Show Summary Details
Page of

Making the most of medical school 

Making the most of medical school
Chapter:
Making the most of medical school
DOI:
10.1093/med/9780198836308.003.0016
Page of

PRINTED FROM OXFORD MEDICINE ONLINE (www.oxfordmedicine.com). © Oxford University Press, 2021. All Rights Reserved. Under the terms of the licence agreement, an individual user may print out a PDF of a single chapter of a title in Oxford Medicine Online for personal use (for details see Privacy Policy and Legal Notice).

date: 27 October 2021

So you’re going to be a doctor . . .

Congratulations—you’ve made it! Having achieved the difficult task of getting in, you can now look forward to spending the next few years living, studying, and socializing at university. University can, and should, be one of the greatest experiences of your life, provided you get off to a good start. Unfortunately, many new undergraduates are ill-prepared for the realities of university life and enter with a mindset that is uninformed and unsustainable. There can also be practical hurdles to catch out unsuspecting ‘freshers’, from mix-ups with the Student Loans Company to sitting degree-level exams for the first time.

This chapter offers an insight into university life, as well as advice on how best to settle in (see p. 334). There are some tips for learning (see p. 336) and living (see p. 340) as a university student, which can be different from even the most independent A level student experience. These pages will also be relevant to medical school applicants who have not yet secured a place, as they paint a picture of life as a medical student. Finally, the importance of early career decisions will be covered—taking a step towards your possible future medical career as a doctor (see p. 344).

There’s a lot to learn about medicine at medical school. However, there’s also a lot to learn about how to be an effective medical student. The Oxford Handbook for Medical School (published by Oxford University Press) provides everything you need to get off to the best possible start at medical school.

What will university be like?

Everyone has a different opinion about what university is like and you will hear various descriptions of students, from being lazy and hung-over to studious and nerdy. The accounts will depend on the storyteller’s own personal experiences and prejudices. Of course, the truth is somewhere in between.

University life will probably be different from your student experiences so far. Not only is the material delivered in a different format (see p. 336), but you are likely to be one of the many students who are living away from their parents for the first time (see p. 341). It is worth remembering that you will not only be a university student studying for their degree but also are a doctor in training. This adds an additional dimension to your learning experience and one that is different from students in other disciplines. With all this change happening at once, starting university can be a daunting time. The key to success is finding your feet early on (see p. 337) and knowing what to look out for and what to avoid.

What can I look forward to?

  • Making friends If you look past the horrible cliché, you may begin to appreciate the fantastic opportunity that starting university offers. This is the largest and most diverse group of people you will ever meet. Starting university is a great opportunity to expand your horizons and form a new group of interesting friends, some of whom you will stay close to for the rest of your life.

  • Joining the profession You’re not only a medical student, you are a student doctor. This is reflected in your course content, which includes both professional and academic content (see p. 338). With the status of joining the medical profession comes significant responsibility for you as a student doctor, even at this early stage (see p. 342).

  • Life skills Although this is likely to be your first experience of living away from home for a long period of time, you should seize the opportunity to gain independence. University is a time for maturity and developing a sense of personal identity.

  • New beginnings One of the best things about university is the genuine opportunity to be yourself. The cohort of students are less likely to be judgemental than your school colleagues—so if you’ve held back in your academic, social, or personal life, this is your chance to show your true colours.

What should I avoid?

  • Solitude Homesickness is common when starting university, as is the fear of not fitting in or finding any close friends. Often this is something you can get through together with the friends you make during Freshers’ Week (who will inevitably feel the same).

  • Excessive debt With the amount of financial support in place for university students, you shouldn’t struggle to live comfortably, provided you are sensible with your finances (see p. 14). Debt is inevitable after completing a medical degree, but careful spending can limit the final bill.

  • Alcohol Students are not exempt from the excessive drinking culture of ‘Binge Britain’. It is worth remembering that doctors suffer one of the highest rates of alcoholism of all the professions. Medical school is a time to form a healthy relationship with alcohol. At best, a heavy night risks wasting the next day through the haze of a hangover. At worst it can result in death or severe injury (spend any Friday night in A&E to witness this first-hand). Drunken misdemeanours can also bring students to the attention of their institution’s Fitness to Practice Committee. You do not want a written warning on record for the rest of your professional career. So, if you are partial to an alcoholic beverage, learn self-restraint early.

  • Sex Freshers’ Week is all too often the source of regretful one-night stands, fuelled by the excitement of independence and cheap alcohol. It is worth bearing this in mind when you start university.

  • Recreational drugs The GMC (not to mention the law) looks very dimly on drug abuse and you risk ending your career before you’ve even qualified. Being a student does not absolve you from your responsibilities as a citizen or as a professional in training.

  • Resits Exams are an inevitable part of any university course and provide an opportunity to assess how well you are learning the subject. They represent another milestone and a step closer to becoming a doctor. However, you do need to prepare early to avoid resits. There is a limit to the number of times you can repeat medical school exams: usually once unless there are exceptional circumstances, after which you may be asked to repeat the year or leave the course.

Starting university

There are often mixed emotions when starting university. Parents may be upset about releasing their ‘child’ alone into the world for the first time. Students themselves may experience a mixture of excitement at the prospect of new experiences and anxiety that it will fail to ‘work out’. In fact, you will probably find yourself looking back fondly on the emotional rollercoaster of starting university only weeks after arriving, having happily settled in and dispelled any misconceptions that you had formed. The following will hopefully help you to reach this sense of nostalgia more quickly.

Arriving at university

You should receive specific instructions by post, telling you where to go and what to do on your first day. Most first-year students arrive a week before academic term begins, which provides an opportunity to participate in a week of activities (Freshers’ Week) organized solely for them.

You will probably need to exchange paperwork with the university authorities when you first arrive. Successful completion of these administrative challenges is rewarded by a room key, map, and timetable. The timetable will be useful for finding out when and where you need to be for various academic introductions and social gatherings. You can then begin the arduous task of unloading a car full of belongings into your new room (if you have been successful in persuading your parents to offer their services—highly recommended!).

Settling in

You will find it a lot easier to settle in if you are well prepared with all of your everyday necessities.

  • Bedding It’s best to check what will be included with your accommodation before you arrive, but most students prefer to bring their own pillows and duvet covers.

  • Home decor Student rooms aren’t renowned for their palatial furnishings, so it is worth bringing a few home comforts: pictures, cushions, throws, and beanbags. There are often poster sales that run during Freshers’ Week too.

  • Entertainment Remember that you will be spending a fair amount of time in your halls of residence, so it’s worth bringing along something to keep yourself entertained when you have a moment to relax. Books, speakers, tablets, headphones, musical instruments, and sport accessories can offer useful respite (if used judiciously).

  • Documents Remember to bring important documents that the university/medical school will need to see prior to you starting the course. This may include student finance/Local Education Authority letters, criminal record (DBS) checks, and vaccination forms. Photo ID (driving licence/passport) is often necessary for banking matters and has a role in proceeding past doormen at local bars and clubs.

  • Computers All universities have significant computing resources for their students, but it is helpful to have access to a computer in your own room. A laptop has the added benefit of portability, which will be useful for clinical attachments. You won’t need anything too advanced—most medical students use their computers for creating documents and slide presentations, checking their email, and browsing the internet. Don’t forget to look for student deals on computers and software, and university grants can help to contribute towards the cost (see p. 16).

  • Clothes As a medical student you will need a smart wardrobe for working on the wards and in general practice, as well as day-to-day clothes. The NHS has a ‘bare below the elbow’ dress code, meaning that sleeves must be rolled up (or short-sleeved shirts worn). If you choose to wear a tie, it needs to be tucked into the shirt or worn with a tie-clip so as not to hang loose. Also bear in mind that your wardrobe needs to (ideally) see you through the entire term at university. You may require a lounge suit/cocktail dress or black-tie outfit/ball gown at some point, but this decision can be deferred to a time when your social calendar has become clearer after the start of term.

