The Surgical Placement Experience: Navigating A New Learning Approach as Medical Students

Naturally, clinical placements can be challenging and seem daunting, but they provide valuable opportunities for students to learn the science and art of medicine. As medical students, our first few clinical placements are a deep step into another world, a steep learning curve with snippets of what seems like a new language that we cling to understanding from pre-clinical lectures. For a successful transition, effective preparation, encouragement and clear identification of learning objectives are key. Furthermore, placement experiences are known to influence future specialty choices, and students have a unique role to play within them. Although there is much focus on student preparation for placements 1, 2, this article presents a student's perspective on a first surgical placement, while also offering practical insights for both students and educators. The General Medical Council (GMC) states that clinical placements give medical students ‘practical experience in different healthcare settings’ 3. As a second-year medical student, the opportunity to see what my future could look like was both exciting and slightly intimidating. Being a student in a busy surgical ward, it is easy to feel lost and out of place. The hands-on mode of learning is completely different from pre-clinical lectures, placing greater responsibility on students for self-directed learning objectives. On the first day, having been allocated to an upper gastrointestinal firm, there was a wealth of information to absorb. During the ward rounds, we encountered patients with varying surgical conditions, including bowel obstruction and trauma. Additionally, we had the opportunity to join theatres, witnessing a laparoscopic cholecystectomy for the first time. I recall feeling like a member of the operating team simply donning the green scrubs and watching the procedure live on the screen. Supervisor engagement enhances the likelihood of students achieving their learning objectives 4. For example, consultants may ask—‘What do you want to do today?’ and being prepared with an answer ensures mutual satisfaction. Inevitably, the placement experience varies considerably depending on the medical team to which students are assigned 5, and students may feel unsure about how tangible the learning on placement is compared to the well-defined teaching in the classroom setting 4. In addition to learning on the wards, maintaining perspective is key: With early starts, long commutes and breakfast consistently being eaten while on the move, morale at times was low. Furthermore, halfway through our placement, the foundation doctors had their changeover, and I was concerned about integrating into a new team, having just settled into the previous one. Approaching this as an opportunity to meet different people, work on first impressions and learn alongside them helped me reframe the transition more positively. For example, I observed how the doctors worked during ward rounds. Furthermore, I witnessed how they impart clinical knowledge to patients in different ways. One profound example was when a consultant asked a patient: ‘Has it been explained to you what the CT scan has shown?’ This reflected what I have learned from our teaching on patient-centred care and how seniors can be role models for students. I also learned the importance of teamwork in reducing clinical errors 5. For medical students like me, a sense of belonging to a team can greatly influence learning. Wenger's communities of practice theory argues that this is crucial, introducing the concept of ‘learning as belonging’, highlighting how learning is a social activity 6. This can be as simple as introducing ourselves to the whole team during handover meetings or writing our names on the theatre whiteboard during operations. This was particularly evident at handover, when one of the consultants paused, showed us a CT scan and explained the findings. Moments like these made us feel truly part of the clinical team—we became more engaged, confident and excited to learn. A unique perspective is that, as medical students, we have more time to spend in conversation with patients. Although there are limits, students can help during the consent process, scrub in and follow the patient's journey before, during and after their operation 7. There is no substitute for first-hand learning from procedures and speaking to patients living with conditions: You cannot learn this from a textbook! During our reflection and debriefing session, our surgical teaching fellow emphasised how, as medical students, we are the youngest members of the medical team and should feel part of it. Medical students can act as a bridge between patients and health care professionals. For example, when asking permission to perform an abdominal examination, the patient asked—‘Can I ask, what is an abdomen? People keep talking about it!’ After it was explained, he smiled and nodded. This was a small chance to apply my knowledge directly to patient care. Patients have expressed how they can find meaning in sharing their lived experiences with medical students. This is also key to nurturing empathy 8. Opportunities like these are rewarding as they allow students to put learning into practice: Student engagement leads to better placement experiences. It is these moments that will persist in my memory of placements. Reflecting on my experience, it can be easy to take placements for granted. However, there are almost no other opportunities where students can see so many specialties in such granular detail. A positive placement experience is vital to developing the confidence of medical students and can influence their future specialty of choice 9. The concept of collaborative learning fits this approach: Learning with others has been shown to improve clinical knowledge and reduce anxieties 10. This is particularly important when navigating an unfamiliar environment. Following this surgical rotation, advice for students and educators has been compiled (Tables 1 and 2, respectively). Set personal goals for each week of placement. Examples include taking a history and presenting it to a doctor, learning to perform an examination, observing procedures and reading about conditions you have come across. Speak to different members of staff and shadow them to better understand their roles. For example, approaching discharge coordinators, healthcare assistants, pharmacists and nurses. Create learning opportunities where you can allow more integration within the team. Take responsibility for your learning: identifying new acronyms, terminologies or newly encountered diseases and pathologies, and searching and reading on them afterwards. Request specific feedback in advance (for instance, advice on taking and presenting a history) from supervisors. Anticipate the follow-up questions that doctors may ask after a patient history has been presented. This involves thinking what blood results or medications (like anticoagulants) may be particularly pertinent to know. Attend multi-disciplinary team meetings to facilitate this: They provide the opportunity to present, observe and identify specialty-specific pertinent questions. Always reflect in-action and on-action. There will be challenging situations while on placement. Reflection is necessary to increase clinical competence, professionalism and pinpoint learning needs 11. Topics for reflection may include self-directed learning (planning skills to practice during the placement), areas of strength and weakness. If you are unsure how to begin, using Gibbs' reflective cycle as a framework is one way to structure your approach. This involves documenting a description, feelings, evaluation, analysis, conclusion and action plan 12. For instance, when taking a supervised history, I forgot to ask about allergies. After being prompted by a foundation doctor, the patient told me about their history of an anaphylactic reaction to maize. Reflecting on this encounter, I now take extra care to ask about allergies and ensure I establish the type of reaction that patients have. Ensuring you have enough to eat or drink is vital, especially before attending a theatre session to observe surgical operations. Wear comfortable shoes and clothing, since a lot of time on placement is spent standing and moving around, so wearing appropriate shoes and clothing is important. Make clear the expectations, learning outcomes 3 and competencies of the students. As students from different years rotate, hospital staff may not be aware of their education level and limitations. For instance, I was unable to cannulate as a second-year medical student. This can be challenging, and students may feel ‘like a spare part’ 13. Emphasise that patients are far more than their illness, use inclusive language and reinforce the human element of medicine. Encourage your students and emphasise the unique role they have and their professional responsibilities. Students can feel they are ‘just a medical student’; changing this narrative to encourage proactivity will lead to both them and the team they are in benefiting. Create a safe space to give and receive feedback, making it specific and actionable. Aligning feedback with competency-based frameworks offers a clear and structured goal for learners, such as demonstrating proper inhaler technique to a patient, promoting both meaningful development and increased confidence 14. It is also important to emphasise the importance of a growth mindset among learners. Through this, you encourage students to proactively seek out learning opportunities. For instance, using language such as ‘it may be easier to ballot the kidneys through this method’ or ‘read up on stoma types and tell me tomorrow’, instead of ‘practice your abdominal examination further’. Identifying specific areas for improvement increases feedback credibility and learner reflection 15. Promote self-care during the placement induction, through awareness of events such as Schwartz rounds. Thoughtful gestures, like pointing out the location of water fountains, microwaves and common rooms, make students feel welcome. Share healthy coping strategies, such as reflection; in the GMC's Outcomes for Graduates document, this is referenced as a way to care for well-being 11. Clinical educators as professional role models fuel ‘growth-enhancing’ learning experiences 15. Students value your advice and look up to your practice. In conclusion, the experience of a clinical placement is a highly beneficial learning opportunity for medical students. The opportunity to see what is taught in pre-clinical lectures applied in actual practice cannot be understated 3. However, there are challenges that students might face during their placements, for instance, difficulty accessing structured teaching, achieving a sense of belonging crucial for learning 6 and integrating quickly into teams. Therefore, student proactivity, educator clarity regarding student roles and tailored feedback approaches will maximise the learning students can gain from placements and ultimately contribute to the development of better and more resilient future doctors. Tengyu Zhao: conceptualization, writing – original draft, writing – review and editing. Melden Darrell Barcelona: conceptualization, writing – original draft, writing – review and editing, supervision. The authors have nothing to report. The authors declare no conflicts of interest. Data sharing is not applicable to this article as no datasets were generated or analysed during the current study.