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Saturday, July 13, 2024

Rounds: A transformative experience

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By Isatou Nyang,
5th year medical student

UTG Medical Students’ Association

“It is time for rounds” and “let us go for ward rounds” these are certain words that medical students and physicians utter daily although it is not music to the ears of medical students. Medical rounds are an integral part of a medical student’s education, providing a unique opportunity to enhance clinical skills and knowledge. During rounds, students join a team of healthcare professionals, including consultants, residents, and nurses, to review and discuss patient cases. This dynamic environment allows students to observe diagnoses, treatment plans, and patient management whilst actively participating in discussions, asking questions, and presenting findings.

Medical students develop critical thinking abilities, improve communication skills, and gain valuable insights into the complexities of patient care. This space of the medical field serves as a bridge between classroom learning and real-world patient interactions, making them an essential experience for aspiring doctors. With the magnitude of its significance, it is the most dramatic stage in which learning can happen.

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My journey from pre-medicals to bio-medicals and laboratory medicine, ward rounds was a novel experience during my clinical year. Seniors explained the dark and grey sides of rounds and not only were my colleagues and I fascinated but we had an inkling of fear of what to expect. Any time we chit chat we would ask questions like; Would we be burnt out like they mentioned? Embarrassed to the point of crying or sent away because our outfits are not professional enough? Or would the patients give us their consent to clerk them? These all kept us on our toes and up for the task as long as our minds were prepared to be on the alert because of the information gathered from our seniors. We certainly got those answers during our first rotation.

The set of rules of the dos and don’ts given to us before the rotation began was scary because the paragraphs that highlighted discipline, punctuality, and respect were unending. We had the impression of being in a military barracks rather than a medical school. The call duty hours always result to protest from some students especially if they must be on call during weekends or on a holiday. The most hilarious part is the 75% and 90% attendance for classes and clinical activities respectively in order to be eligible to do the end-of-posting exams. Most of the student leaders would start counting the number of classes they are bound to miss as they are usually busy with the affairs of students and the perpetual absentees made tremendous adjustments in their habits.

Ward rounds elicit fear in some and the detailed preparation that a medical student makes can equate to warfare. Students had to make sure that their Lab coats are washed clean, and ironed to the point of seeing the fine lines on the coat. Shoes cleaned and polished, ties fasten on the shirts of men, belts buckled, and the females dressed in modest clothes which are not too showy or attractive. The call to look smart, professional, and presentable was part of the induction of who we aspire to be as long as this field is concerned.

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Apparently, sizeable notepads are part of the equipment that one cannot do without during rounds. One is prepared to jot down any important information during the course of rounds. This is to prevent the consultants from thinking that you are unserious if you have no writing materials. Our morale was high, and we anticipated a fruitful clinical year filled with effective ward rounds but in a blink of an eye, our fantasies were cut short. Seeing a team of medical doctors consisting of consultants, residents, and house officers was very intimidating. The anxiety of answering their questions because of being scared to make mistakes and be termed stupid or being laughed at by our mates coupled with the reluctance to ask questions that would be deemed irrelevant, took a big toll on us. Things that we even knew by heart would easily be forgotten due to pressure and inner confinements of one’s self-esteem.

Moreover, most of us would resort to hiding behind in order to avoid questions or challenges but some doctors would just have to pick you out to answer their questions. My state of mind when asked a question cannot be easily explained due to sudden tachycardia, stuttering, and getting so sweaty as if I ran a 5000m race. The embarrassment felt when I am unable to answer a question would make me wish to find a hole and bury myself, but I take courage to comfort myself by saying that; they were in the same position as me and reassuring myself of the heroine I am, helped me conquer my fears and unfolds my capabilities towards what I love doing. As time went by, we all got used to it and the rounds got normal and enjoyable. One of the most important things we learned during rounds is to say “no” if you have no clue about a question you are asked. Medicine requires expertise and there should be nothing like “I think” or “maybe” because you are dealing with the precious lives of people.

