in quality of evidence and a 
in bias.Reflection is a task that will either plague you or carry you through medical school and much further beyond. If your case quickly begins to feel like the former, you are not alone. If you identify more with the latter, you already have the advantage. Whether you realize it or not, we are all constantly reflecting on our daily occurrences, whether professional or personal. Reflection can range from a passing thought about a minor experience, to a structured essay or formal meeting with a senior clinician.
First consider what reflection is not; it is not a ‘Dear Diary’ entry. Your reflection should be structured around a well-recognized reflective cycle. While a ‘Dear Diary’ entry classically focuses on feelings towards a situation, a full reflective cycle delves into this and more. Second, consider what reflection is. In broad terms, a complete reflection should discuss the situation at hand, how you felt about it, what this means to you, and how you will use the knowledge gained from this experience. As you progress throughout medical school and your career as a doctor, your reflective skills will be further refined. Rather than reflecting solely on experiences, you may be asked to reflect upon a range of topics including minor procedures such as taking blood, medical journals, critical incidents, and more. A commonly used reflective cycle is the Gibbs cycle.
You will always have deadlines and assessments for written reflections, but this really is one of your most valuable tools for developing both professionally and personally. A robustly referenced reflective assignment will teach you a considerable amount about a subject you may otherwise have glossed over briefly in your subconscious mind. In many stages of your career, it will also be a method of evaluating you as a medical student and later as a doctor. Your reflections will be some of your only proof that you experienced something, and learned from it. Embracing this huge part of your learning experience can only help you now, later, and much later.
One such student chose anaesthetics, but because this was such a popular option, she was given the ICU. This placement required a structured reflective report at the end of it. She was required to summarize the job of an ICU consultant, research career paths to intensive care, and describe interesting experiences during the placement. She has now decided to pursue a career in intensive care, which goes to show that without the reflective assignment, she would have blindly whizzed through the placement, waiting for it to end. What a lost opportunity that could have been!
By this stage in your academic career, you will have done too many presentations to count. The end of this learning tool is not in sight. Throughout medical school, you will have several presentations assigned to you. The majority of these, you will find, will be for the purpose of learning, rather than assessment. It is important to give each of these projects your full effort, regardless of their weight on your grades. You will go on to complete a range of types of presentations; however, the same underlying principles for all of these apply.
The presentations you will be required to complete in medical school and your medical career will vary considerably. Some will seem easily manageable, and some may feel overwhelming at first. Here is a list of a few types that you will soon become very familiar with:
One of the most common types of presentation that you will be assigned. If your medical course is split into preclinical and clinical years, you will always be a part of a small group during the preclinical years. Presentations are one of the many valuable learning tools you will use in these groups. You may be required to present these to your small group in subgroups or on your own. The topics of presentations here are generally focused around the course material; however, often the subject of your presentation may be entirely student selected.
Another very common type of presentation in medical school. Throughout each of your clinical placements, you will be a part of yet another group. Because clinical placements are such a new environment with a new lesson to be learnt each day, you will have to be proactive about seizing this knowledge. Your group should be attached to a lead consultant who will help you structure this learning as much as possible. They may ask a different member of your group each week to present something you encountered on the ward during that time. Your topic may be anything from a simple case history, a review of a new medication, a common chronic condition, or management of a specific medical emergency. Again, this may be chosen by your lead consultant, or may be left up to you.
Occasionally, you will be required to take up some sort of research. However, some of the time, this will be a completely elected project in later years of medical school. As an assigned project, you may end up presenting your findings in front of your clinical group or the team on the ward. As an elected project, or an assigned project which you chose to take beyond the realms of medical school, a presentation is a huge achievement and a privilege.
These presentations may be at a local lunchtime meeting in the hospital department of your project’s specialty (e.g. your project on asthma would be presented at the respiratory lunchtime meeting), or a poster presentation where you are required to summarize your project on a poster which is displayed at a conference, or potentially a formal PowerPoint presentation delivered to leading specialists at a national or even international conference. These are great for your CV! These are just a few of the types of presentations you will come across throughout medical school. Each of these is beneficial to you in several ways, and should be embraced with enthusiasm as large as your to-do list!
