• When you start your clinical attachments, it will be helpful for you to reflect on whether or not you enjoy the following about the clinical placement:
  • The work/life balance
  • The pace of the work
  • The variety of the work
  • The contact with people. This could be with respect to working within your team or working with patients
  • Do you like working in a hospital or would you prefer a community-based role e.g. being a GP?

Once you have thought about the above, it will be valuable for you to look at our specialty pages which is where you can find out a bit more about each specialty. You can also link what you have found out about the specialty to your careers values. There is an interactive tool for careers values on this website.

• You will have the opportunity to learn many skills that will be invaluable for your career as a doctor. The skills you will learn will include:
  • Taking a patient’s history
  • Giving a physical examination
  • Practical procedures
  • Communication
  • Professionalism

You may also take the chance to take part in the following:

• • Taking part in a hospital audit- you may be able to present the findings to other professionals or even to publish a paper. Read our separate section on audits.
  • Teaching – when you are in your final years you will be in a position to pass on some of the skills you have learned, whether this be with an individual or in a group setting (to someone in the years below you).
• Networking opportunities talking to junior doctors and consultants  - chance to ask them about the good and bad aspects of a role.
• You should get chance to shadow junior doctors and be able to learn from them. This is usually arranged for the week before you start your F1 job and you would be well-advised to take up the opportunity.

Andrew Bowhay in the book edited by Simon Watmough (2011) (see resources below), sets out the types of clinical encounters you can expect:

• The consultant ward round – often will be with a variety of staff at different levels and learning needs. You can learn a lot by observing the senior clinician and how they deal with patients, particularly their history and examination techniques, clinical reasoning skills and professionalism. Andrew Bowhay states that ‘You may however experience examples of poor practice which run counter to what you have learnt before; in other words the doctor is not practicing what they are teaching. It is important that you think about what you have seen and heard and decide whether you would wish to incorporate it in your practice’.
• The working ward round with a doctor in training – This will prepare you well for Foundation training as you will be learning how to manage the day-to-day tasks of working in a hospital.
• A ward round or clinic with a specialist nurse – these nurses have taken additional training and often have a great wealth of knowledge about their area of practice.
• Going to the operating theatre to watch surgical and anaesthetic procedures – read our separate guide.
• Attending outpatients with a consultant or doctor in training – these are often busy and the appointments are short so there is little time for elaborate teaching. It is good to think about differential diagnoses, further investigations and treatment plans. Patients will often present with multiple problems which must be addressed simultaneously; the doctor cannot focus on one problem for teaching purposes.
• Attending a GP surgery – the appointments are often very short, so learning to take a history in a short time is important. You will find that most GPs are expert at time management. You can think about which conditions will need to be referred to a specialist and which can be handled and managed by the GP.
• Attending multidisciplinary team meetings – the professional group may consist of nurses, physiotherapists, occupational therapists, dieticians, social workers etc.
• Going on home visits with a GP to meet patients and carers in their home – you will see how patients live and cope with their illness at home (this is an important aspect of holistic care).

• Keep up your e-portfolio (if you have one) about your experience on a clinical placement, you will be able refer back to that experience later on and this could help you with your future career decisions
• Nerves on the first few days. The first clinical encounter may seem a bit stressful as the ward round, operating theatre or clinic may feel like an intimidating environment if you are not used to it. This may be your first proper interaction with other medics and healthcare professionals. It is normal to feel a bit nervous. Read our case-study below where we have asked a medical student in his clinical years to comment on his first clinical attachment.

The following case-study was written by Guy Rughani, medical student at Edinburgh Medical School:

First day on a clinical attachment

The first day was exciting, but terrifying. Having found my way through the labyrinthine hospital to the correct theatre, I scrubbed up and waited awkwardly for the consultant to arrive, surprised at my ability to be incredibly in the way - in every place I stood!

The consultant appeared, introduced himself and we had a little chat.  I managed to make myself sound utterly idiotic, and watched the morning's surgery wishing that I'd been quiet and reserved.

Poor start over, the afternoon's surgery was great. I was allowed to assist with the operation cutting sutures, vacuuming up blood and holding patient's legs! By the end of the day, I was starting to understand a few of the theatre routines and was being of vague assistance to the frighteningly efficient surgical nurses.  I finished feeling that although the routines were a bit of a shock, the medicine was good fun and infinitely better than being stuck in a lecture.

