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What to expect from CBM: First year

  • Writer: GP Society
    GP Society
  • Oct 9, 2020
  • 4 min read

Written by Zaylie Mills Second Year Medical Student


Want to know more about your CBM placement in first year? Well for me it really shaped my understanding of the many aspects of a GP’s role from doctor-patient interactions to working within the whole practice team. They quickly became the days I would look forward to, with a different learning environment and more practical applications of all the anatomy and physiology you learn in med school!


It is also a really important time to develop more of your communication skills and learn how to interact with patients. My tutor taught me some specific tricks such as never saying “Good morning” to a patient, instead she simply says “Morning.” When a patient arrives, you do not know what state of mind they are in, they could be in intense pain and discomfort, or just having one of those days and saying this could cause a hostile reaction and start you off on the wrong foot. Something so simple has the potential to change your entire interaction with a patient, and given time is so limited it can be difficult to recover. Other things that I learnt were more straightforward such as how to properly introduce yourself and gain consent for whatever you are trying to do. One of the scary things about starting placement can be being left alone or in a pair to talk to a patient, but as long as you properly state what year you are in and your experience level they won’t normally assume that you know everything! The patients you meet to in first year have also normally been specifically asked to come in to talk to students so are often very open and friendly.


Another key skill that is developed is taking histories, essentially the different types of questions, and how to ask more difficult or personal ones. A lot of this is also made easier by having created that open and comfortable environment in the first place. I also became more confident in some clinical skills such as abdominal examinations, chest auscultations and looking at arthritic joints. Becoming familiar with the computer systems used (SystmOne in my practice) also meant I was able to quickly find information in order to familiarise myself before the patient arrives.


There are however some unexpected challenges, especially when on your first medical placement. One of the first ones I encountered was the different approach that has to be taken when an interpreter/translator is also in the consultation. It can be difficult to know how much information is being accurately relayed and what their level of understanding is. In one particular consultation I observed, the interpreter was also the patient’s social worker, meaning they knew a lot about the history and were not really asking the patient questions but rather were responding themselves. The problem with this is that the patient might have had a different opinion or different concerns, which were difficult to get across. Another challenge is seeing patients who have issues that are out of your realm. For example, cases where peoples housing situations are negatively affecting their mental health. This can be difficult as you are empathetic to their situation, but it is not something anyone in the medical profession can really fix, there are often social or familial issues that also should be being addressed.


A slightly different challenge can be when having a consultation with a patient who is particularly chatty and talkative. They can often sway off of the topic you want to discuss and before you know it they’re talking about grandchildren or their day! Due to the time constraints, you do have to learn how to nicely redirect them and learn when it is appropriate to interject. I feel like this is really a skill that gets less awkward and uncomfortable the more you have to do it. The first few times you can be worried about coming across rude but really you just have to word it well and still be professional and approachable. A lot of the challenges and unexpected experiences depend on where your practice is and the demographics in its catchment. There can be a real difference in the variety of issues you see as well as how busy they are depending on these factors.


Having reflected on my first-year placement I think there are a few final pieces of advice I would give to freshers starting placement now. Firstly, I would say be as confident as you can, both in your peer group with your tutor and in consultations. It is a very safe environment to bounce off ideas and discuss various topics. Secondly, always keep an eye on the time, finishing watching consultations later than expected can delay everyone else and mean teaching has to be rushed (obviously if you are in a particularly interesting consultation you normally won’t need to get up and leave!) Thirdly, and probably my most important piece of advice in my opinion, focus more on the communication styles and skills rather than medical specifics. You have so many other opportunities to learn information like drug treatments, try and focus your energy on getting more comfortable at interacting with patients as the sooner you start to develop these skills the better you become!




 
 
 

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