Refining the art of a good presentation will enhance both your personal and professional skills. You will be doing them for the rest of your life, so you may as well start developing these skills now! Practising presenting in front of either a large or small group of people will help you firstly to develop confidence. Presenting in front of your peers feels different to presenting to leading medical professionals. Thus, being confident in yourself and your abilities early on is important. Secondly, presentations are a fantastically efficient way to deliver information. Not only this, but when you know that you will be in charge of this important task, your thorough preparation will teach you an impressive amount on the subject of your presentation.
Presentations related to research, whether at a local meeting or at an international conference, can have a huge, positive impact on your career. Applying for your very first job as a doctor happens through a points-based system. At this time, presentations specifically do not add points to your application; however, a project which is presented may go on to be published—which will add points to your application. Besides this, having a presentation (or two or three) looks fantastic on a CV and really puts you at an advantage. This shows future employers that you are keen and dedicated to the progression of the medical field. It’s also a great way to learn a great amount about a specific topic in a specialty!
If you are averse to public speaking, you are far from alone. Glossophobia—the fear of public speaking—remains the number one phobia. This means that people are more afraid of public speaking than spiders, darkness, heights, and even death! Do not feel as though you need to be the best presenter on your first day of medical school. You will be presenting often enough that this practice will eventually become slightly less daunting.
When someone reads aloud, you will find that you need it to be read to you much slower than the speed at which you would read quietly to yourself. Present to others with this in mind. Do not read your presentation to yourself. Focus on speaking slowly, and then speak a little slower than that.
This may sound obvious, but when you are nervous, speaking clearly can be a challenge. Avoid stumbling your way through your talk, or using too many ‘umms’ and ‘aahs’.
There are few things more embarrassing than realizing in front of your audience that you have included the same slide twice. Practising can help avoid problems such as this, and keep you familiar with the words you will be speaking. It will also help you with timekeeping and rehearsing speaking slowly.
Read around your topic. You may be asked questions afterwards, and knowing that you are prepared will help with both your presentation quality and anxiety. At the same time, however, be prepared to defend your sources. No matter how clever you sound, referencing a poorly recognized source is a sure-fire way to lose your credibility.
If you suffer with something like dyslexia, try to accommodate for this to allow for a smoother presentation and to settle any worries you may have. You may want to practise a few more times to avoid having to read cue cards during your talk. Including more figures and visual aids, which you can discuss rather than written facts, may also be of help to you. Planning for potential presentation issues will help both yourself and your audience. Consider what you would do if the computer or presentation failed. Would you still be confident to deliver the presentation?
Besides looking professional, make your best effort to be aware of how you appear to your audience. Try to stand up straight, avoid fidgeting, and make eye contact with your audience rather than your slides or cards.
It is an art to be able to hold the attention of your audience throughout your presentation. You will have attended hundreds of lectures by the time you graduate and you will be able to appreciate what tactics do or do not work. The audience usually begin to lose interest or only remember the first 15–20 min of the presentation.
Being a good presenter does not always mean that you will have a great presentation. If you are going to focus on a PowerPoint presentation, bear in mind the following things:
Have you ever tried driving with someone who promises to get you to the destination, but only tells you where to turn about 3 metres from the turning point? Whether or not you drive, this is clearly an annoying position to be in. Do not let your audience feel this way! Having a slide dedicated to clearly laying out a plan for the rest of your presentation goes a long way, and shows that you are organized. Keep offering signposts. The more memorable lectures are the ones that answer the audience’s questions before they have asked them because your presentation follows a logical structure.
Keep the words on your PowerPoint slides minimal. They should only be used as aide-mémoires. Your audience is also more likely to remember your slides if they contain succinct information only. Use them only to guide your topics of discussion. Your audience can only concentrate on a few things at once. They will not appreciate it if you are speaking while the presentation behind you is inundated with a plethora of words in tiny font and flying visual effects. There is such a thing as too much stimulation! Keep it simple and draw the attention to you as opposed to your slides.
