How-To Guide: Y3 MD ROTATIONS

Recaps of every single Y3 MD hospital rotation ARE HERE!

Students have summarised their experiences, covering everything from watching joint replacements in orthopaedics to cannulating patients in gen med to delivering babies overseas to doing their own consults in general practice!

Recapped rotations include:

  • General medicine
  • General surgery
  • Orthopaedics
  • ENT
  • Oral and maxillofacial
  • Urology
  • Acute surgical unit
  • Vascular
  • Ophthalmology
  • Community placements e.g. Cambodia, Peru
  • General practice

What did a typical day look like?

A typical day at Belmont starts with the morning meeting, which is attended by all the junior doctors on the Gen Med teams, as well as any 3rd and 5th year students on placement. The after-hours registrar then does a handover of the patients admitted overnight to the registrar of the team that was on take for that day. Following this there is usually a presentation on some medical condition by one of the doctors or medical students.

After the meeting, ward rounds begin, which generally just involves following the doctors around while they talk to each of your team’s patients to see how their conditions and treatment are progressing. At 11am there is an allied health meeting where the allied health staff ask about the team’s patients and how they’re coming along.

Once the meeting and ward rounds are over, the registrars and JMOs generally do any paperwork or admin tasks that need to be done for the patients, which depending on your team and your own motivation, often means you can go home, but you also have the option of going around and talking to some of the patients, or hanging around for some of the intern teaching sessions that are on most days.

What health conditions and surgeries did you see?

The gen med teams get a range of conditions, but since Belmont is a smaller hospital, patients with more complicated conditions that require specialist follow up beyond geriatrics and cardiology are often transferred to John Hunter or the Mater. This does, however, provide opportunities to familiarise yourself with some of the more common hospital presentations such as influenza, delirium, electrolyte disturbances, complicated UTIs, and sepsis.

What were the highlights?

The highlights have been the opportunities to observe various pathological signs on patients such as cardiac murmurs, respiratory abnormalities, and fistulae. In my experience, both the junior doctors and consultants have been pretty helpful with regards to answering questions and teaching you about conditions you’re not familiar with. Most patients are also lovely and quite happy to have a chat with you.

What were some challenges?

It can be quite boring at times following the doctors around on ward rounds, and as you’re only there 3 days a week, it can be hard to keep up with some patients’ conditions and treatments. As a third year, there’s also a lack of training in a lot of practical skills such as cannulation until a few weeks into the rotation, and Belmont’s mostly old patients can be difficult for someone with little experience. Patient deaths can also be difficult and confronting.

What’s a helpful tip you received from the team?

The consultant once showed me a patient that had crackles that could only be auscultated on the anterior chest as an example of things that can be missed if shortcuts are taken.

What advice can you pass on to future students?

Might be something that you hear repeated all the time, but get involved as much as you can, so try and write the notes for a few of the patients, go and observe any practical procedure that you haven’t or seen done before, such as ABGs, and death certifications. If you have a 5th year on the team, ask if you can come along and observe one of their long cases. Look up any medications or conditions you’re not familiar with, and don’t hesitate to ask questions!

What did a typical day look like?

  • 7:00 am – Ward Rounds
  • 8:00 am – Operating Theatre
    OR
    Variable Start times – Clinics (Out – patient or Melanoma)
  • During free time (typically in between ward rounds and clinic), do a case report on a patient on the wards, present to Registrar and discuss the topic (if they are not busy, usually during coffee break)
  • End Time – Variable; depending on how busy the days are.

What health conditions and surgeries did you see?

This primarily depends on the sub – speciality of the consultants on the team or if the team is on take, then any general surgical presentation to ED. During my rotation, I mainly saw cases related to Upper GI, Colorectal and Melanoma.

  • Upper GI –
    • Cholecystitis > laparoscopic cholecystectomy
    • Gastric Cancer > Gastrectomy
    • Hepatocellular carcinoma > Liver segmental recession
  • Melanoma – wide local excisions, sentinel node biopsies
  • Colorectal – Colonoscopy, diverticulitis
  • General – bowel obstruction, hernia, appendicitis

What were the highlights?

This was my first surgical rotation. Therefore, it was the first time I scrubbed in, observed a surgery from start to finish and got to assist, which is the main stand out, personally.

Specific to General Surgery, I would have to say when they did a midline laparotomy and I was able to fully appreciate the anatomy of abdominal cavity. I felt there was a clear difference from attending Anatomy labs, to see it first – hand in surgery.

What were some challenges?

