How to survive the ward round 

The dreaded ward round began at 08.30. You were buzzing, coffee swilling warmly through your veins, notebook and pen at the ready; a diligent student of a glorious vocation ready to learn. It’s now 09.15 and you’re stealing guilty glances at the clock, your weary eyes sliding down to your crumpled patient list to see how much more of this ordeal you must endure. A mortifyingly audible rumble emanates from your midriff as the consultant falls silent to listen to another wheezing chest. A whiff of barrier cream tickles your nostrils and you feel that all-too familiar wave of disappointment wash over you as you realise the round is less than a third of the way through, complemented by a trickle of frustration at the dogged determination of the patient that just won’t stop asking questions about their management. You watch in awe at the junior doctors relentlessly scribbling away in the notes, rifling through drug charts like finely-honed machines, occasionally handing you snippets of useful information and asking ego-destroying questions like ‘can you name the 27 causes of clubbing…?’

How do they survive these things? How are they not starving? Are they even human?

A Game of Endurance

Ward rounds are like marathons. They can last anything between two and seven hours depending on how quick you are, they require uncomfortable amounts of time on your feet, a large proportion of which is spent wondering why anyone would do this out of choice. They also both require training; you need to allow your body and mind to build up the endurance required to survive, and hopefully succeed. Over the last three years I have found a few things that really helped me get to grips with ward rounds, making them more interesting and less soul-destroying, so I thought I’d share:

• Get your food right

  This was probably the most important change I made to my routine. A friend of mine used to down an espresso and a pain au chocolat each morning before turning up to ward rounds. Her fifty shades of beige frenzy of sugar and quick-access caffeine ensured she was a veritable Goddess of concentration for approximately thirty-eight minutes, before the inevitable crash came and she joined the rest of the zombies trailing the age-defying consultant who seemed to have it all impossibly together. Sugar is cheap, feels good, tastes good, and certainly boosts cognitive and physical performance in the short (very short) term. But it provides very little useful nutrition, and certainly isn’t going to last long enough for a full ward round before you’ll need a top up. I found that by having a much bigger breakfast with a lot less carbohydrate, I was able to concentrate for longer, felt less groggy at 11.00am and didn’t need to eat again until at least 2pm.

  • My pre-ward round breakfast:
    • 6 Eggs
    • 1/2 punnet Mushrooms
    • 2 Veggie sausages
    • 1 piece of toast
    • 1 Big Coffee with milk (the fat in the milk absorbs the caffeine, giving you a slower infusion, rather than a kick)

• Set yourself specific goals

  Try not to just turn up to ‘do the ward round’ because you’ll end up bored, demoralised and probably won’t learn a whole lot. Set yourself a specific thing to do, and ask the consultant if it’s alright beforehand, and you’ll take away so much more from the experience. Having a specific job to do should keep you interested and will also let you be a useful part of the team. Ideas include:

  • Ask to see one of the patients later in the ward round, and be the one to present to the consultant when they get to that patient
  • Write in the notes for two or three of the patients (just make sure you get them countersigned)
  • Be the ‘drug chart checker’ for that round (look for kidney busters and blood pressure tankers…)
  • Check that every patient has got VTE prophylaxis
  • Listen to at least one bubbly chest
  • Check every patient’s catheter
  • etc

• Don’t stay for all of it

  I’ll caveat this with the following: there is the occasional consultant that expects all of his medical students to attend all of his ward rounds all day of every day. There isn’t much you can do about this except upgrading your breakfast and hoping for the best. Most consultants nowadays however have a more relaxed attitude towards quantity of round attendance as long as it’s good quality, and you’re not just doing nothing the rest of the time. If you ask beforehand “May I join for the first half of the round, and then read up about the topics?” there is a good chance they’ll agree. They may even give you specific patients whose conditions would be good to read about. You can then concentrate hard for the first few cases, knowing that the end is near…

  • This is especially useful in third year, when many of the topics are completely new and quite daunting. See two or three patients, and then go read about their conditions, using them as your ‘model patient’ for that condition.
  • As time goes by and you become more experienced, the rounds will become easier as you get used to their ebb and flow. Checking observations and drug charts becomes routine, and you start understanding why the consultant is asking the specific questions that they do.
  • It’s good to see the same patients on consecutive days or a few days apart, to see how they progress and how their management changes. It’s a very different experience when the patient recognises you and smiles.

• Ask the consultant to grill you

  This one is strictly optional. I’m one of those people who likes being put on the spot in front of the ward round and grilled for a response to questions I could have never have hoped to answer. “…Er…why?…” – because in that moment, when the adrenaline is scouring the lining off the inside of your arteries and your shirt becomes eerily moist, your brain goes into survival mode, slowing down time and remembering everything. I find it’s the most efficient way to learn – get grilled on a topic once, and not know the answer, and you’ll never forget it again! Just remember to breathe afterwards.

Hopefully these are of some use, they were certainly my main strategies for surviving the rounds. I’ll add more as I think of them, but if you have any top tips for fellow med students out there, please comment!

UM