A series of slides solely filled with words or with graphs is sure to quickly exhaust your listeners. Simply varying your methods of delivering information will keep your audience engaged and interested. Keep the font large, dark on light background, and easy to read (even from the back of the room).
Thus, if you clutter your slides, you clutter their minds. Simple, punchy, and succinct bullet points will be outstanding. Consider what ‘buzzwords’ to highlight to convey your principal messages clearly.
Asking an opening question to spark a debate is just one great way to allow an audience to participate in your presentation. You can also ask questions throughout the presentation. This will minimize the audience having to listen to just one voice during your presentation, while keeping them involved. Once again, your audience will be more likely to remember your presentation if you interact and immerse them into your topic.
Learn their content and their style. Make notes on what you and the rest of the audience appreciated and things that did not work.
Essays are another type of assignment you will encounter throughout medical school. It is likely that you will have essays assigned to you much less frequently than reflective assignments and presentations, but you will find them to be equally important. You also may find that you are assigned essays much less often than your friends on other courses. For this reason, it is important to maintain basic essay writing skills, as you may eventually begin to feel out of touch with writing them.
The most difficult part of an essay is starting. Getting your sources together and making a plan is the best way to get past this barrier, while simultaneously setting yourself up for writing a well-structured essay. Examples include bullet points and mind maps.
Find out which referencing style your university uses, and make sure to reference your essay as you write it. Getting into this practice will save you from ending up with a horde of links at the end of your essay, which you will struggle to match to your statements. It will also save you copious time, which is so precious! Try and use resources such as EndNote™ which make it easier to keep a track of references. Library staff should be able to teach you how to use it, or else you can always learn through trial and error!
This may seem obvious, but you would be surprised to see that this is sometimes ignored by many, especially with the last-minute writers among us. You may also want to bear in mind that your essays will include many words that the spell-check program on your writing software will not recognize, such as hyperhomocystinuria or haematemesis. Also ensure your language setting on Microsoft Word is for English (United Kingdom) to avoid common spelling errors.
No one is in your head but you. If you can deliver information clearly and efficiently, you are already on the path to a great essay. One way to enhance the clarity of your paper is to include subheadings. This allows your reader to follow the essay, knowing exactly where they are going.
You need to step away from the assignment and give your brain a break! Short frequent breaks will make you more efficient, as well as give you a fresh perspective when you return to your desk. Suddenly that run-on sentence your tired brain could not figure out how to fix is so obvious!
We all have (or identify as) that friend who does not start an essay until midnight before the due date. This reflects on your work and is extremely obvious to your assessors. Writing when you are tired allows for careless mistakes and only puts forward half of your best effort. You did not get into medical school by putting in minimal effort, so why start stumbling through unenthusiastically now?
Once you have finished writing, send your essay to a trusted friend or family member. A second opinion is always a good idea.
There are many obvious things not to do in an essay, many of which are to ignore the above-mentioned basic essay writing tips. However, there are less obvious mistakes that can cost you. Here are a few of these:
It is actually really easy to accidentally plagiarize. Try to get out of the habit of switching words around, rather than collating information and delivering it in your own style. Luckily, most universities now require you to use proofreading software which detects phrases that can be matched to both online sources as well as an archive of assignments submitted years before yours. This software should produce a percentage value which indicates the proportion of your essay that has been found to match other sources. You can then alter your essay to make it more appropriate before submitting your final draft.
No matter how thoroughly you cover one aspect of a topic, if you ignore the rest, you render your essay to a poor grade and possibly even a fail.
This is also really easy to do. Discussing the adverse effects of smoking may lead you to researching COPD which leads you to the treatment of this disease and then onto a drug review of the newest inhalers and then inhaler accessories and on and on. There is nothing wrong with giving a good amount of background information, but make sure you can relate it to the original subject of the essay.