During my rotation, some were educative and interactive whilst others were not. At a point in time my team termed ourselves as lost sheep with no direction because we go for rounds, move from one bed to another, be on our feet from morning to afternoon, and did not learn anything because the team has a huge number consisting of both junior and senior students and some of the doctors would be inclined to engage the seniors more. There are some doctors that are not willing to teach as they are in a hurry to see all their patients before rushing to the outpatient clinic. Others would just show their disinterest in teaching medical students and that would make most of us distraught and not have any sense of belonging. When inclusivity is used, what is learned becomes the greatest achievement for that day.

Similarly, we always equate a lack of teaching and team involvement as a poor ward round learning experience because the fundamental benefit of rounds to students is to learn the art firsthand. My team was always envious when other colleagues explain how their rounds went as their consultant would take more time in not only reviewing patients but teaching them as well. We looked forward to having similar experiences, but it took a while before we did. Things got better in the subsequent rotation as we learned a lot and got exposed to so many things that were taught in class. It was enjoyable and the impact was huge.

The ongoing issue of hierarchy and absolute respect for seniors became the order of the day during rounds. Responding to any questions by saying ‘yes Sir” as most of the consultants dislike it when we use the terms like “yeah” when addressing them. The junior students would be running about to get the blood pressure and sugar machines to check the vitals of the patients. We would become the assistants of house officers by getting them prescription pads and lab test sheets while some of them would organize sessions after rounds to teach us a thing or two and supervise us when doing other procedures which have to be included in our log books. This session creates experiences that students gain insights into the art of medicine. This supervision helps bridge the gap of doubt to foster a deeper understanding of patient care.

In addition, the most challenging part is looking for patients to clerk. Any consultant that is around would ask the team to take a detailed history of all the patients in the ward and present the following day. We would be rushing to find a patient who is in good condition and willing to answer our questions. It is always disappointing to find out that they were already clerked by our colleagues. Some of the patients would not be willing and others would select what to share particularly with the students. Most times, we got to realize this after going through their files after clerking. Sometimes we are selective in the patients we clerk by choosing those who are newly admitted and not those that have been in the hospital for a long period of time because clerking those who were admitted for a long period of time is usually difficult. It is frustrating as a first-timer to clerk because you are yet to know the essential details to take and the language barrier becomes a problem.

The first-time of history presentation is always tough no matter how well you went through the patient’s history to see if you miss out on some important details because the consultant would always have something to say. Your choice of words and grammar would always be scrutinised as the doctors have diverse ways in which they want the presentation.

The satisfying thing about rounds is taking note of the progress of the patient and seeing them recover. Healing from all ailments is the yearning of every physician and his/her patients. You feel as if you have achieved everything if the patient is discharged back home free of all ailments. A single thank you from the client makes all your efforts worth it.

However, it is always disheartening to come the next day for rounds and be told that the patient could not make it. Everything stops still and you begin to wonder what went wrong in the management of the team, is it the inadequacy of resources or the lack of expertise in the field? Disheartening circumstances like this in a ward are not news that we want to hear. However, it is a challenge for us to sit back, evaluate and come up with better solutions to solve or treat similar cases if we encounter them again.

Ward rounds are effective for both formal and informal learning of clinical facets as well as moral values. The lack of support sometimes from working staff, the fear of making mistakes, and too many students simultaneously at the site are challenges always faced during rounds but above all the constraints, the experience gained, the new things learned and the joy of serving humanity overshadow all the difficulties.

Medical rounds are an indispensable component of a medical student’s education. They provide a transformative experience, bridging the gap between theoretical knowledge and practical application. Through active participation, observation, and collaboration, students develop clinical skills, critical thinking abilities, and effective communication techniques. Medical rounds serve as a stepping stone towards becoming competent and compassionate physicians who are well-equipped to navigate the challenges of patient care.

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