Recently, I spent a week observing the care of patients admitted in a specialised tertiary neurology unit. The reason for arranging this was purely selfish: to expose myself to atypical presentations as well as a short trial run of neurology to hopefully determine whether the specialty is for me. However by the end of the week, I found that I had also changed my perspective on inpatient medicine and my approach to learning. This brief reflection will cover my thoughts about the placement, changes I'm going to be making as a result and finally a short section on how and whether to arrange something like this.
Setting the scene
The Acute Neurology Unit is a specialist ward dedicated to the diagnosis and treatment of complex neurological disease. In essence, it covers everything except stroke (for which there is a dedicated centre). As a result, patients on the ward had a wide range of pathology from cerebral venous sinus thrombosis to autoimmune encephalitis. To respond to a wide case load, the unit is armed with a team of multiple subspecialist consultants, resident doctors, physician associates and specialist nurses.
The experience
Each morning began with a comprehensive discussion of overnight changes and concerning patients in the staff room, followed by a ward round to visit and update patients on management plans. There were several cases with significant diagnostic uncertainty despite extensive testing and examination. I observed as the consultants approached these patients as not problems waiting to be solved but evolving narratives requiring patience and continued thinking. What struck me was the was their transparency to patients about uncertainty and the mental stamina required to continuously review and pore over available information. This transparency seemed to strengthen the doctor-patient alliance rather than jeopardise it. As medical students, we are often presented all the information in one fell swoop through single-best answer questions and OSCE stations. In reality, conditions can take years to manifest and antibody tests can take several weeks to come back from the lab. Information across hours, days, weeks and years were all integrated into characterising a complete picture.
Learning opportunities
The environment engaged me across several domains: understanding, experience, practical skills and critical reflection. Daily ward rounds became impromptu teaching sessions (see the art of pimping), with consultants pausing to demonstrate examination techniques and explain pathophysiology. The nature of neurology demands precise definitions, distinguishing paresthesia from dysesthesia and separating seizure types. Examination was particularly useful in characterising the extent of pathology. One particular case stands out, where thorough assessment of vision can distinguish functional visual loss from optic neuritis in a patient with multiple sclerosis. The patient reported no perception of light in her left eye, but a pupillary light reflex and optokinetic nystagmus were present, proving that not all of the visual loss is a result of optic neuritis. Findings that seemed subtle on Monday would be revisited on Tuesday with fresh eyes and contextualised differently. The immersion transformed abstract knowledge into practical wisdom, demonstrating how the best clinical learning occurs not through passive observation but through guided participation in the diagnostic journey.
Changes to my approach
This granularity extends to management decisions, where treatment protocols are calibrated to specific antibody profiles, lesion locations and temporal patterns of disease evolution. Such precision has convinced me that casual familiarity with neurological conditions is insufficient; I now see the critical importance of regularly engaging with high-quality medical literature like NEJM and Lancet, where emerging evidence and unique cases are rigorously presented. Whilst reading future developments in medicine, I also plan to look backwards at foundational pathophysiological concepts from pre-clinical years at medical school. Solid foundations connect each new clinical pearl or research finding to existing mental models, creating a more coherent and applicable understanding to enhance reasoning at the bedside.
Conclusion
What began as a career exploration exercise evolved into a recalibration of my understanding of good medical practice and my approach to learning. I hope some of the rigour, precision and curiosity of the team has rubbed off on me and I look forward to continuing learning and growing.
Arranging similar attachments
If a similar short stint in a particular specialty would be beneficial for you, I would recommend reaching out to a consultant you know personally or asking to be connected to someone in that specialty. Contacting the hospital admin department is also important to ensure a swift introduction and no time wasted with mandatory training and ID card access.