My Mid-Year Placement Reflections

 

Mid-Year Placement Reflections and Learning Plan at Kingston Medical Plaza

Throughout my GP placement at Kingston Medical Plaza, I've spent the first half of the semester gaining hands-on clinical experience and improving my understanding of chronic disease management. I thoroughly enjoyed the different dynamics of a GP and hospital setting, where a GP provides primary point of care and a hospital is emergency-based medicine. In this reflection, I'll reflect on my strengths, identify areas of improvement, and how I would like my learning to look for the remainder of the year.

Reflections on Skill Development

One of my key strengths during placement has been building rapport. Going into the GP clinic initially had me worried. I am in my first year of med school and I was worried that my lack of medical knowledge would make me look like a fool. However, even surprising to me, I felt confident communicating with both patients and clinic staff. I was able to confidently say I didn’t know something, and the GP explained it to me. 

In history taking, I'm comfortable with most components, including symptom history, social history, and lifestyle factors (e.g. drug, alcohol, and smoking habits). However, areas like sexual history, mental health, and adolescent assessments haven’t yet been covered in MD-1, and I feel I need further practice to become fully confident.

Regarding physical examinations, my confidence varies. I’m reasonably comfortable with vital signs, gastrointestinal assessments, and basic wound care. However, my confidence is limited when performing cardiovascular, respiratory, musculoskeletal, and skin examinations. I particularly lack confidence in neurological exams and diabetic foot assessments, as I’ve never learnt how to do these beforehand. Also, the GP hasn’t done these, so I haven’t had much experience.

In procedural skills, I’m pretty confident in administering immunisations when I got to give a few. I'm also confident in demonstrating inhaler techniques, especially because I have asthma myself. Yet, I need more exposure and practice in procedures like urinalysis and ECG recordings. The clinic has an ECG clinic set up on a different day from my placement, so I plan to go and observe. 

For clinical management, I feel somewhat confident in identifying and managing common acute presentations. I practise this by trying to guess what the GP will diagnose a patient with and the appropriate treatment. 

Additional Learning Areas

In discussion with my supervisor, we identified two additional important areas:

1. Being more comfortable with the GP's role in performing minor procedures (e.g., biopsies). Upon observing the GP do a biopsy, I almost vomited, and I need to get better at handling blood, especially before next year when we do surgical rotations.

2. Time management- being more on time for placements. I have taken on this feedback by making sure I set my alarm a little bit earlier. 

Identified Learning Gaps

Through ongoing discussions with my supervisor, three primary learning gaps have emerged:

• Understanding the broader roles of GPs beyond patient consultations, such as coordinating community resources. My GP visits an old-age home to provide the residents with medical checkups, and this would be a great opportunity for me to see. 

• Chronic disease monitoring and follow-up, particularly observing how GPs manage long-term conditions such as diabetes and hypertension. 

• Clinical reasoning, e.g., understanding the GP’s decision-making process during consultations.

My Learning Goals

In collaboration with my supervisor, we discussed some ways I can improve:

1. Observation of Consultations

I plan to observe consultations more actively by identifying the different stages of a consultation: introduction, history-taking, examination, and management planning. 

2. Refining Communication Techniques

I plan to continue my observations of Dr Ram and documenting effective phrases and strategies such as how to communicate difficult news with a patient. I particularly want to focus on my ability to demonstrate empathy and learning how to best explain complex medical concepts in easy-to-understand language for patients.

Measures of Success:

Here’s how I plan to measure my improvements over the second semester:

1. Supervisor feedback confirming observable improvements.
2. Increased self-reported confidence in previously weaker areas (e.g., neurological exams, diabetic foot assessments).
3. Demonstrated ability to independently conduct patient histories, physical exams, and formulate appropriate management plans (in discussion with my GP after a consultation).

Feedback Mechanisms:

1. Weekly check-ins with my supervisor.
2. Final end-of-semester evaluation on my clinical and communication skills.
3. Ongoing personal reflections to identify areas for further improvement.

Evidence of Learning:

• A completed skills journal with supervisor comments.

• Reflective journal demonstrating growth in the areas I previously reported weaknesses in. 

• Structured case presentations to improve clinical decision-making.

My placement at Kingston Medical Plaza has already been an amazing growth opportunity, and I look forward to my continued improvement throughout the remainder of my placement.