  • Bike At some universities, cycling is a common mode of transport. Visiting on an open day will have helped to determine whether a bike would be useful. If you do take one, remember to bring a heavy-duty bike lock, helmet, and lights.

  • Don’t forget . . . Towels, coat hangers, lamps, extension cables, kettle, crockery, cutlery, cookware, washing-up cloth, tea towels, Blu-Tack®/drawing pins, stationery, and tea/coffee. A 16–25 Railcard is an immensely valuable investment, offering one-third off rail journeys for £30 a year, and all students are eligible. If you have to wait for your bank account to be activated, bring enough cash to last a couple of weeks.

  • Storage space Storage can be limited so you should avoid bringing too many needless extras before you know how much space is available. Find out whether you have to move the contents out of your room between terms.

Fresher’s week

Every year around the middle of September, freshers (another word for first-year university students) across the UK begin a week of activities, organized by the university and student committees (e.g. JCR, MedSoc). Whilst most activities are voluntary, they are often great ways to get to know your colleagues as well as your surroundings, and are definitely worth attending. You will also gain a better idea of the services and facilities that are available. Look out for the societies fair, where you can join one of the hundreds of societies covering every conceivable interest. You may also get university ‘parents’: students in the years above who will be able to dispense their advice (of variable quality). Rumours about medic initiations can often run rife during Freshers’ Week and it is common for students to feel anxious about what they may be asked to do. Suffice to say, you should only take part in what you feel comfortable with, whilst not forgetting your professional responsibilities. Your first visit to hospital as a medical student shouldn’t be for intoxication.

Learning at university

There are fundamental differences between the teaching at sixth form and in higher education. The uniqueness of higher education requires a new approach to learning.

How is university education different from A levels?

  • Content It goes without saying that the material you will cover at university will be different. In fact, it’s not just the details of each subject that will be new to you but the way in which subjects are pursued. Lectures offer a starting point to help you read around the subject, so the learning is more self-directed. You will develop a deep understanding across a wide range of topics relevant to medicine. Such breadth and depth can seem daunting at first.

  • Resources Unlike your sixth-form education, you will spend a great deal of time reading material from textbooks, journals, and websites.

  • Teachers There will be ‘teachers’ at university but their role is less obvious than at sixth form. They may deliver lectures, lead practical classes, or oversee problem-based learning (PBL) presentations but, unlike high school, they will have other commitments in their area of expertise. This might include leading a research team or working full-time as a doctor. As a result, they are better seen as a resource for clarifying uncertainties than a source of spoon-feeding. Textbooks and online resources are your new best friends.

  • Dynamic curriculum Medicine is constantly changing, from the understanding of the basic sciences (e.g. how the brain works or the pathophysiology of heart failure) to clinical developments (e.g. chemotherapies in cancer treatment or the indications for a particular operation). This information comes from ongoing research, so your lecture material is only ever a snapshot of current knowledge. Students must be aware of new research findings and gaps in medical knowledge, as well as the details that are understood.

  • Professional dimension Unique to medical students are the legal and ethical elements of your role as a future doctor. These require additional teaching to reflect the social implications of implementing biomedical knowledge.

  • Exams The exams you will take during your preclinical and clinical years will depend on the university at which you study. They are likely to include the following: multiple choice, short answer, essay, and practical questions (based on lab data, histology slides, and pathology specimens) and prosections (anatomical specimens from which you are asked questions). Clinical exams include mock interviews with actors, clinical examinations of patients with diseases, and practical clinical skills (e.g. taking blood from a plastic model). You may also be exposed to oral examinations (vivas).

An insider’s view …

Perhaps the biggest difference between medical school and high school is the human element. Medicine is a pragmatic application of scientific principles, requiring effective communication with each patient in view of their psychosocial context. This requires a professional awareness and emotional maturity that medical schools must impart to students before they graduate.

What will I learn?

Medicine is a broad subject, which is taught in a variety of ways (see p. 92).

  • Basic clinical sciences Traditional courses focus their preclinical teaching on the individual subjects upon which medicine is based. This includes everything from biochemistry to psychology.

  • Systems-based courses These teach the important principles of each subject in a series of lectures that are linked by a common set of organs. For example, studying the renal system will involve understanding the physiology of the normal kidney, visualizing the anatomy of the urinary tract in the dissecting lab, gaining an appreciation of the congenital and acquired diseases that affect the kidney (via pathology and genetics), and learning the pharmacology of drugs that act on the kidneys.

As you can see, by the end of the preclinical years, students from all types of course will have a similar understanding of how the body works and what can go wrong. This enables them to focus entirely on its pragmatic application on the wards in the clinical years.

  • Clinical attachments After a few years of book learning, medical students begin their full-time clinical attachments. Up until this point your clinical exposure could have been anything from once a week to bi-annual patient contact, depending on your type of course (see p. 92). In the clinical years most students are assigned to medical or surgical teams in hospital, for four to eight weeks at a time.

A student’s experience …

I found it quite difficult to immerse myself in the esoteric detail of my preclinical course, which was taught as basic clinical sciences. It is difficult to see the immediate relevance of lectures when you are learning about the intricate molecular interaction between oxygen and haemoglobin. I found this depth of study made it particularly challenging to stay focused during my revision. Fortunately, I am now in the clinical stage of my medical course, studying the subject I originally signed up for. It is a lot more enjoyable when there is a clear purpose to your efforts.

How will I learn preclinical medicine?

The following teaching methods are used to different extents, depending on your course type (see p. 92). However, most courses include at least some of each type.

  • Lectures One speaker usually teaches the entire cohort of medical students for 50 minutes. The size of the audience therefore depends on the medical school, but it can be over 300. The format is often a slideshow presentation and, if a handout is provided, this may be a printout of the slides or notes to accompany the lecture content. Your decision to take notes will depend on the quality of the notes you receive and how well the textbooks cover the same material. Remember, lectures are fantastic for grasping principles for the first time, but the minutiae can often be found elsewhere, so don’t worry about catching every word.

  • Seminars Smaller groups, usually between 10 and 30 students, are taught by one tutor. There is usually an element of participation, either through small-group exercises or direct discussion between the teacher and the group. Seminars are often used to reinforce important topics or teach discursive subjects such as law and ethics.

  • Problem-based learning (PBL) cases The number of PBL cases you will complete will greatly depend on the type of course (see p. 92). PBL cases usually take place over a week in which a small group (eight to ten students) are given a problem/clinical scenario to learn about independently. The group reconvenes at the end of the week to share their findings.

  • Dissection Human cadaveric dissection is increasingly being replaced with the use of pre-prepared prosections (professionally dissected specimens) to teach anatomy to medical students. However, full cadaveric dissection is still found at many medical schools. Others use prosections, plastinates (prosections that are solidified), plastic models, or electronic methods of teaching anatomy.

  • Practical classes During your preclinical education you are likely to encounter various practical classes in order to further understand physiology, biochemistry, pharmacology, and histology. Practical skills are often neglected by medical students, who see them as an enjoyable escape from intense lectures. Whilst they are often enjoyable, they are also examinable and offer easy marks at exam time provided the material is well understood and time is invested in producing a complete workbook.

Key points

Every subject has a list of aims and objectives that you are expected to complete by the end of the course. It is useful to familiarize yourself with these before beginning the relevant lectures or laboratory classes. This can help you concentrate on the material that is examinable (i.e. the aims/objectives) and focus your attention on ‘high-yield’ information.

How will I learn clinical medicine?

In many ways, clinical attachments are like apprenticeships. Groups of medical students (usually between two and eight) are assigned a clinical ‘firm’ to ‘shadow’. You may follow a ward round and even write in the patient notes. Your firm’s doctors will run clinics in which they assess outpatients and determine their management (e.g. considering a patient for surgery or altering their drug treatment), which you can also attend.

  • Good manners You must always remain polite, especially towards patients. Your kindness towards them will often be reciprocated by their permission to allow you to examine them or perform procedures.

  • Lend a hand Don’t be afraid to get stuck in. Practical tasks on the wards always need doing and you will be actively contributing to the running of the ward. Ask if you need help, only do what you are comfortable with, and never expose yourself or a patient to risk.

  • Attending theatre You should receive an introduction to surgery and theatre etiquette before beginning your first surgical attachment. There is a strict hierarchy within the operating room, with the scrub nurse placed squarely at the top! Introduce yourself to the whole team as soon as you enter an operating theatre. Ensure that everyone is happy with your attendance, and not just the consultant. Ask where they would like you to stand and be careful not to touch anything within the ‘sterile field’.

  • Scrubbing in This can be a useful experience if the surgeon is willing to teach in theatre. However, be warned: surgery might look exciting but it soon loses its appeal after the fifth hour of holding a retractor in position. Although you must experience assisting (especially if your consultant says you should), your time could often be better spent elsewhere. Ask your consultant if you feel you could learn more from seeing patients on the ward or in clinics instead.

  • Attention to detail Good students soon learn that there is a wealth of detail they can never hope to master if they want to pass their exams. You won’t face a question in finals on dosing regimens of anti-retrovirals, so learning them is not a good use of time. Learn what interests you but remember it is a strong grasp of basic knowledge and underlying principles that will get you through the exams.

  • Books or patients? It’s difficult to achieve the right balance between clerking patients and learning theory. Clinicians will encourage you to take histories, examine patients, and consider their management. The ability to diagnose patients cannot be achieved from books alone. That said, it is easy to overlook the quantity of information you will need to know for your clinical exams, so it is important that you strike the right balance.

  • Asking for help Don’t be afraid to ask. You can do almost anything with appropriate supervision—ask someone to teach you. You are there to learn.

An insider’s view …

He who studies medicine without books, sails an uncharted sea, but he who studies medicine without patients, does not go to sea at all.

Sir William Osler, a Father of Modern Medicine

Living at university

If the different style of learning at university wasn’t enough for you to get used to, living as a student will definitely require pause for thought. Many students find themselves having to manage finances, maintain a work–life balance, and look after themselves for the first time. Hopefully this transition to independence hasn’t come all at once but, if it has, you are certainly not alone. The advice in this section should make this transition easier and point you in the right direction should you come across any difficulties.

Money

Pages 14–16 covers the cost of medical school in detail. Suffice to say you will be spending in the region of £160–£300 a week on tuition fees, rent, and living costs. The first two are fixed, but the estimate of living costs is very dependent upon your lifestyle as a student. The lower boundary doesn’t prevent you from socializing, nor does the upper estimate guarantee you stardom within the upper echelons of the university high life. You will need to determine your weekly budget early on. Every so often, it is worth checking that your ‘books balance’, to ensure you are not overspending.

Should you run into financial difficulties, you have several options to consider after parental contributions have run dry. You could seek a larger loan through the Student Loans Company if you are not already claiming the maximum amount. If your circumstances have changed, you may be eligible for reassessment or perhaps a grant/bursary from the university. You could consider a part-time job, but beware that this does not interfere with your education. Professional trainee loans of up to £25,000 are another option, but the interest rates are often high and should be avoided if possible. Credit cards should be avoided at all costs as these debts can increase dangerously due to the high interest rates.

Key points

Should you find yourself in excessive debt, you need to reassess your current expenditure to avoid making the situation worse, as well as prioritize any debts you have to pay. Do not ignore the issue. Seek advice from pastoral tutors, students’ union services, and/or the Citizens Advice Bureau.

Health

Whilst learning about the ills of others and how to treat them, it’s often easy to overlook your own health. University offers a bewildering array of hazards, from fresher’s flu to alcohol intoxication. Moreover, the intensity of the course makes it easy to become run down, and it is therefore important that you register with a local GP.