There is a so-called hierarchy of evidence which is important to become familiar with, especially when writing a literature review of various sources of research on a topic. It is acceptable to use evidence of various clinical values, but be aware that the stronger your evidence, the stronger the basis of your essay. As you travel up the hierarchy there is an in quality of evidence and a in bias.
Many students choose to intercalate (see 
Chapter 5). If you decide that this is the path you want to go down, you will be required to write a dissertation. Everyone has a vague idea of what it entails, but what exactly is a dissertation? We asked a few students how they would describe this subject, after having completed one:
• A dissertation is an extended formal project, which discusses a specific research question about a chosen topic.
• You can think of it as a very detailed essay. However, there are more differences than this. Here are a few:
• An essay does not have to be about a study or research, but a dissertation is.
• A dissertation is the conclusion of your studies. It provides in-depth information about what you have been studying, experimenting, and potentially discovering during the year (or longer for some). An essay, however, can be written about any topic at multiple points during your studies.
• A dissertation is a write-up of a study for assessment. Essays can be an analysis, discussion, or even just a small review of literature.
The options are endless. Once you choose a field to intercalate in, that only just narrows it down. Many people can get lost at this first hurdle, but once you get past it, you will have already begun your journey. Your university may provide a list of interesting topics to intercalate in—choose wisely!
Here are a few tips to guide you:
• Think about what interests you and what will motivate you. You will be putting a lot of time and brainpower into this one project. If it does not interest you, you will put in less effort than is sufficient to excel. More so than this, spending an excessive amount of time on a topic you care very little about is agonizing!
• Talk to other people. Find out what other people are thinking of researching. Speak to people who have already completed a dissertation in your field. Obviously your research should be unique, but discussing other people’s plans may point you in the right direction to help you figure out where to start.
• Consider the level of work already done on the topic. Do not do something that we already know everything about, because in simple terms, what’s the point? Try to choose a topic that has a few gaps in the research. This way, you will provide yourself with a clearer plan, as well as be more likely to produce a project that will generate further interest.
Now that you have chosen a broad topic, you have to get specific. What will your project look into? Again, make sure you are actually interested in answering the question you have come up with. Do not come up with something just to meet a deadline. Once you start, you have committed! You can also discuss this with your supervisor(s). It is best to have an idea of what you want to research, rather than to set up a meeting only to ask ‘So what should I do?’ Show your supervisor that you have at least started to set up a path for yourself. Once you have an idea of this, look into papers to make sure that your question has not already been answered. Again, try to find a gap in the research, to make your project more impacting and worthwhile. Finally, be realistic. If you decide you want to enter into cancer research, for example, bear in mind that you probably will not find a cure to all cancers. But you can definitely make an important contribution to the field for you or others to build upon!
You will generally be given an extended period of time to complete your dissertation. Resist the urge to procrastinate. Remember the future you is still you! Do not let future you feel stressed and pressured by the minimal time they have left, because present-day you could not face starting this huge task. You will need all the time you can get—whether it is used in the planning stage, meeting with your supervisor or colleagues, writing, or accommodating for setbacks. However, with all of this in mind, remember that you are only human, and humans need breaks too. If you feel like you have burnt out or are starting to go down that route, then stop. Only you can figure out your personal limitations. Sometimes it takes walking away from your project for a short period of time to feel ready to tackle it with some fresh ideas. No one will tell you to take a break. It takes the independence of knowing yourself and your abilities to be able to work well and efficiently. Never forget, your research and dissertation is not taught: it is yours. Use your knowledge, research, and dedication to help you complete an exemplary project.
This can happen in a variety of ways, ranging from technical problems, logistic issues, and experiments going awry to simply realizing that your original plan is no longer valid or possible. Here is a short list of what you can do to deal with these:
• Expect it: research and experiments rarely go as planned. That is the nature of discovery. Many people before you have experienced setbacks, both big and small, only to work through them and achieve success.