Being a “night – owl” the early start and being ready to go for the 7:00am Ward Rounds was difficulty. Also, surgical content was not covered in the pre – clinical years, therefore there was a learning curve.

What’s a helpful tip you received from the team?

If you know, tell your team which days you have commitments (teaching, research or other clinical placements), therefore they are not expecting you. Similarly, if you are free, ask your team to tell you if there is an interesting or educational case, that would benefit you at your level. Communication is key!

What advice can you pass on to future students?

Find out a general outline for your team before you start your placement, so you can maximise your time. For example, which days do they operate, which days are the clinics, where are the clinic. This will save you being lost on the first day, help to be prepared and find your footing. Additionally, if you can find out which surgeries are happening on the follow day then read around the topic, so you can truly appreciate what you are observing.

What did a typical day look like?

  • Come in at 7am to E3 to meet with the team you were allocated to for that week.
  • We would commence morning ward rounds
  • Then we would either go to theatre or go to the orthopaedics clinics
  • In the clinics you would bring a patient into one of the rooms, pull up there CAP information and open their latest imaging. Take a quick history from the patient about what happened up to this point in time (Hx presenting problem, surgery), ask about pain/pain management, have a look at there imaging and perform a quick examination (be ready to present findings to one of the doctors). Find one of the doctors and handover the patient to them.
  • In the clinic you will also write in the notes for the patient you see, you may be allowed to perform small things like removing backslabs and sutures.
  • In theatre you typically watch a surgery. Scrub in if you can because you tend to get a way better view of what is going on.
  • The days are a bit longer and finish when the surgeries or the clinics for the day end.

What health conditions and surgeries did you see?

Surgeries

  • Joint replacements
  • ORIFs
  • Fusions
  • Debridement
  • Ligament repairs
  • Amputations
  • Deformity repairs (Hallux valgus)

Conditions

  • Fractures
  • Joint Arthropathies (Osteoarthritis, etc.)
  • Deformities (Hallux valgus)
  • Ligament injuries
  • Soft tissue injuries
  • Spinal conditions (Scoliosis)
  • Rare conditions (Marfans, Ehlers- Danlos)

What were the highlights?

  • All of the doctors are super nice and very willing to teach.
  • Lots of exposure to patients

What were some challenges?

  • 7am starts!!!
  • The days can be very long sometimes
  • Clinics might get a bit boring
  • Some surgeries you will not get to go to because the doctors don’t want students in the theatre

What’s a helpful tip you received from the team?

  • Ask to scrub in to surgeries, you will get a closer view and they may let you do small things (hold things open, suction, etc.)

What advice can you pass on to future students?

  • Revise musculoskeletal anatomy, how to read x-rays of limbs and common conditions you expect to see before the rotation and you will get heaps more out of the rotation, especially the clinics
  • The more enthusiastic you are about learning and getting involved, the more you will get out of the rotation
  • Take the clinics as an opportunity to practice talking to patients, taking important parts of their history and handing over to doctors in a succinct way.
  • Don’t be afraid to ask questions.
  • Recommended reading by peers: Orthopaedic Secrets

What did a typical day look like?

7am ward rounds with the other six students and team, then split up into groups of 2-3 for theatre or clinic. Usually home by 2pm or earlier. ENT-specific grand round (consultant teaching session followed by consultant-led ward round) held every second Friday.

What health conditions and surgeries did you see?

Inpatients

  • Lots of head and neck cancers for inpatients. A few acute things like post tonsillectomy bleeds, peritonsillar abscesses, epistaxis.

Outpatients

  • There was a big range – tracheostomies, hearing loss (kids and adults), pre-op sinuses, things stuck in people’s throats and noses.

What were the highlights?

Seeing cute kids in clinic, neck dissection in surgery, grand rounds (the team seemed really keen to teach, and I learned a lot). Also just hanging out with the team – they’re really fun and very knowledgeable.

What were some challenges?

Not really being able to tell what’s going on in surgery because they are working in such small spaces so it can be hard to appreciate the anatomy. Having such a large group of students on rounds was difficult because we were often in the way, couldn’t all fit in the room, not much chance to examine patients in this context. Also it can be hard to find case base discussions cases (assessment task) on ENT.

What’s a helpful tip you received from the team?

Practice with the equipment (eg otoscopes) every chance you get on this rotation because you might not get another chance before you’re a JMO.

What advice can you pass on to future students?

If you get asked to present a topic for grand rounds, try and do an awesome job. The team will love you from then on, regardless of anything else you do. It’s also worth doing the ENT VIVAs before you start because they give you a good background of what you’ll be seeing. Have a vague understanding of interpreting audiograms (sensorineural vs conductive etc). Recommended reading by registrar: ABC of Ear Nose & Throat.

