I started Internal Medicine Training in the UK with a rotation in Geriatric Medicine at Hammersmith Hospital for 6 months, and it is coming to an end next week as I prepare to rotate to Acute Medicine in St Mary’s Hospital. It was a valuable learning experience, providing both challenges and opportunities for professional growth. While I enjoyed many aspects of the specialty, I also encountered difficulties that helped me develop essential skills for my future career.
What I Enjoyed:
One of the highlights of this rotation was working with Dr. Melanie Dani. Her ability to communicate with patients and families, particularly elderly patients with dementia, was something I deeply admired. Every Monday and Friday, when Dr. Dani led the ward round, I would go home and reflect on every single conversation she had with patients and their families, trying to replicate her approach the next time I found myself in a similar discussion. The way she communicates with patients and their families is a skill I hope to develop. Having the opportunity to learn from someone like her has been a privilege.
I also appreciated the independence I was given, particularly in conducting ward rounds on my own. This responsibility allowed me to develop my decision-making skills and gain confidence in my clinical judgment. Similarly, the on-call shifts were invaluable, as they provided exposure to assessing and managing acutely unwell patients, performing procedures and handling high-pressure situations.
Attending clinics with Dr. Shuli Levy helped me develop my skills of assessing multimorbid patients in an outpatient setting, which I particularly struggled with. I often felt overwhelmed trying to keep track of all the issues that patients presented with, but discussing cases with Dr. Levy always clarified things and made them crystal clear for me. A particular learning moment for me was when Dr. Levy examined a patient after I had reviewed him and pointed out subtle positive findings on examination that I had initially missed. This experience was incredibly valuable in improving my clinical skills and attention to detail. I also appreciate the time Dr. Levy took to go through my clinic letters and correct them. It became a routine of mine to review all the letters I had written the previous week, compare them with Dr. Levy’s corrections, and reflect on the changes to improve my documentation skills. This exercise helped me refine my ability to summarize complex cases concisely while ensuring clarity and accuracy in communication.
One of the most formative experiences was leading Medical Emergency Team (MET) calls multiple times when I was the first responder. These moments gave me a glimpse into the role of a medical registrar, reinforcing the leadership and critical decision-making skills required at that level.
Challenges Faced:
While I appreciated the holistic approach of geriatric medicine, I found it to be a less acute specialty than I would ideally prefer. I realized that I enjoy managing acutely unwell patients, which was something I found lacking in this rotation due to the absence of take shifts.
Another challenge was engaging in family discussions, especially those surrounding goals of care and end-of-life decisions. These were emotionally taxing and initially uncomfortable, but over time, I learned how to handle them with more confidence. Similarly, resuscitation (DNACPR) discussions were new to me at the start of IMT, but I improved significantly as the rotation progressed.
Initially, I found clinics quite challenging, as many patients had multiple comorbidities and a wide range of issues, leaving me overwhelmed and unsure about which problems to prioritize and act on. I sometimes felt that I had limited interventions to offer. However, as the weeks went by, I observed how Dr. Levy approaches patients and learned how to prioritize issues, optimize treatment plans, and communicate effectively in complex cases.
Skills Developed:
Throughout this rotation, I gained confidence in several areas, including:
- Communication skills: handling resuscitation discussions, breaking bad news, and difficult family conversations with greater confidence.
- Clinical decision-making: conducting independent ward rounds, managing polypharmacy, and ensuring continuity of care in elderly patients.
- Holistic and multidisciplinary care: appreciating the role of OT, PT, dietitians, SALT, and when to involve them for optimal patient outcomes.
- Palliative and end-of-life care: understanding symptom management, DNACPR discussions, and transitioning patients to palliative pathways.
- Clinical documentation and case management: improving clinic letter writing and gaining confidence in managing complex multimorbid patients in outpatient settings.
Areas for Improvement:
I need to continue working on managing patients with complex medical conditions that require both acute and chronic care. Many elderly patients have multiple comorbidities, making it challenging to balance immediate medical needs with long-term disease management. This rotation has helped me develop a structured approach to such cases, but I recognize that I still have room for improvement in optimizing chronic disease management while addressing acute issues simultaneously.
I also realized that I lack knowledge in certain areas, which became clearer to me in specific situations. For example, I once ordered a hyponatremia screen for a patient but later struggled to interpret the results by myself and correlate them with the clinical picture. This reminded me of the importance of continuous learning and the need to solidify my theoretical knowledge. As a result, I have started actively working on clearing my postgraduate exams and aim to complete MRCP Part 2 written within this year.
Additionally, I sometimes noticed that I was not fully aware of the details of certain patients, particularly when I was not directly involved in their decision-making or day-to-day care. However, as the ward doctor, I should have a clear understanding of each patient’s clinical trajectory, key decisions, and overall management plan. Going forward, I aim to be more proactive in keeping track of all patients under my care, even if I am not the primary doctor managing them.
Final Thoughts:
Despite its challenges, my geriatric medicine rotation was incredibly rewarding. It gave me invaluable experience in communication, decision-making, and holistic care—skills that will be essential in any specialty. While I have realized that my interests align more with acute specialities, the lessons I learned during this placement will undoubtedly shape my approach to patient care moving forward.
One unexpected highlight of this rotation was being friends with people at work. I never thought I would make friends here, as people don’t typically socialize much with colleagues outside of work. However, getting to know them made this experience even more enjoyable, both professionally and personally. I would like to thank two of my friends in this new country- Hafsa and Nicola, for tolerating me, being kind to me, and for being there for me during difficult times. Their support has meant more to me than they probably realize, and I am grateful to have met them.
Tags: