Challenge me!

When I went to a facilitation training session 2 weeks ago, we were asked to list things that we do well + why do we do well and also things we don't do well + why. It was an interesting exercise, I learnt quite a lot about myself in just two hours.

One of points raised in the discussion was rather interesting. Many people felt that many a times, they are not able to do things to their maximum potential because they haven't been challenged. I know, I know. Medical students are supposed to be all self sufficient and self motivating and self challenging. But sometimes we just come to a point where we don't know which way is forward.

I think this has happened to me in my fifth year. I thought this year started badly with an unstimulating placement in the specialist cancer hospital. I wouldn't even call it a placement because I was hardly ever in. I spent less then 20 hrs in total in that hospital over the four weeks placement. We were not working under a named firm. We were not even allowed to take self initiative and turn up to clinics or wards - we were to strictly follow the time table. We had plenty of lectures and seminars - hardly challenging sitting on my arse for most of the time in the hospital. My only non-lecture based activities on my time table were a clinic and a bedside teaching. That's it. Two half a day of patient contact over the four weeks period.

Then I moved geriatric medicine in my usual teaching hospital. I am glad to say that because they were always short of medical staff and that there wasn't a house officer in the ward, I was usually the acting junior doctor. I still had to use my initiative quite often - constantly asking if there was a job I can do. Gradually they just give me jobs without me asking and I get things done without being told. Being involved in their continuing care, I knew every single patient in the ward well and felt quite happy making clinical judgement, ordering investigations, making referrals and to give information to patients and relatives. I knew that those jobs were well within my capabilities as I have been doing them since my fourth year. I guess working in a team is my strength and trying to build a good working relationship with my colleague just wasn't going to be a challenge at all. So in summary, extremely satisfying placement but perhaps not stimulating enough.

Now in GP land, I am having a great time with the doctors. The two GPs supervising me are fantastic teachers. I am finally feeling challenged by having to see my own patients. I have no problem doing the history, examination and diagnosis, but have never really ventured into informing patients about my diagnosis and management plan (mainly because I don't feel confident enough. Silly yee yen!), and now I am forced into doing that. I mean, if a consultant ask me quesions like 'What do you think the diagnosis is' or 'What is your management plan', I'd never ever say 'I don't know' because that'd make me look very stupid. A wrong answer is better than no answer. However, I am not so sure with patients, so on my first week I just resorted to saying 'I'm not sure, see what the doctor says' to everyone I see. But then I found that I have been right most of the time. So why not just discuss my thoughts with the patients? And I find that quite difficult. If all they need is prescription, that's easy. But if not, for example if they need lifestyle change, then I've got to explain things from how does the illness arise to how lifestyle changes can ease the problem. It's something that you'd think I ought to know, but I'm not very good at it. So I'm glad that I've found something to challenge myself for the remaining two weeks.

(This bit is not important)
Finally, I'd just like to moan about sitting in with nurses. In general, I don't think fifth year students need 'sitting in' with practice nurse anymore. Sitting in with the GPs is fine because there are clinical problems to solve and a high expectation is expected of me that I should be as capable and knowledgeable as a qualified doctor. On the other hand, nurse doesn't. The practice nurse that I am asked to sit in with is the friendly and lovely. But she just thinks I don't know anything. She talks about obesity and hypertension being a major problem in the community, and then showed me the immunisation schedule. (Great. Actually I am in my fifth year and I know and have already been examined on these before...) And she's never offered to let me do anything (and to be fair I haven't really asked except for today I asked if I could do a smear, she asked 'Have you been trained?' and later the answer to my question was no). But then you'd think even if I haven't been formally taught these skills, shouldn't it be her responsibility to teach and let me observe then try doing it under supervision? I dread sessions with her as they are just so boring. They are mainly just chronic disease review which consists of filling in template questionnaires. So she asks the patients the same questions off the computer and perform the same tests/examinations, followed by the same advice on smoking, diet and exercise. It can't get more ROUTINE than this. Talking about challenge - this is plain zero challenge. I might as well be in the library reading. Which is why, this Friday as there is no GP in the surgery to supervise me, I have asked to have a day off being I don't think it's worth the time sitting in with the nurses. I don't do day off normally. But I think I just have to take change of my own education and stop doing things that are not beneficial to myself. I hope I don't see anymore of this 17th century practice of passive 'observation' teaching. Sorry, I'm feeling irked.

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