What did a typical day look like?

7am rounds, then clinic, then surgery in the afternoon

What health conditions and surgeries did you see?

Head, neck and lots of mouth cancers, facial trauma

What were the highlights?

Seeing patients on our own in clinic, scrubbing in with super supportive regs in theatre.

What were some challenges?

Getting there at 7, consultants grilling us.

What’s a helpful tip you received from the team?

Introduce yourself as a ‘student doctor’, take control of your own learning journey.

What advice can you pass on to future students?

Find the doctors that enjoy teaching!

What did a typical day look like?

Showing up for rounds at 7am, then being told to do whatever I want after around 8am. I was usually told to go to theatres or study. I wasn’t instructed on what I should do, so I often just did what I felt I needed at the time.

What health conditions and surgeries did you see?

Mostly urinary cancers. Some BPH. I saw a nephrectomy and many cystoscopies and transurethral resections of the prostate

What were the highlights?

I did a PR examination on a man with very advanced prostate cancer and the consultant allowed me to dissect the pathological kidney to find the renal cell carcinoma

What were some challenges?

The was very little teaching. I didn’t find out what a trial of void was until my 3rd week

What’s a helpful tip you received from the team?

The team rarely spoke to me, I was mainly just an extra of the team. I was able to have lots of flexibility though, especially with study. One consultant took some time to help me with phrasing my vivas

What advice can you pass on to future students?

If you want a rotation that requires little face to face time, this is your rotation. Keep in mind you won’t get nearly as much teaching as the other rotations.

What did a typical day look like?

  • Ward rounds at 7 (although some days the consultant was stuck in surgery, so we would go for coffee, then start at like 8:30/9)
  • Theatre straight after rounds
  • Afternoons varied based on my mood, either hanging out in theatre, or going off to do long cases or private study (it all really depends on what surgeries are on that day and how keen you are to see them)

What health conditions and surgeries did you see?

  • Surgeries:
    • Laparoscopic appendicectomies (some were more acute than others which was interesting, comparing a perforated one to one that was not even inflamed was good)
    • Ischaemic bowel resection (open laparotomy à they then let us handle the bowel after they had resected it and do a preliminary macroscopic pathology exam on it)
    • Double mastectomy
    • Laparoscopic cholecystectomy
  • Health conditions
    • Bowel obstructions
    • Appendicitis
    • Peritonitis
    • Cholecystitis
    • Abscesses
    • Fractures (trauma)
    • Pancreatitis
    • Hernias
    • Mesenteric adenitis

What were the highlights?

  • Scrubbing in on the double mastectomy
  • Learning about the different anaesthetics for different emergent procedures from the anaesthetists (as well as helping to cannulate patients in theatre when needed, but this is something you can do regardless of the rotation you’re on, all of the anaesthetists at Gosford are so so so lovely)

What were some challenges?

  • The unique thing about ASU is that, although the juniors in the team stay the same, the consultants change twice a week, so there can be good days and bad days
  • It was challenging at the start, figuring out how the team worked, given the frequent changes, but after a week it was a lot easier and I got into a rhythm with them

What’s a helpful tip you received from the team?

  • They always were sure to keep me in the loop about any particularly interesting surgeries coming up
  • They also made sure to let me know about any good patients to do cases on

What advice can you pass on to future students?

  • Any rotation is what you make of it à you can go to as many or as few surgeries as you like, turn up on as many days for ward rounds as you would like, and ask as many or as few questions as you would like
  • My advice is to see at least one of each surgery, and then use the time to catch up on private study or long cases, or help out the JMO/RMO with jobs on the ward.

What did a typical day look like?

It depends! On most days we started ward rounds at 7am, but our consultant liked starting on 6am on some days. Depending on whether we had to be in clinics or in theatre, we could end anytime between noon and 5pm. Outside of ward rounds, clinics and theatre time, our team always loved a good coffee round 🙂

What health conditions and surgeries did you see?

We mostly got to see endarterectomies, aneurysm repairs and angioplasties during our vascular rotation. However we were lucky enough to see an open abdominal aortic aneurysm (AAA) repair and a popliteal artery entrapment syndrome repair during our rotation, both of which are apparently fairly uncommon! Surgeries aside, most of the patients we saw had peripheral vascular disease or venous/arterial/neuropathic ulcers. 

What were the highlights?

