Background: Medical students are expected to know how to function on hospital wards and to be at ease within the ward environment. Such ward-based knowledge indicates that a student is 'ward smart'. However, formal teaching in this area seems to be somewhat neglected, with students being le to gather this knowledge through experience. Methods: Data were collected via an online questionnaire comprising both closed and open questions designed to assess students' ward smarts, focusing on knowledge of the ward environment (routines, equipment, and terminology used), relevant clinical knowledge, and communication/roles of other members of the multidisciplinary team. Multiple regression was used to identify factors in uencing students' scores (i.e. demographics, work experience). Thematic analysis was used to explore medical students' opinions on how their ward understanding could be improved. Results: In our sample of 53 medical students, 96% did not know how to turn on a hearing aid and only 30% knew what a Waterlow score was. Furthermore, 89% did not know how to read an oxygen owmeter, and only 55% knew where the CPR lever on the bed was situated. Multiple regression showed that ward smarts can be predicted by previous hospitalbased work and year group, both of which may represent time spent on wards. Thematic analysis suggested that students felt they would bene t from more ward time and shadowing healthcare professionals on the wards. Discussion: This suggests that students may not be prepared to work in a ward environment. We propose, based on training implemented in other medical schools, that a speci c ward-based interprofessional learning placement or experience should be added to the medical curriculum. As an initial step, speci c teaching and/or practical sessions for students centred around patient communication and understanding the ward environment would be bene cial.

BackgroundMedical students are expected to know how to function on hospital wards and to be at ease within the ward environment. Such ward-based knowledge indicates that a student is ‘ward smart’: levels of ward smarts vary between students (e.g. based on prior work experience and opportunities offered by placements). However, formal teaching in this area seems to be somewhat neglected, with students being left to ‘pick up’ this knowledge as they go along, which can have an impact on their clinical education. MethodsData were collected via an online questionnaire comprising both closed and open questions designed to assess students’ ward smarts, focusing on knowledge of the ward environment (routines, equipment, and terminology used), relevant clinical knowledge, and communication/roles of other members of the multi-disciplinary team. Multiple regression was used to identify factors influencing students’ scores (i.e. demographics, work experience). Thematic analysis was used to explore medical students’ opinions on how their ward understanding could be improved.ResultsIn our sample of 53 medical students, 96% did not know how to turn on a hearing aid and only 31% knew what a Waterlow score was. Furthermore, 88% did not know how to read an oxygen flowmeter, and only 57% knew where the CPR lever on the bed was situated.Multiple regression showed that ward smarts can be predicted by previous hospital-based work and year group, both of which may represent time spent on wards. Thematic analysis suggested that students felt their understanding of wards would benefit from more ward time and shadowing allied healthcare professionals on the wards.ConclusionsThis suggests that students may not be prepared to work in a ward environment. We propose, based on training implemented in other medical schools, that a specific ward-based interprofessional learning placement or experience should be added to the medical curriculum. As an initial step, specific teaching and/or practical sessions for students centred around patient communication and understanding the ward environment would be beneficial.

Medical students are expected to know how to function on hospital wards; i.e. where to find things, other Health Care Professionals’ (HCPs’) roles, and how to use certain items of equipment (GMC, 2018). This ward-based knowledge indicates that a student is ‘ward smart’.1 Whilst being ‘ward smart’ is key for many aspects of medicine, it is particularly important for students learning geriatric medicine: older patients (who make up around 42% of all inpatients)2 are more likely to have communication difficulties and to require assistance. However, formal teaching in this area seems to be somewhat neglected, with students being left to ‘pick up’ this knowledge as they go along.3,4 In our sample of 41 students in their penultimate year (most of whom were undertaking their Healthcare of Older People placement), 98% did not know how to turn on a hearing aid and only 24% knew what a Waterlow score was. Furthermore, 88% did not know how to read an oxygen flowmeter, and only 59% knew where the CPR lever on the bed was situated. This is a significant gap in knowledge: Students may not be as prepared to work in a ward environment as expected. Students felt that their understanding would be improved by teaching sessions, more time on wards, formal ward inductions, and shadowing other HCPs: only 41.5% had had a ward induction or introduction, and less than 20% had shadowed a nurse. We propose specific teaching/practical sessions for students during their Healthcare of Older People placement centred around patient communication and understanding the ward environment. References 1. Walker, Wallace, Mangera, & Gill, The Clinical Teacher, 2017, 14(5), 336–9. 2. NHS Digital, 2018. 3. Prince, Bozhuizen, Van der Vleuten, & Scherpbier, Medical Education 2005; 39(7):704–12. 4. Monrouxe, et al., BMJ Open 2017; 7(1):e013656.