13 Aug 2015

medschool: respiratory medicine placement

Last year, I had three five-week blocks of placement: one on a 'medicine' placement, one on general practice and one on a 'surgery' placement. For my medicine placement, I was placed on a respiratory medicine firm and I knew it would be good based on reports from older students. Plus, some of the respiratory teaching we've had from various consultants have been excellent so I had high hopes.

For this placement, we were given a handbook of things we were recommended to attend - these varied from clinics to watching some lung function tests to attending teaching sessions. To ensure I was as organised as possible about all these sessions, I used my Iconic essay book to draw up a timetable for each week of the placement block.

To ensure I was as prepared as possible, I revised some common respiratory conditions and these included asthma, COPD and pneumonia. I made sure I knew the common presentations, investigations and management for each inside out just in case I was asked by a consultant or registrar. Personally, I think it's bad form to go into a placement without at least knowing these basics about the most common conditions.

Anyway, onto the bulk of the placement.

Ward Rounds

For me, ward rounds got a bit boring after the first few times. My placement was in November time so most of the patients were in hospital because of acute exacerbations of asthma/COPD or had pneumonia. Most of them had also been in hospital for quite some time so when it came to presenting patients on ward round, it became a bit dull after the third or fourth time.

However, that's not to say they aren't good learning opportunities - ward rounds enabled me to see how doctors determined management plans for patients and also learn how to write in a patient's notes. I also learnt about prescribing on drug charts and even wrote up a few drugs myself (but of course, had them checked and signed by a qualified doctor!).


Clinics were a good opportunity for one-on-one teaching. The consultants on my firm were extremely friendly and keen to teach so I enjoyed all of the clinics.

Before each clinic, I would read up on the common things that may come up (so, for example, in the cancer clinic, I'd read up on lung cancer and their different types and also mesothelioma) so that I wouldn't seem like a deer in the headlights if the consultant asks me a question. I also tried to gain at least one learning point per patient.

Clinics can seem mind-numbingly dull to some but to me, they were an ideal time to shine. I could show the consultant how interested I really was by asking questions (and I was! Respiratory medicine is interesting!) and also get some one-on-one teaching which is actually pretty hard to come by.

Consultant Teaching

I was quite lucky in that there were a number of consultant-taught sessions throughout the placement. If you have these - go to them! Teaching is teaching and can help you reinforce concepts that you may have found difficult. We had sessions on taking different types of histories, interpreting blood and ABG results and also radiology interpretation.

Ward Work

I'll be honest here - I didn't take as much blood as I probably could have done and I didn't insert as many cannulas as I could have done either. What I did instead was practice clerking patients as it was recommended that we clerk an average of five patients a week - a number I did in fact manage. In hindsight, I maybe could have clerked a few less and inserted a few more cannulas. I don't mind doing practical procedures - I actually quite enjoy them - so this year, I'm going to try and get a few more of them done.

Other Bits of Learning

On this placement, I learnt a lot about asthma, COPD, lung cancer, mesothelioma and pneumonia. As a result, I felt extremely confident with these topics and very little revision was needed because I clerked at least one patient with each of those conditions.

There was a sad moment where I attended a meeting with a patient's family to talk about what action would be taken if the patient were to have a cardiac arrest. This patient was very, very poorly and they had deteriorated significantly over the last two weeks so the decision was taken to keep them as comfortable as possible. It was a sad moment when I went to the ward one day to see their bed now had a different patient in.

Respiratory medicine allowed me to see how patients were managed acutely (I had a week on an acute ward within this placement too) but also see how long-term inpatients were treated too. There were some sad times but overall, the staff and patients were mostly lovely and I learnt an awful lot in a short space of time.

Overall, I really enjoyed my medicine placement and in all honesty, I probably would have enjoyed this placement no matter which specialty I had been allocated to. The main thing is to throw yourself into it and just take an interest in patients! Remember why you went into medicine in the first place and use that motivation to get you through the hard times but also bring you back down to earth during those really, really good times.


  1. Sounds like you're a kick-ass med student - I would have loved it if you were my student when I was working on the wards! :D

    Yes practice at putting in cannulas and taking bloods is important - if you know how to do those two things your first year as a doctor will be so much easier. But having said that, I didn't learn to cannulate properly until my first week as an intern because when you're a student you tend to practise on the easier patients (as you should, to get confidence) but they're not the people you have to cannulate when you're a doctor! My first intern rotation was geriatrics... by the end of two months I was putting 23G blue ones in the inside of wrists, on shins and in feet!

    1. You're too kind! I'm just a very keen student hehe.

      That sounds promising - I've only ever cannulated 'easier' patients and am dreading a difficult one! I suppose it'll come with practice and experience :) x

  2. Wow. You're a much better student than I ever was!

    One of the best pieces of advice I had as a final year student was not to spend too much time putting in cannulae and taking bloods. Nothing compares to the steep learning curve of your first ward cover or A&E shift as an intern. (Obviously you need to know how to do it safely.) I would definitely prioritise clerking patients over doing procedures. Things you learn from patients will stick with you forever. You have your whole career to do procedures but once you're a doctor it's unlikely you'll be able to spend as much time clerking each patient as a medical student can spend.

    Just my 5 cents worth. Feel free to ignore of course!

    1. Thanks! I tried to clerk one patient a day on placement last year and I just about managed this in my first five week placement. I agree - patients are so interesting and when they give their perspective, I learn something new too.

      Knowing that my first on-call shift is potentially less than two years' away now is super scary...! But what you've said has made me feel a lot calmer :) x