Advice to someone who has never been on a clinical attachment

Clinical medicine is very different to the preclinical years. Firstly you are much more responsible for your own learning. It's clichéd but true that you get out what you put in. Everyone in hospital is busy, and if you are not proactive, you can go unnoticed and get remarkably little from your hours on the wards.  As such, although you may hate the idea of being a 'keen' medic, being a bit proactive can make you feel more in control in the hectic hospital environment. I phoned my consultant's secretary to find out her timetable and organised extra teaching sessions with friendly foundation doctors (they're often very willing to teach, and can remember what it is like being the 'lowest of the low!').

It's also useful to find out early how you are actually going to learn the medicine. You really need the clinical experience, but in all the fun of being on the wards, don't forget that you've also got to pass the exams! Find out from senior students what resources they found useful and force yourself to read them early in the rotation. The sooner you do it, the more you can apply, and the more you will get out of your clinical attachment. 

Remember that you can learn something from every clinic - however dull! When you observe each consultation, think about what the doctor is doing right, and what you think they are doing wrong. I've found this very useful for thinking about the sort of doctor I want to be.  Having said that, don't waste your time hanging around on the wards if nothing is going on. It is tempting to loiter in the hospital and think that because you are there, you are being productive!

Finally, although medicine is interesting remember that there is more to life. Retain your sanity by continuing your other activities like music and underwater basket-weaving.

Please note the content and opinions expressed in all case studies are those of the writer and do not necessarily reflect the views of the medical careers team.

The following case-study was written by Siobhan Graham, 4^th year medical student at Brighton and Sussex Medical School:

A clinical attachment that made me want to pursue a particular career.

‘During my four years at medical school I have had a number of clinical placements in a variety of specialities from General Practice placements in my first two years, to core hospital placements in 3^rd year and sub-specialities such as Ophthalmology in 4^th year. Having the chance to do an assortment of placements has allowed me the chance to see which specialities appeal to me and those which do not, for each individual student this will vary depending on what you are looking for in your future role as a doctor.

For me, my Gynaecology and Obstetrics rotation in year 3 opened my eyes to a new speciality I had not considered before. During my rotation I got the chance to encounter a range of learning environments allowing me to see the variety a job in this speciality would allow in a day’s work in the future. From the ward rounds, theatre and clinics in both gynaecology and obstetrics, to the gynaecology emergencies which presented to A and E, special care baby unit and the labour ward to mention just some. This variety was amazingly appealing to me as the chance to later have a work day that was diverse in activities is something which I feel would suit me. However the highlight for me was the time I spent on the labour ward during my clinical placement. I will always remember the first delivery I was a part of as I was honoured to not only witness the birth of new life but also got the opportunity to literally ‘catch’ the little baby girl as well as cut the umbilical cord. For me a job that allows you to assist daily in bringing new life into the world whether that be in the form of a natural birth, water birth, assisted delivery or a caesarean section seemed like a career that I should definitely consider for my future.

However, unfortunately my future career decision is not quite that simple, as Gynaecology and Obstetrics has not been the only speciality that my clinical placements have made me want to pursue as a career option. General Practice has a massive appeal for me as my time spent there has shown me the true challenge that this role can offer as from one appointment to the next you have no idea who will walk through your clinic door, whether they will be a newborn or a 90 year old, whether they have just a headache or a subdural haemorrhage. As a GP you have access to only the most basic tests and therefore are required to diagnose and treat using your clinical knowledge, history taking and examination skills. This was particularly highlighted when as part of my clinical placements I was given my own patients to see and attempt to diagnose and manage, allowing me to truly experience the GP’s role. The continuity of care, diversity of conditions managed, diagnostic challenge and part time opportunities available are all attractive to me.

So for me my clinical placements in both Gynaecology and Obstetrics and General Practice have influenced my potential future careers. However with a few more years of clinical placements to go who knows what other specialities may appeal, maybe I have yet to encounter my future post in medicine.’

Please note the content and opinions expressed in all case studies are those of the writer and do not necessarily reflect the views of the medical careers team.

Book: Simon Watmough (2011). Succeeding in Your Medical Degree (Becoming Tomorrow's Doctors), Learning Matters. (Contains a chapter on Clinical Placements).