Bringing learning to life
The journey from student to medical health practitioner is often chronicled. The stories of brilliant, young and driven medical students, charged on caffeine and entrenched in late night rounds, are frequently depicted through the glamorous filter of Hollywood.
But at London Health Sciences Centre, far away from the land of scripts and sets, a very real experience is felt by over 2,500 students who arrive each year to complete the on-the-job portion of their training. In the hallways, labs, surgical suites and everywhere in between, future physicians, nurses, and other health professionals receive a chance to pull back the curtain and see, with their own eyes, what a career in health care holds.
According to Dr. Vanessa Burkoski, Chief Nursing Executive/ Quality & Patient Safety Officer/ Professional Scholarly Practice, the on-the-job experience provided at LHSC is invaluable to producing the next generation of health-care providers.
“It really allows them to take the theoretical aspects of care and research and put those pieces together in a very practical way,” she says. “It also allows students to really see how a variety of disciplines come together to support patient care delivery. From the time they come to this organization, they become part of a team and understand their involvement as a team player – someone who will contribute in their unique way to supporting the patient in terms of health management, as well as having an effect on patient experience. That’s really important.”
But in addition to gaining personal experience, students provide something invaluable to patients too, as their work contributes to LHSC’s culture of excellence in providing patient care. Dr. Robin Walker, Integrated Vice President of Medical Education, stresses the diversity of learning opportunities available at LHSC, as well as importance of student contributions to the hospital.
“London Health Sciences Centre is one of only 16 hospitals in all of Canada to provide the most intensive and broadest spectrum of teaching for health-care practitioners,” he says. “Students provide a lot of clinical services in addition to receiving learning opportunities.”
And students keep staff ’on their toes’, according to Burkoski. “Students apply theoretical knowledge based on the most current information in their courses and it challenges the mid-career or later career professionals to stay abreast of that knowledge. They want to know the right answers [to student questions] and so they make an investment in their continuing education. There’s a tremendous benefit.”
Students at LHSC have proven they have a knack for compassion and are known to make an effort to go the extra mile, not just for patients, but for family members at the bedside too. “Sometimes in our hectic world we forget about the small things, but students don’t because they’re practicing them and they remind our seasoned staff about them,” says Burkoski. “It builds that reflective practice that allows you to stay current in your practice."
When patients are seen at a teaching hospital they may encounter students in a number of ways, but it’s important to note that patients are always asked for permission for the student to participate in their care. If consent is given, the student may participate in care in a number of ways including conducting a patient interview, observing a procedure or providing patient care under supervision.
For medical students specifically, in-hospital experience is gained in two stages, first as a medical student earning their medical doctor (M.D.) designation, and later, as a resident. Residents have earned their M.D. and are completing further work in the hospital to determine their specialty, such as internal medicine, paediatrics or general surgery. Residencies may last anywhere from two to six years.
While there are countless ways in which students may be involved with care, perhaps the best way to understand the impact of student involvement is through the eyes of the students themselves. Here, we explore the experience of learning at LHSC through the eyes of three students: nursing student, Justin Toth, medical student Michael Meschino and medical radiation sciences student Jacob Cottreau.
Name: Justin Toth
Program: Western-Fanshawe Collaborative Bachelor of Science in Nursing
Experience level: Fourth year
Expected graduation: June 2015
Q. What made you want to start this whole process to become a nurse?
A. I wanted to do something to help people and I wanted to be as close to patient care as possible. I had cancer as a two-and-a-half-year-old, and that’s been part of my inspiration. I know that, [as a health care practitioner], patients and family members won’t remember you exactly, but they’ll remember the effect that you had on them. I remember the impact that the health care team [at LHSC’s Children’s Hospital] had on me and I decided that I’d like to have that effect on someone else.
Q. Can you describe what the nursing program has been like for you?
A. It’s gone by really quickly. It’s perfect for me because there’s lots of hands-on learning and clinical and theory and the sciences. It’s been really interesting and has opened my eyes to what nursing actually is, including the philosophy and the research that goes on in nursing, which I didn’t know happened.
Q. So what do nurses [and nursing students] do?
A. Everything! Usually the first person you come into contact with at the hospital is a nurse. We do so much. I thought nursing was strictly working on the floor, doing things for doctors, therapists and everything – but I’ve learned so much. A lot of the patient care is given by nurses or allied health professionals. They are the connection and liaison between patients and their therapists and doctors. Nurses are advocates for our patients.
Q. Do you remember your first patient experience at the hospital?
A. Yes. We’re always paired with a nurse, shadowing but still helping. I remember one of the first patient procedures I was there for was an enema. I remember thinking this is really awkward! But it’s not awkward now because I’ve had so much clinical experience and have worked with patients.
Q. What is interacting with patients like as a student?
A. I always explain to them that I’m a student. If there was something I had never done, I would never do it by myself. I always got a nurse or my clinical instructor one was with me always], and they’ve always been really supportive. They’ll tell me: ‘You’ve done this in lab, so you can do this here. It might be a little different, but we can help you along.’ Patients have never said anything negative. Most often, I get a ‘thank you very much, you did a great job.’ At LHSC, clinical staff members are also teachers. They’ve been dealing with students for so long that everybody is willing to teach you. Everybody is so supportive. No one is going to leave you high and dry as long as you ask for help and you are willing to learn, there’s always going to be somebody to teach you here.
Q. What would you like patients to understand about the process you go through as a student learning on the job?
A. I’d like to ask them to please be patient with me. Students want to give their best and give their all for patients. When we start out, we only have one patient and that patient is the centre of our world. When I’m doing clinical work – patients are the reason I’m there. If [students] didn’t want to be in nursing, we wouldn’t be there. As a patient, you are incredibly important to my education; I’m going to do everything I possibly can for you. I know the amount of questions you’re going to be asked can get frustrating but, at the end of the day, we just want to care for you in the best possible way that we can.
