Charlotte Ralston and Ciaran Walsh

You can always spot the new medical students on a hospital ward. They look unsure—intelligent, but professionally gangly and ill at ease with their surroundings and the people that fill the unfamiliar and intimidating hospital space. Uncertainty and self consciousness may be reinforced by distrust from patients and ward staff. This does not constitute an ideal learning environment.

Medical students rapidly need to learn to interact successfully with two groups of people: the patients and the staff. Success with both sets requires similar but different skills and ultimately comes down to communicating well after gaining an understanding of each groups needs, perspectives and priorities. The educationalists would have us believe that communication training in medical school is the answer. Our opinion is different and was formed during a recent medical student attachment on a surgical ward where we worked together. Ciaran Walsh, a consultant, rapidly became aware how much more comfortable Charlotte Ralston, a medical student, was in the ward environment than was usual. The comfort and familiarity with the ward environment, patients, and nurses, clearly generated a confidence to set about clinical learning. The answer when sought was simply that Charlotte had worked as a healthcare assistant (HCA).

Getting more familiar with handling patients comes only with experience. Even during bedside teaching a medical student is seldom alone with a patient to hear their inner fears and aspirations, or indeed required to physically help them with personal tasks. An HCA doing bedside washes may see someone at their most vulnerable and have developed a deeper level of understanding and empathy towards their situation.

People who are inpatients on a hospital ward want and need to be cared for. Some of that care will be treatment, but much of it will not. It will be a knowing reassuring smile, a drink of cold water, or a hair wash. It will be accurate drug administration and appropriate checks prior to a blood transfusion. Inpatient’s families also want their relative to be supported in a caring professional environment. Nursing and HCA handover is centred on personal abilities and patient manner—what is normal for them and what isn’t. Learning how much people appreciate the simple things, be it a shower or brushing their teeth.

Going onto the hospital wards will always be intimidating for medical students, particularly early on in training. However, previous experience through working as an HCA provides fundamental knowledge of ward structure and function, as well as the teamwork needed for good patient care. The stress of not knowing how a ward operates, who the various players are, and what their roles are, is alleviated after HCA work experience. Moreover, we feel that being exposed to this work at an earlier stage in medical school will help gain insight into life as a patient in a hospital setting, and the variability and individuality of each patient and their personal care requirements and perspectives. It will make medical students more confident about moving, handling, and caring for patients of variable ages and abilities as well as improving their communication skills.

Our personal view is that medical students would benefit greatly both in the short and long term, from a period of time spent working as an HCA on a hospital ward prior to their clinical attachments.

Charlotte Ralston, third year medical student at Queen’s University Belfast and healthcare assistant. 

Ciaran Walsh, consultant general surgeon, Wirral University Teaching Hospital.

Competing interests: None declared.