The art of medicine was to be properly learned only from its practice and its exercise.
Thomas Sydenham 

So after managing to prolong my training to its maximal extent, with two separate years in Perth, Australia and a PhD, tomorrow my medical ‘training’ in one sense comes to its end as I start work as a consultant. I’ve had a chance to reflect on what I have actually learnt since starting on the wards as a wet-behind-the-ears junior doctor back in 2001. Its funny, I don’t feel I am in any way, shape or form an expert now, even though I have probably done my obligatory 10000 hours. I certainly don’t feel as wise as the paediatric consultants I remember when I was a house officer. This might reflect an element of an impostor syndrome – or perhaps I have actually become unconsciously competent.

I’m not really sure how this all happened. I struggle to remember more than a handful of occasions when I specifically learnt anything from anyone, although there are some notable exceptions.

“Don’t listen for the murmur, listen for the absence of noise”

This brilliant advice has always stuck with me, especially as someone who has always struggled with the complexity of paediatric cardiology.

I remember being shown during my first neonatal attachment that babies often open their eyes when put over their mother’s shoulder (which makes identifying the red reflex much quicker).

One of my most powerful experiences occurred in Australia as I watched an Emergency Department Consultant at the resuscitation of an infant from an out-of-hospital cardiac arrest. After several of rounds of CPR it was clear the outcome was going to be devastating. I saw the mother realise this; she was inconsolable. And then the consultant handed leadership of the resuscitation to someone else and went over to her, putting his arm around her and bringing her to her child’s side. He spoke to her about loss and how no more could be done. I don’t remember exact words but I vividly emember him crying with her as we all took a step back. It was one of the most incredible things I have seen a consultant do.

Clearly I was taught things – lectures, seminars, ward rounds must have had an impact – but nothing tangible remains and many of the times I know I learnt the most were situations when I was on my own, sometimes inappropriately so.

I have no idea how I learnt to cannulate the septic ex-prem with tiny hands already scarred, little knowledge of when I gained the confidence to lead a group of people I have never met to deliver emergency care to an injured child, and certainly not a clue when I began to appreciate the subtle difference in the reaction of a parent who has not deliberately injured their child compared to one who has when asked how that bruise happened.

But what is more incredible is what I still have to learn. I am a mere ’13 years old’ – health permitting, I may be practicing medicine for double that time yet. It is inconceivable that I will not learn exponentially in that time. And it will be an exciting time, I think. I hope I continue to reflect on those learning experiences, painful or not, in this next phase of my life.

My training begins again  – it’s just that now I have a different title.