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Pre-Clinical Medical Years: What I Wish I Knew

As a preclinical medic, the idea of clinical medicine may seem daunting. How does one cope with the transition from lectures, dissections, tutorials, small group teaching and PBLs to spending your days on the wards and interacting with patients? As a preclinical medic myself, I often worry about how do I know what I need to know whilst on the wards? How much do I need to know? How will I make notes and find the time to commit what I have learnt to memory? Fortunately,I had the pleasure of interviewing Mitchell Osei-Junior iBSc (Hons), a medical student at King’s College London with dreams of becoming a Child and Adolescent Psychiatrist/Psychotherapist. Having recently acquired a diplomas in Applied (STEM) Mathematics & level 3 Child Psychology, he is also currently studying for level 4 diplomas in Adolescent and Child Psychology as Mitchell’s main interests lie in psychosocial and developmental psychology.

1. What is the difference between preclinical and clinical years at medical school

The main difference between preclinical years and clinical years is the focus of the year.In preclinicals, the emphasis is on you getting the 'basics' of medicine in terms of Anatomy, Physiology and other various human sciences that will form as foundations for clinical years.However, in your clinical years, the emphasis is on 3 main components: I) Knowledge (applying your foundations for understanding clinical conditions) II) Communication (being able to convert medical jargon to lay language whilst also building rapport) III) Practical skills (Because OSCEs become an important thing)

2. How is teaching/learning different during clinical years compared to preclinical

In pre-clinicals, you spend a lot of time attending lectures, dissections (to supplement anatomy teaching) and small group teaching (to consolidate what you have learnt in your lectures). In essence, there is a lot of spoon feeding as a preclinical medic!

In clinical years, you only have lectures 1 day a week & the rest of your week is spent on the wards. Bedside teaching becomes a regular feature where a doctor/physician's associate takes you around to practice your physical examination techniques on actual patients.

In terms of learning, in your pre-clinical years, your lecture notes are usually sufficient enough to get by your exams. No other textbook required.However, in clinical years your Oxford Clinical Handbook will be your best friend. Lectures alone are not enough to supplement your clinical knowledge. There is a lot of self-guided responsibility of learning in clinical years which can feel like a bit of a jump.

3. What would you advise to prepare for the change? What practical advice would you give to medical students starting clinical rotations?

In terms of preparing for the change, I would suggest that practicing taking a professional history and attending the clinical examinations sessions during your 1stand 2ndyear is important!Examinations and history taking are your main metaphorical 'sword & shield' for the clinical years. Once you have these skills all you need is building the bricks of clinical knowledge from each patient you meet.

In terms of practical advice, I will advise spending induction week for each block building a sign-off timetable. Apart from all the things you need to learn during clinical years, getting sign-offs for your portfolios are key. Space your sign-offs fairly so you still have time to visit wards, speak to and examine patients. This gives you enough time each week to do some much needed independent revision/study. Time management is a really key skill during clinical years.

4. How to make the most out of your clinical years?

In terms of making the most out of your clinical years, in the first few weeks of your first clinical block you are most probably going to be really scared of talking to patients and examining them too. Not to worry, every student, foundation doctor, core/specialist trainee, and consultant has felt the same way and remember their first clinical year fondly. Some even have embarrassing stories of mess-ups they had during the period (oh let's not discuss my first time taking a history and accidentally causing a mess with a patient's glass of water during it!)

Patients know fully well you are students and you need to learn. So they generally don't mind you forgetting questions that you need to ask, or not understanding certain medical procedures they went through, or accidentally saying medical jargon, or pressing too softly whilst palpating during an examination etc. I would advise during clinical years, clerk as many patients as you can and ask them to clarify treatments they have been through. Patients actually make the best educators and they want you to be an amazing doctor when you graduate.

So in summary, if you are not spending at least 30 minutes taking a history from a patient on a ward you really haven't learnt much about them!

Also make spare time for yourself to carry out your hobbies! Your mental health is important too. :)

Interviewed by Sarah O’Connell


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