The main highlight was getting to learn so much about vascular surgery and vascular diseases that we otherwise would never have come across. We also got to improve clinical skills that we wouldn’t normally practice outside of a vascular setting, such as feeling for distal pulses.

What were some challenges?

One of the big challenges for me was the long hours — I wasn’t quite used to that at the beginning of the rotation.

What’s a helpful tip you received from the team?

Practice makes perfect. Whether it’s just history/examination skills or procedural skills such as cannulation or catheterisation, it’s always good to practice whenever you get the chance, even if it may be scary at first, because that’s the only way to improve.

What advice can you pass on to future students?

Establish expectations with your team early on in the rotation. While my teammate and I were meeting the hospital hours required by the uni, our team expected us to come in a lot more often than students on other teams because they were really keen to teach us. We got quite an earful for not showing up “enough” at the beginning of our rotation!

What did a typical day look like?

  • On surg rotation at Maitland students are assigned to half-day sessions which may be clinics, surg ward, theatre or private rooms.
  • If you’re in theatre or private rooms, call the surgeon’s receptionist the day before to confirm your attendance, get a start time and any other info/instructions they may have for you.
  • Other than that, just turn up as instructed, change into scrubs, introduce yourself to the anaesthetics team, the theatre nurses and the surgeon. Find the list and see what’s coming up. Ask the surgeon if it’s worth scrubbing in… unlikely for ophthalmology as the surgical field is so small.

What health conditions and surgeries did you see?

Many, many cataracts/lens replacements… apparently it’s the single most common surgery worldwide! Also a couple of macular hole repairs.

What were the highlights?

Watching a very experienced and highly specialised surgeon doing their bread and butter work is impressive. Apart from the anaesthesia and prep, the actual procedure would take 5-10 min which seems trivial until you think of the improved quality of life for the patient.

What were some challenges?

Very little hands on involvement. Limited opportunities for question/discussion as the procedures are quick and highly technical.

What’s a helpful tip you received from the team?

Ophthal surgeons have a reputation for working through lists very quickly, try to keep up!

What advice can you pass on to future students?

  • Talk to the scrub and scout nurses, ask them to help you set up the secondary eyepiece for the microscope (the microscope view is also displayed on a monitor, but you’ll get a better view of what’s happening through the scope itself)
  • Talk to the anaesthetist and watch at least one nerve block.

What did a typical day look like?

A typical day started with a cold shower because the apartment had no hot water. We’d have brekky (with plenty of fruit and traditional Cambodian food) made by Danei, our cook. We would then have a 30-minute tuk tuk ride to the hospital, holding on tight to our bags so that they wouldn’t be stolen by ride-by theives. At placement where we would observe the doctors and nurses and help out where we could. After placement we had plenty of time to explore Phnom Penh with the other students from the apartment.  We went to the Royal Palace, the Killing Fields, S21, the Riverside, Friends café, central market, night markets, roof top bars, swimming pools, and many more places around Phnom Penh.

What health conditions and surgeries did you see?

In the ED, I saw lots of trauma from motor vehicle accidents because traffic laws are virtually non-existent. A large number of patients had alcohol withdrawal and presented to the ED acutely agitated or seizing. An overwhelming number of patients had tuberculosis. In Maternity, I was able to witness a few births. Occasionally we were able to deliver the babies with the help of the Obstetrician. We also followed a few women into theatre to watch their C sections.

What were the highlights?

The highlight was delivering and holding the babies. Travelling on weekends was also amazing. I got to swim with elephants at Mondulkiri, see Angkor Wat and the other temples at Siem Reap. We also travelled to Koh Rong Island on our last weekend.

What were some challenges? 

One challenge was watching patients presented to hospital at a very late stage in their disease because they hadn’t been able to afford to see a doctor earlier but resorted to the ED out of desperation. Every day we saw patients and their families struggle for money because they weren’t able to pay for the treatment that they needed. Also, in Cambodia many women believe that it is better to have small babies because it makes the labour less painful (understandably due to the limited pain relief the women received). Women would deprive themselves of nutrients and smoke in order to keep their baby as small as possible. Infection control throughout Cambodia was not at the same standards as Australia and so you had to be extra mindful of keeping yourself and your patients safe. Language barriers also posed a challenge. The doctor’s in Cambodia spoke fluent Khmer and French, however, they didn’t know much English and so it was often hard to figure out the story behind each patient.

What’s a helpful tip you received from the team?

When investigating a patient’s symptoms, be very mindful of how the test is going to impact your decision making because if it isn’t necessary then you shouldn’t expect a patient to pay for it.

What advice can you pass on to future students?