Make sure you inform someone if you are feeling particularly unwell and be alert to any signs of danger (in yourself and your peers). For meningitis, these may include headache, fever, vomiting, stiff neck, drowsiness, avoidance of bright lights, and non-blanching bruises.

Central to your health is your mental well-being. Whilst the overall incidence is low, doctors have one of the highest rates of depression, alcoholism, and suicide of any profession. There are various services on hand including your GP, welfare tutor, and university pastoral support services. The Samaritans can be contacted 24 hours a day on 116 123.

Key points

Beware the phenomenon of the hypochondriacal medical student. As you study disease every day, you may begin experiencing symptoms or recognize a rare syndrome in yourself. This is normal and local GPs expect a steady stream of concerned medical students throughout your course. Fortunately, this wears off and you are less likely to self-diagnose Kartagener’s syndrome or bubonic plague after the third year.

Work–life balance

Maintaining a work–life balance is an issue that arises for every student and medics are no exception. With so much to condense into a short period of time, you quickly risk being overrun with lecture handouts and an ever-growing reading list. Two extremes of students can materialize. One stays up until the early hours in a vicious state of catch-up, trying, often with limited success, to cover everything. The second stacks their workload for the coming holidays, admits defeat, and concentrates on socializing. Neither is an ideal strategy for success.

It is nearly impossible to be familiar with all of your course materials at any one time during term. More importantly, it is not necessary. If you are examined regularly (via modular tests), then there is a limited amount of information you must know for each test. Otherwise, simply concentrate on having a good understanding of the principles of your subjects and addressing the difficult concepts whilst the material is fresh in your mind. It would be foolish to begin learning esoteric details for an exam that is nine months away.

Adopting such a strategy should give you enough time in the day for personal respite. How you choose to utilize this is entirely up to you, but free time need not be unproductive. It is possible, even at this stage, to take up enjoyable activities that can be directed towards your medical CV later on (see p. 345).

Hobbies and interests

Application forms for medicine are teeming with extracurricular activities and voluntary services that are often impossible to continue to the same extent at university. Medical schools look for this breadth to ensure students can deal with demands beyond the A-level syllabus and have coping mechanisms that are adequate for the pressures of medical school.

Finding a life outside of medicine is essential to the health and well-being of student doctors. Whether it is a morning run, working for a student newspaper, or being a committee member for the medical society, you will find it difficult to cope without some type of outlet. You may wish to continue a hobby from your school days or pursue a completely novel interest that has caught your eye during Freshers’ Week (see p. 335). Just make sure you have something that you can regularly participate in, which takes your mind off the workload.

An insider’s view …

It’s not unheard of for a medical student to work themselves into ill health. Previously top A level students can arrive at university with an unrealistic level of academic standards, and their downfall is precipitated by a failure to establish a network of friends or develop interests outside of medicine. It is important that new medical students possess the coping mechanisms to overcome the difficulties they may face and seek assistance when necessary.

A day in the life of a student doctor

The following entries give you an idea of the day-to-day life of a preclinical and clinical student. Note there will be some differences between course types (see p. 92) and the exact content of the lectures will obviously depend upon how far you are into the course.

A day in the life of a preclinical student …

08:20

Get out of bed after hitting the snooze button for the fifth and final time. No time for breakfast. Run for the bus to the hospital. Just miss it . . .

09:05

Creep into the back of the first lecture, the third of six lectures on the hypothalamic–pituitary axis. Need to read about this later, as it goes completely over my head!

10:00

The next lecture is on pregnancy. The online handouts are a little sparse so it’s worth getting out a notepad and taking some notes.

11:05

Grab a quick coffee before attending a PBL session on genetics and development. I am assigned to a group of seven medics (four of whom I’ve never met before). Our presentation is on epigenetic disorders and I have to research Prader–Willi syndrome.

12:30

Chat to friends, then grab a quick bite at the canteen.

13:30

Neuroanatomy teaching in the dissection laboratory: this session is on the motor system, looking at prosections of the cerebellum and spinal cord. I spend the hour receiving informal teaching from demonstrators and reading posters that accompany the anatomical specimens.

15:00

Pharmacology practical, investigating the effect of drugs on the neuromuscular junction. We apply various drugs like acetylcholine to a guinea pig ileum and measure its response using an electrical transducer. The experiment is a complete failure but it’s an enjoyable exercise nonetheless.

16:30

Meet up with my ‘student-selected component’ tutor to discuss my upcoming project in the Department of Psychiatry. I will be writing a 4,000-word dissertation on the neurodevelopment of obsessive compulsive disorder (OCD)—an area I found fascinating when it was briefly covered in our lectures last year.

17:15

Get to the sports pitches for lacrosse training—an intense session in preparation for the inter-university competition later on in the month.

18:30

Stop by the library to pick up books on genetics for the PBL presentation and on endocrinology to fill in the gaps from the morning lecture.

19:00

Get home and cook myself a student special—pasta with pesto—then finish off some pharmacokinetics calculations for a seminar tomorrow.

20:45

Watch a bit of TV before getting ready to go out.

22:00

Meet up with friends at the union bar, play a few games of pool, and catch up on the latest gossip.

00:30

Check the alarm is on for 7:30 and hit the sack.

A day in the life of a clinical student …

07:45

Wake up; shower and breakfast before leaving the house.

08:15

Arrive at a friend’s house who is driving four of us to our current cardiothoracic placement 10 miles away.

09:00

Wait for the doctor to arrive for a cystic fibrosis clinic.

09:30

The Specialist Registrar (SpR) arrives half an hour later, after attending to emergencies on the ward. Thankfully I brought along my Oxford Handbook of Clinical Medicine and so managed to refresh my knowledge about the condition beforehand.

09:45

See the first patient, a 15-year-old girl recovering from pneumonia whose symptoms have worsened. The patient is given an additional course of oral antibiotics and is told to return in a fortnight for a trial of nebulized saline.

10:30

The second patient fails to turn up so the SpR uses the opportunity to teach me about cystic fibrosis; this morning’s reading proves particularly useful.

11:00

The next appointment is a routine follow-up reviewing a patient’s drugs. There is an interesting discussion on the risks and benefits of long-term antibiotics and the patient decides to ‘watch and wait’ regarding her chest symptoms.

11:30

Final patient is particularly tearful and prefers that a student doctor is not present during his assessment. I attach myself to the physiotherapist and dietician and sit in on a few of their consultations.

12:30

Grab lunch at the hospital canteen, then go to a clinical lecture on asthma and its management.

14:00

Change into scrubs and ask the scrub nurse if I can observe the scheduled lobectomy. I had previously clerked this surgical patient a few days ago on the ward. He had been diagnosed with lung cancer after smoking for 25 years.

14:20

The surgeon arrives and offers me the chance to scrub in. I spend the next two and a half hours assisting with the lobectomy—holding retractors, ‘following through’ with sutures, and providing suction.

17:00

Head home, but get stuck in rush-hour traffic.

18:00

Cook dinner, then head to the medical school where there is a guest speaker at the Surgical Society talking about the history of plastic surgery and offering advice for students interested in pursuing this specialty.

20:30

Return home and attempt to complete a poster presentation I am producing with a registrar. We hope to send it off to be considered for a conference.

22:45

Admin: send out an email in my capacity as vice president for the Jazz Society, arranging the next rehearsal and confirming the location for the weekend’s gig.

23:30

Skim a few pages of a non-medical book before falling asleep.

The importance of early career decisions

Only 10 years ago, the career path of medical students was vastly different from what it is today. The longer hours meant that junior doctors were exposed to more clinical medicine, and the job application system allowed student and junior doctors to develop a wealth of experience before selecting their chosen specialty. However, medicine is becoming increasingly competitive, with doctors having to make career decisions earlier in their training. Applicants have had less time to distinguish themselves and demonstrate an interest in their career of choice. This section explains why making career decisions early is important, and how to pursue them.

Why is it necessary?