• Discuss it with your supervisor: they will also be expecting some sort of blip in the plan. However, try another route up the same mountain before going to them.
• Alter your plans as appropriate, with realistic goals.
• Report it in your dissertation, and discuss how you overcame it: it is unlikely that everything you plan will turn out exactly as you had planned it. Your assessors will be more impressed by a report that is honest and unrelenting, than one that suspiciously states that everything was seamless and simple. Anybody who has conducted research will not be a stranger to the trials and tribulations of yielding positive data. Facing obstacles does not make you a researcher but finding solutions to those obstacles demonstrates your creativity and ability to overcome those obstacles. There are countless researchers who may have spent years without obtaining positive data but at least they have demonstrated one possible way of not finding the answer. Negative results are still publishable in conference proceedings journals.
Broadly speaking, the role of your supervisor is guidance, support, and advice. Try to meet with them or contact them regularly. They are there to guide your overall research, so use them to help point you in the right direction. Do not be afraid to approach them. Generally, they have taken up this role because they are interested in the subject matter and are more than happy to provide this support role. However, do not ask them technical questions or issues that you could potentially figure out on your own.
Some people have trouble with their supervisors, whether it is due to them being difficult to access, less receptive to your questions or a clash of visions and personality, etc. Firstly, some people actually have two supervisors. Try not to keep either of them out of the loop, but if you find that one is being more helpful and invested in your success, approach them for support initially. Secondly, use this as an opportunity for learning. Unfortunately, you will find yourself outside your comfort zone at times, but this does lend itself to valuable learning opportunities. Embrace this and know that at the end of it, you will have gained another useful skill. Formal complaints really should be a very last resort. Remember, even if you do not always see eye to eye, they are experienced academic professionals and are granted the role of supervisor for a reason. If you believe that your case is exceptional and is having a negative impact on your project, discussing the matter with the course organizers is an option. Possible outcomes include mediation, reassigning you to another supervisor or research department, or a new project altogether (e.g. library project, audit, or grant proposal).
A proposal is exactly what it sounds like: proposing what you intend to research for your dissertation. Most proposals include a small literature review, your goals for the research, the reason for your motivation, and why it is important or worthwhile. You may also want to include a timeline to map out your general goals. This will show that you have been planning thoroughly and realistically.
Everyone does this differently, but it is definitely much easier to start with a plan than to dive head first into a blank document. It may help to jot down the general structure of your dissertation first. Here is a suggested one:
• Title, including your details, name of supervisors, and department.
• Methods including any technical details, e.g. any equipment used.
• Discussion including limitations and suggestions for future studies.
• Appendix (e.g. raw data if deemed necessary).
Write as you go along. This especially applies for your introduction and literature review, as these should not typically change much. This makes the barrier of starting much easier. Once you have a general structure, start to jot important points, then expand on these points. You may refer to other dissertations to inspire a structure. Just ensure that you do not plagiarize, and make sure to reference anything you use. But it is more than fine to read around for inspiration.
If you cannot back it up do not claim it as yours unless it is genuinely your own idea. You will be challenged, so make sure you have a reputable source for anything you report. Reliable information can generally be found in well-recognized papers and journals. When considering using a source, think to yourself: ‘Could this stand in a debate on the topic?’ If you are really unsure about a source you want to use, you can ask your supervisor what they know about its validity. Remember to be extensive. If you have not come up with the specified information yourself, you must back it up. Do not forget to include references of any images, figures, and tables that you have not made yourself. Some images and graphs may be susceptible to copyright issues so ask for written permission prior to its inclusion within your dissertation and reference correctly. You can also use references to direct your reader to more information. This will keep your word count down, as well as keeping your report focused on your work.
Writing a dissertation can be very daunting at many and possibly all stages of the task. This is normal, and everyone experiences this feeling. However, try to bear in mind the number of people before you who have done it, and the number of people after you who will do it. Other students have had your supervisor and have made it work. You are just as equipped as they are, and your dissertation is yours! Make it the best you possibly can!