It’s a great experience. Even though our health system in Australia isn’t perfect, we are incredibly lucky. Always have small money for tuk tuks (like 1 US dollar or riel). Learn a few words in Khmer so that you can interact with patients. Google translate is your saviour. Be sure to talk to the younger nurses and doctors, as well as the local students because they will have the best English. Although they are shy, they are happy to practice their English by speaking to you.

What did a typical day look like?

Starting at about 8 at the hospital meant that we left home at 7:30 to walk the couple of kms down busy streets to the hospital. We then went into the emergency building (each department had separate buildings) and upstairs to the intern’s room to change into our scrubs. Then off to our wards to start ward rounds. Ward rounds were huge. The surgical ones were small and they had at least 10 interns and 3 residents following the 1 consultant around to every patient in the ward. Rounds once went for over 4 hours straight. We would carry out wound cleanings and dressings and if lucky there was a surgery on to go watch. That was usually the rest of the day at hospital Goyeneche.

What health conditions and surgeries did you see?

So much appendicitis! I was on the general surgery ward the longest and I saw so many appendicectomies! I did get to watch some cool surgeries with the special surgery teams though like when they took our a cyst the size of a soccer ball from a woman’s stomach. That was crazy.

What were the highlights?

Traveling was obviously the highlight of the trip and even just traveling on the weekends I was able to see so much of Peru. Though my favourite experience was still probably climbing Misti volcano which is one of the 3 volcanoes that surround the city of Arequipa, and the only one that is still active. It was an insanely difficult hike but so worth it for the view from the top overlooking the city and other mountains. Then in the hospital setting it was probably getting to know a couple of the interns well and watching one get to assist in their first surgery. This one intern I got along with really well helped me a lot with translating Spanish as well, and he got rotated to the same wards as I did at the same time which was amazing!

What were some challenges?

Spanish. No, I did not speak fluently before I went. Yes, you definitely should try to before you go. It made ward rounds a million times more boring when you couldn’t even understand what was being said. I mean it would have been nice if the uni gave us time to do the intensive Spanish course week before-hand as well, but I guess I can’t blame them entirely for my lack of Spanish.

What’s a helpful tip you received from the team?

Always agree on a fair before getting in the taxi. You’ll get extorted if you don’t.

What advice can you pass on to future students?

Learn the language well, and I did it through work the world so if you do, make sure you become good friends with your housemates. Mine were really fun.

What did a typical day look like?

The morning start is much more bearable compared to Med and Surg, starting at 9.00 am but this obviously differs from practice to practice. And finishing at around 4-5 pm. I personally was attached to a female GP, meaning I was able to see a lot of different areas, especially women’s health and paediatrics. My role started minimal, I usually watched, listened and ask/answer questions during consultations, but as the week went on, I started to perform basic procedures (mainly vaccinations), and even ran my own consults in the spare room, and passed the info to the doctor.

What health conditions and surgeries did you see?

Being a GP practice, it is the classic community health scenario. There was a lot of mental health conditions, to first presentations of serious conditions (I saw a DVT and sent them to hospital), and plenty of paediatric patients. Procedure wise, it is limited to injections and skin lesion removals/biopsies so not as exciting as other rotations. Sure, there’s the boring stuff like filling scripts, filing Centrelink forms or housing situations, but you can talk and connect with the patient a lot more, and have time to work on the base skills of becoming a doctor. This is the urban scenario, people who attended rural GP clinics, were basically doing pseudo hospital placement.

What were the highlights?

Paediatrics was my highlight for sure, as we do not go into our paediatric rotation until next year, it was a fresh (and much needed) change rather than handling the one age group you will mainly see in other rotations. Another is seeing mental health and how widespread it is. It woke me up to the severity in our local communities, and I gained valuable experience when observing their consultations.                     

What were some challenges?

Being a male student following a female GP, it was understandable to be asked to leave for sensitive issues. Otherwise the less interesting workings of GP placement such as administration forms, for the clinic, Centrelink or Worksafe, is a struggle to take interest, and even stay awake.

What’s a helpful tip you received from the team?

Take your time to talk to the patient and be thorough when typing up findings. It is a lot easier and beneficial when health professionals write up patient notes meticulously, as it allows future visits to reflect on these notes and observe any changes which could be key for consultation. So, in the end, learn to type fast.

What advice can you pass on to future students?

Relax, most GP placements is regarded as the time to kick back, and not stress out. GPs are generally more down to earth and appreciate a healthy work-life balance more than doctors in other specialties. Othewise have lunch, even if your GP is not, and take advantage of the drug reps who bring free food 😊.