Learning in a Hospital Environment

Dr Pauline Jennings, Clinical Tutor in Medicine

In a large hospital, most of the services that you are attached to are very busy and individual attachments are relatively short.  Despite this teams are keen to involve enthusiastic students.  It is very important to be proactive and integrate yourself into these teams. You are expected to attend all of the team’s activities including ward rounds, out-patient clinics and multi-disciplinary team meetings.  

Most teams will be on-call for at least one 24hour period during your attachment. It is highly recommended that you would participate in this.  It is an excellent opportunity for you to see patients presenting acutely with a variety of symptoms and signs. In consultation with the on-call team, you should clerk one of these patients, formulate a differential diagnosis and present to the consultant on the ward round the following day.  It is very beneficial to follow your patient through their admission from their acute presentation, through diagnostic work-up and treatment to discharge.

Remember you get out of any attachment what you put into it. If you approach it in this way, you will find it not only a wonderful learning experience but thought provoking, stimulating and rewarding. 


  • Be proactive - you need to make contact with your assigned service on the first day of the attachment and arrange to meet with them. Nominate one person in the group to do this. Initially bleep the intern. If there is a difficulty contacting them, try the SHO, then the registrar. Be persistent and do not give up! If this is unsuccessful the Department of Medicine Office can assist you. Present at every opportunity as it is it an essential skill. It also plays an important part in how you will subsequently be assessed.
  • Be enthusiastic - involve yourself from the outset, integrate into the team and attend all of their activities including going on-call with them.
  • Attend Tutorials - structured teaching including Medical Professorial Unit (MPU) tutorials is also incorporated into clinical attachments. These give you the opportunity to present to members of the MPU and get feedback from them.
  • Be prepared – best preparation for the examinations in Clinical 1 is spending time on the wards taking comprehensive histories and examining patients and then presenting to doctors/ tutors. This should be supplemented by selfdirected learning. The skills acquired are essential for day-to-day clinical practice and all of your assessments from Clinical 1 through to postgraduate examinations.