skills in cooperation with more senior staff. This included basic airway management, joint relocations, abscess drainage and anaesthetic field blocks. Furthermore, I was able to follow some of my patients from Emergency to other departments. Hence, I was able to assist with the coronary angiogram and stent insertion of a patent who presented to the Emergency Department with an acute myocardial infarction.
On one occasion, when I followed such a patient into the catheter laboratory, the patient had a cardiac arrest. The Medical Emergency Team was called, and the nurse coordinator told me to start alternating with another staff member doing chest compressions. I could barely believe my ears. Me? The medical student? Adrenaline coursed through my veins. Then I realised I have been trained for this situation, I have done countless chest compressions on plastic models, I am prepared. And so I calmly took over from my colleague and used the skills I had so diligently learnt, patiently counting the compressions as I went. Afterwards, the nurse coordinator took me aside to congratulate me on my technique. To this date I have never received such rewarding feedback. Although I hope never to need to use that particular skill again anytime soon, it is comforting to know that if the situation arises, I can manage it.
This elective isn’t for people who want to spend four weeks lounging on a tropical island. It was hard work, but it was rewarding work both professionally and personally. I had many opportunities to practice my clinical skills, and I learnt a lot about myself and my ability to cope in a variety of situations. And, for the most part, it was a lot of fun too.