Name: Jacob Cottreau
Program: Medical Radiation Sciences, McMaster University and Mohawk College
Experience level: Fourth year
Expected graduation: 2015
Q. What inspired you to pursue a career in Medical Radiation Sciences?
A. When I was younger, I had to have a lot of surgeries and my hero was my doctor. Back home in Nova Scotia, I volunteered at my hospital and had the chance to work around the X-ray, MRI, and CT departments and I really loved it. When a friend of mine told me about the Medical Radiation Sciences program at McMaster, I looked into it, thought it was interesting and ended up getting in!
Q. What will your job title be when you graduate?
A. I’ll be a medical radiation therapist.
Q. What do you remember about the first time you interacted with a patient?
A. My first patient interaction was in a breast cancer unit and I felt kind of awkward. But the patients are so nice and since they’ve been seen by a number of people at the hospital, they feel more comfortable, so I became more comfortable too.
Q. What are you doing to gain on-the-job experience at LHSC?
A. At the hospital, we have certain competencies we complete, for example we may be properly positioning patients to receive radiation therapy. We also have to ‘assess and respond’ to patients’ needs. For instance, one of the most common reactions to therapy that breast cancer patients experience is a skin reaction, so as a student I must assess their skin health and respond to any issues. We will also do other things. We retrieve the patient from the waiting room and ask them how their day is going. We verify their personal information and ensure the area is set up properly. In order to properly align the radiation therapy machine, patients have little ink dots placed on their skin called ‘tattoos.' We have to ensure that these are placed in the right location. Our instructors are always watching over us and have different involvement depending on the case. Right now I’m at the end of my third week at LHSC, so mostly they’re observing me as I go and if I need something, then they jump in.
Q. Why did you choose a placement at LHSC?
A. It’s a bigger centre than where I completed my first placement, with a different intensity. It’s good to see both aspects – smaller hospitals and larger centres - before I graduate. I’m hoping to be competent in everything and to understand all aspects of treatment. The therapists are good teachers. Even just the little things that they do, it sticks to you. It could be the way they move patients when delivering treatments, or even advice on things to say, things not to say, and how to approach certain subjects, etc.
Q. What would you say is the benefit to patients attending a teaching hospital?
A. Well, I think that having students here keeps everyone on their toes because they’re teaching you and you’re going to be asking them a lot of questions. Also, I’ve noticed that different patients relate to different types of people. [Students] stay on a unit for about a month and if patients feel more comfortable talking to you then that’s a positive for their experience here.
Q. What has been the best thing about your experience so far?
A. Everyone I speak with always thinks that radiation therapy is such a sad field because it has to do with treating cancer, but it’s so amazing. Patients come in with smiling faces, they’re generally happy. It’s awesome. Even if you wake up in a bad mood, you’re not going to stay that way for long because you’re working with amazing patients.
Name: Michael Meschino
Program: Western University Schulich School of Medicine and Dentistry
Experience level: third year
Expected graduation: 2016
Q. How do medical students gather in-hospital experience?
A. During the first two years of the program we spend one afternoon each week practicing clinical skills either in the hospital or simulation setting. We are also free to schedule observerships [time spent observing in the hospital] during our free time – typically two afternoons each week. As a third-year medical student we are given the title clinical clerk. In this role we function as an active member of the medical team, learning hands-on how to manage patients and put the knowledge gained over years one and two to practice. We spend the third year rotating between different services in the hospital as well as in the community, including medicine, surgery, family medicine, psychiatry, paediatrics, and obstetrics and gynecology.
Q. Is it challenging for students to transition from the classroom to the hospital?
A. Transitioning from the classroom to the workplace can be overwhelming. In the classroom setting your learning is very much laid out for you. As a clinical clerk, you become responsible for your individual learning. Every patient encounter, every discussion with your senior (physician teacher), nursing staff or other allied health professional becomes an opportunity to build on the knowledge gained in the classroom. The greatest challenge transitioning to the workplace is learning how to deal with the uncertainty of real life medicine. On classroom examinations there is always a right answer, a correct diagnosis, or a logical management plan. In real life, things are much more complicated and too often there is no one right answer.
Q. How does it feel to begin interacting with patients?
A. My first interaction with a patient as a clinical clerk was in the cancer treatment unit at Victoria Hospital. I spent about 20 minutes reviewing the note from my senior (physician teacher) and writing out a plan for what I wanted to ask the patient. I was concerned with looking awkward, uncertain, unprofessional – basically looking like a medical student on their first day on clerkship. Thankfully, the patient I was visiting was very understanding and cooperative as I stumbled my way through a history and physical exam. Since then my confidence has grown as I become more comfortable in my role. However, every patient encounter is a new experience and a test of both confidence and competence. As a medical student, I think it’s a good thing to feel as though you don’t know everything yet; it ensures that each patient gets the attention to detail that they deserve.
Q. What would you like people to know about the benefits that students offer to patients?
A. The hospital is a busy place and it can be difficult to slow things down for teaching purposes. Fortunately there is a great culture at LHSC where importance is placed on teaching at every level of medical expertise from medical student to consultant specialists. For patients, being in hospital can be very stressful and confusing. In my limited experience, I believe most patients view the extra time spent with clinical clerks as an opportunity to express all of the things that they feel are important to their unique situation.
As students, we often have more time to get to know the patient personally – a luxury that may not be possible for the busy consultant. It’s also important for patients to feel comfortable when communicating with medical students. All patients should know that everything we learn from the encounter is shared with a senior physician and discussed in depth before any management plan is put in place. As a patient, you should feel confident knowing that any encounter with a medical student is only an additional component of your care and never merely a substitution for a visit with the doctor.