George is from South London and did A levels in Chemistry, Biology, Maths and Physics. He wrote this account in his fifth year on the Medicine course here at King’s College, Cambridge. So George has already completed the three years of pre-clinical Medicine, and wrote this in the second year of Clinical Medicine.
What attracted you to studying Medicine at Cambridge?
The science of physiology, disease and treatment has always been fascinating to me and there really is no better place to learn more about it than Cambridge. Getting to put that knowledge into practice in hospitals in and around Cambridge in the clinical years is even better!
What was starting the Clinical part of the course like?
Starting the clinical course after three years of academic work in the pre-clinical course can be daunting, as the wards are a very different learning environment to the classrooms, but the clinical school supports you well along the way. Teaching comes from senior doctors at the bedside, lectures in the clinical school, practical procedure experience in the skills lab, and communication skills training. All of these components help you to move from being a biomedical scientist to a junior doctor.
Have you specialised at all?
Committing to a specialty is something that doesn’t happen until after you graduate. However, if you have an interest in a particular specialty, there are opportunities to pursue that at the clinical school such as SSCs ("Student-Selected components") and your elective. I have an interest in anaesthesia and intensive care and have completed a SSC in Addenbrooke’s Intensive Care Unit (ICU) where I completed a project on hepatorenal syndrome and worked in an ICU in Canada for my elective. Now in my final year, I'll be going through the last of my specialist rotations - ENT (ear, nose and throat), ophthalmology, and A&E among others - and getting ready to start practicing as a junior doctor.
What placements have you done?
In my first year,I completed two medical and two surgical placements (gastroenterology, upper gastrointestinal surgery, hepatobiliary surgery and medicine of the elderly). In my second year, I rotated through psychiatry, paediatrics, obstetrics and gynaecology, oncology, cardiology, respirology, cardiothoracic surgery, neurology, rheumatology and orthopaedics. Throughout both years you also get time in General Practice, where you can interview, examine and suggest treatments alongside an experienced GP!
What were the main things that struck you about the transition from A level to studying at Cambridge?
For me, the main shock of studying at Cambridge was the level of independence I was expected to work at. Rather than the multi-tasking that A levels require, study at Cambridge is very directed, and weekly essay assignments require you to work in a very independent and focused manner.
What do you do in an average week?
Addenbrooke's Hospital in south Cambridge.
An average week will consist primarily of ward work. This will consist of ward rounds, outpatient clinics, operating theatre time (when on surgical placements) and structured teaching with senior doctors. Alongside this, if you are placed in Addenbrooke’s, you have practical skills workshops and communication skills training. In the evenings when you get back you follow up what you have seen on the wards with some book work. If you meet a patient with an interesting disease you’ve never heard of before, go back and read about it that day and you will never forget the disease or the patient!
What have you found most difficult about Clinical Studies, and what have you found most enjoyable?
With clinical medicine, you can never know everything and, even if you did, patients seldom follow exactly what is written in textbooks. Getting used to not having a curriculum to follow and managing uncertainty is something that takes some getting used to and I’m definitely still adjusting. The most enjoyable part of clinical medicine is seeing something you have learnt about academically come to life in helping someone who is unwell. Learning about the immunology of transplantation in a lecture and then seeing a patent given a new lease of life from a transplant operation you were in is an incredible experience.
What is the workload like at this stage in the course?
Much like in the first three years, the work does build to progressively higher levels as you advance through the course. The Clinical Pathology final in particular requires a large amount of steady book work right from the get-go. Overall, I would say that the work in the clinical years is of a greater amount and more demanding, but it is hugely enjoyable to get to as you feel a lot more like a ‘student doctor’ than ever before.
Inside King's College Library. Credit: Jarrod Doll
You do have time to relax and enjoy other things, although extra-curricular activities with very high time commitments can be difficult to sustain when you are 9am-5pm Mon-Fri on the wards and then have to do book work on top. Having said this, make sure that you safeguard some time for fun and relaxation, as you don’t want to burn out and you’re supposed to have a good time at medical school.
Is there a lot of reading at this stage in the course?
This is a difficult question to answer. The field of clinical medicine in boundless and so theoretically you could read forever on the subject. The best way to divide your reading is into groups: the reading you need to do to pass your exams and the reading you need to do to compliment your clinical work. For the former, there still is plenty of studying of reference textbooks, especially for pathology. The latter you can do at your own pace and according to your own interest. As you progress through the clinical school you will come to realize if you are someone who absorbs a lot by being on the wards of if you are someone who needs a lot of additional book work to back up what you have seen/heard during the day.
Do you have to meet any requirements to start the Clinical course?
As of the 2016 intake, all Cambridge students (provided they have passed the Tripos and 2nd MB exams) will continue onto the clinical course. The 2nd MB exams require you to pass the Functional Architecture of the Body (anatomy), Homeostasis (physiology), Molecules in Medical Science (biochemistry), Mechanisms of Drug Action (pharmacology), Neurobiology and Human Behaviour (neuroscience and experimental psychology), Human Reproduction, Biology of Disease (pathology), Introduction to the Scientific Basis of Medicine (medical statistics), the Social Context of Health and Illness (medical sociology) and Preparing for Patients courses!
How are you assessed?
As with all Cambridge courses there are both formative and summative assessments, where the former are to help you know how you are getting on/what to improve on, and the latter have to be passed in order to progress. There are two forms of exam set by the clinical school: written exams and OSCEs ("objective structured clinical examinations"). Written exams can be multiple choice, short answers or essay papers e.g. the Final MB (bachelor of medicine) in Clinical Pathology consists of two three hour written papers, one multiple choice and one short answers. OSCEs are practical exams that take place in the clinical school and have a steeplechase format. The stations in these exams can be clinical examinations on real patients, medical history taking with simulated patients or a structured oral examination by a consultant in the field on a given subject. They can be quite daunting but you get some practice beforehand.
Do you still spend a lot of time in College?
Staying a part of college life can be challenging when you spend so much time in and around the hospital, but if you put the effort in, you can still play a big part in the college community. I became one of the King’s College Graduate Society’s Social Secretaries, which meant that I could stay in touch with my friends who had stayed on at the college and meet loads of new friends in the graduate community. You can do the same thing by getting involved in sports teams and any of the huge variety of other societies that King’s has to offer. The best way to make sure you stay involved in college life is to get involved early on in the pre-clinical course.
What advice would you give to sixth formers who are thinking of applying to study Medicine?
You need to do a couple of things before you send in your application. First of all, work hard at your A-levels and do some reading about medical science. Medicine is a very tough course to get into and it isn’t easy once you get in. Make sure to put in the hours to give you the best grades possible and have enough reading/exposure to the field to make sure it is what you want to do. Secondly, think very carefully about what sort of course you want to apply for. If you want to be seeing patients from day one and aren’t that interested in the science behind the medicine then the Cambridge course is not the one for you!
If you’ve done these things then I can’t recommend applying to study medicine highly enough. It’s a challenging, rewarding and fascinating subject which leads you to a job like no other and you can have an amazing time on your way.
What will you do next year?
Continue with my final year, (hopefully) pass my final exams and become Dr. George Chater after the six most incredible years of my life so far.