With increasing competition, reduced working hours, and the new job application programmes (foundation, core training, and specialist training; see p. 9), student and junior doctors now have to demonstrate their clinical interests at an early stage. This is difficult because final-year medical students and junior doctors have very similar CVs with which they need to distinguish themselves in order to win their choice of positions. The inflexibility of the new training programmes also makes it difficult to change career once you have committed to a particular specialty. So not only does your choice of specialty have to come after less clinical experience but also you need to be absolutely sure early on.

However, it isn’t all bad. The process of trying to identify your chosen specialty early on allows you to engage more closely with medicine and actively identify, or dismiss, future career options.

How do I decide?

  • Clinical attachments Student doctors are in a fantastic position to determine their future careers. The apprenticeship style of teaching means that you have the opportunity to shadow many specialties as a student doctor. Unfortunately, most students fail to exploit their placements for this purpose and instead focus entirely on training to become junior doctors. Whilst this is important, it does not exclude the possibility of considering each specialty as a potential career destination.

  • Asking the right questions There are many factors to consider when making a career decision: working hours, on-call work, salary, competition, and so on. Pick the SpR and consultant’s brains, and ask them as much about the lifestyle of their specialty as about the work itself.

  • Student groups There are often student special interest groups around each specialty that are established in medical schools. These groups tend to arrange regular events/workshops and often receive lectures from guest speakers about the subject.

Key points

You may find the junior doctor’s teaching to be more relevant than the SpR’s and consultant’s when it comes to nailing down the basics for finals. However, if you find yourself interested in a particular specialty, there is no substitute for shadowing the senior members of a clinical team and exploring their roles.

  • Student-selected modules Every medical course includes components where the students themselves decide on an area to study. The student’s efforts could be expressed in the form of a dissertation, poster, or presentation. They can be great ways to learn about an area of medicine in greater depth.

  • Outside the box The majority of medical students enter a career in hospital medicine or general practice. However, a small minority choose to step outside these traditional confines to use their expertise in less common environments . . . military medicine, medical law, forensic psychiatry, tropical medicine, aid work, medical management consultancy, expedition medicine, and prison medicine to name but a few. Keep your eyes (and options) open!

How to direct your medical CV

Once you’ve made a decision about an area you want to specialize in, you need to demonstrate an interest. Consider some of the following:

  • Student-selected modules Use this opportunity to pursue a project under supervision from a consultant within your specialty of interest.

  • Audits An audit refers to a process of review and implementation of change to improve the quality of patient care and outcomes. You start by collecting data on whether set standards are being met (e.g. measuring whether pulse oximetry is being recorded for all chronic obstructive pulmonary disease (COPD) patients in a GP clinic). You may then identify areas of change based on your data (e.g. investing in more pulse oximeters, which you have found to be shared between consulting rooms). If a change is implemented (e.g. purchasing more oximeters for the practice), then you can reaudit after a certain time in order to see whether your results have improved.

  • Research The importance of research in your medical career cannot be overstated—it not only offers extra CV points but also provides an experience of how science and medicine develop. Intercalated degrees offer a fantastic opportunity in your preclinical career for getting published (see p. 68).

  • Medical press Publications do not necessarily have to come from scientific or clinical research. Writing for the medical press, such as a student journal, can highlight your interest and enthusiasm. Note that peer-reviewed articles are of much higher status than those published in other forms (e.g. student magazines).

  • Prizes These can be useful in demonstrating your success in clinical exams. The application process for your first job ranks students by quartiles within their universities (top 25%, second 25%, third 25%, and bottom 25% are each assigned a different number of points). Prizes can highlight additional success. The Royal Colleges also offer prizes for essays written by medical students. These are often undersubscribed and so worth trying for if you have a talent for writing.

Key points

Medical school is the beginning of a career, so begin thinking about the direction of your career from the very first day. Invest in a medical careers guide early, such as So You Want To Be A Brain Surgeon? (published by Oxford University Press) It is in the same series as this book and covers all the available careers in medicine (not just brain surgery).