Real patients, real medicine - a recipe for exam success
By Patryck Lloyd-Donald*
My first taste of rural clinical practice was in Bendigo back in 2013. That's when I joined 30 fellow students in an extended rural cohort for a year of ward rounds, textbooks, laughs, desperately avoiding sterile fields and learning hands-on clinical general medicine and surgery.
It was a fantastic time, improved by the welcoming nature of the community and brilliant clinical teaching.
Having a maximum of three of three students per ward round made us really feel part of the team. Having 30 cannulae under the belt by June certainly gave us a leg-up come examination time.
This was first-class training with fully equipped simulation labs and teaching by leading consultants and professors. To back up the theory, from day one we had the opportunity to chat with and examine (gulp) REAL patients. It was an environment where we were encouraged to grow while feeling fully supported.
The following year saw me complete six months' general practice experience in Maryborough under the guidance of two great rural GPs (thanks Dr Robert Carson and Dr Daniel de Villiers). It also heralded the start of me seeing my OWN patients and "parallel consulting" from day one.
Not only did I assess each patient myself, I also had the chance to develop a diagnostic work-up, management plan and review patients for regular follow-up, all with the assurance of a strong supervisor safety net.
It was this sense of supported independence that helped me make the most of my time in general practice. Whilst rarer in city centres, it is admittedly not unique to Maryborough or rural placement.
What WAS unique was the exposure to anaesthetics, obstetrics and gynaecology (2am first assistant on a C-section anyone?), rotation through the emergency department and independent removal of lesions and minor procedures. So thank you to the people of Maryborough and the team at Clarendon Medical Centre.
Fourth year finished in Mildura, with a whirlwind of O&G, Psych, Paediatrics and the minor issue of final medical school exams. Having just eight 4th year students in Mildura meant we were first to scrub for the O&G lists and were delivering vaginal births before many of our city colleagues had set foot in a birth suite.
Informal tutorials from the Registrars and pearls of wisdom from senior Monash O&G Professor Ian Pettigrew ensured our Mildura obstetrics experience certainly "delivered". We also observed in- and out-patient exposure to mental health services and with only two students per round there was no "kidding around" during the paeds rotation.
So what did all this rural experience culminate in? Having small class sizes and strong relationships with both junior and senior medical staff meant we were better preprared for our senior clinical years. We also performed stronger as a group in our final exams. Extended rural cohort students were over-represented in the higher scores for our year's final exams.
This goes to show, if you actually "learn" medicine, in theory AND in practice, nothing beats seeing as many patients as you can, and rural placements are, in my opinion, the best environment to do that.
Rural placements are NOT career limiting. They are an opportunity to excel in practical and theoretical components of clinical medicine, make connections, smash your exams and advance your future career. But heck, don't take my word for it, get out there and give it a go!
Posted: March 2015
*At the time of writing, Patryck Lloyd-Donald was a fifth year medical student at Monash University where he was vice-president of WILDFIRE Rural Health Club. Patryck was also completing a Bachelor of Medical Science in ICU research and had been a John Flynn placement scholar since 2011.