Clinical Compass

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Methods for lectures, sheets for the ward, and how to read imaging and labs. Pay once.
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hamzaProfile picture@hamzak5·14h

What I wish someone told me before my first week on the wards

1. Nobody expects you to know everything. They expect you to be organised, on time, and honest about what you don’t know.

2. Pick one patient and know them properly. One patient you can talk about in detail beats five you vaguely recognise.

3. Learn how to present before you learn anything fancy. If you can say who they are, what changed overnight and what you’d do, you instantly look like you belong.

4. Say “I’m not sure, can I check?” It sounds weak and it’s the opposite. Seniors trust students who know where their knowledge stops.

5. Ask one specific question a day. “Why did you choose that?” beats “can you teach me something?” every time.

6. Write it down straight after. Five minutes at the end of the day saves you hours of revision later.

If the presenting part is what scares you, I made a free 90-second card for it:

And my short guides on studying, labs and imaging are here:

What’s the thing you were most scared of in your first week? 👇

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hamzaProfile picture@hamzak5·21h

SBAR to a senior: 30 seconds, one ask

SBAR to a senior: 30 seconds, one ask


You freeze on the phone because you start apologising, then dump the clerking, then wait for them to guess what you want. A registrar does not want your whole morning. They want four lines and one ask, so they can decide whether to come now, give an instruction, or tell you it can wait.


This is not the 90-second ward present. That is how you speak on the round. This is how you interrupt someone who is already busy.


Confirm you have the right patient, the latest observations, and the one thing you want before you dial. Treat the patient, not the performance.


What students actually say


"Sorry to bother you. I just wanted to run someone by you. He's a bit off. His NEWS is 3. I wasn't sure if I should... maybe you could have a look when you get a minute?"


That sentence has no location, no trend, no assessment, and no ask. It is anxiety with extra words.


If you cannot name the ask in one breath, you are not ready to call.


Before you dial: four facts on a card


Skip this and you will freeze when they say "go on."


  • Bed, ward, your name, your role.

  • Latest observations, including oxygen device and time.

  • The one result or finding that triggered the call.

  • The one thing you want them to do.


If any of those is missing, look it up first. A call without them is theatre.


If the patient is peri-arrest, say that in the first sentence. Do not SBAR a collapse.


S: situation (who, where, why now)


One sentence.


"I'm Hamza, medical student, ward 7, bed 12. I need you now because saturations have fallen to 88% on 4 litres, they were 96% on air at 08:00."


Not: why they were admitted last week. Not: a list of differentials. Why you are calling at this minute.


B: background (only what changes this call)


Two facts, not the whole problem list.


  • Why they are in hospital, in a few words.

  • The one thing that makes this call different: new oxygen, new confusion, potassium 6.4, just had ramipril, nil by mouth for a scan.


If it does not change what they will do in the next ten minutes, it does not go here.


A: assessment (one clinical sentence)


What you think is going on, or the two options that would change the next step.


  • "I think this is worsening pneumonia, not anxiety. Work of breathing is up."

  • "I think this potassium is real. ECG is done. QRS looks wide to me. I want you to look at it."

  • If you do not know, say so and say what would split it. Do not invent a syndrome.


An assessment that is just the NEWS score said politely is not an assessment.


R: recommendation (the one ask)


One verb. One owner. Not a menu.


  • "Please come now."

  • "Please look at this ECG and tell me if we treat."

  • "Please hold the ramipril. I have told the nurse. I need you to confirm."

  • "I need a senior to prescribe oxygen to target. I cannot do that."


"Have a look when you can" is not an ask. "I just wanted you to be aware" is not an ask. Awareness without a job is how sick patients wait.


If they give you an instruction, repeat it back, write the time, and do it. Then stop talking.


Three drills (write them, do not just nod)


1. The saturations that walked down

S: Ward 4, bed 6, sats 91% air, were 96% at 08:00, more breathless.

B: Day 2 community-acquired pneumonia, on co-amoxiclav.

A: Falling sats and work of breathing. Not a reassuring NEWS.

R: Please come now. I have sat them up. I have not started oxygen because there is no target on the chart.


2. The potassium you should not "mention later"

S: Ward 2, bed 3, K 6.5, not haemolysed, 10 minutes ago.

B: AKI, still due ramipril, ECG done.

A: Real high potassium until you say otherwise. I am not sure about the T waves.

R: Please look at this ECG now. I have asked the nurse not to give the ramipril.


3. The call with no ask (rewrite it)

Bad: "He's a bit tachycardic. I thought I should let you know."

Rewrite: "Ward 5, bed 1. Heart rate 124, was 78 yesterday, temp 38.1. I think this is a new infection. Please come. I have not started anything."


Copy SBAR onto a card. Fill it before you pick up the phone.


The three ways the call collapses


  1. You start with sorry, then the life story, then hope they guess the ask.

  2. You read the NEWS and skip the parameter that is moving.

  3. You hang up without a job, a time, or a name of who is coming.


If any of those happened, rewrite the four lines. Do not add a fifth.


How to practise this until it is automatic


  • Write one SBAR a day from a real patient, even if you do not call. Time-box 30 seconds.

  • Practise out loud to a peer. If they cannot repeat your ask, you did not have one.

  • After a real call, note the one question the registrar asked first. That is the line you skipped.

  • Confirm locally. Never invent findings. Do not give treatments you are not allowed to give.


The Ward Workbook is the daily sheets for this: before clinic, one-patient sheet, after clinic, and the jobs you actually finish. It is $9 on its own, or in the complete set ($33) with How to Study Medicine, How to Read Imaging, and How to Read Labs. Pay once. Study Kit is included free with every purchase.


It does not replace your lectures, your hospital, or a question bank.


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hamzaProfile picture@hamzak5·1d

Five checks on every drug chart before you say the meds are fine

Five checks on every drug chart before you say the meds are fine


You freeze on the drug chart because you scan for a name you recognise and say "meds are fine." A registrar does not want a tour of the boxes. They want the tablet that will hurt this patient today, the one that is missing, and the one you should hold before the round moves on.


This is not a pharmacology lecture. It is not a clerking. It is five checks in the same order, every chart, before you open your mouth.


Confirm the patient, the date, and that you are on today's chart. Treat the patient, not the sticker.


What students actually say


"He's on his usual meds. No allergies. Chart looks okay."


That sentence has no potassium, no blood pressure, no hold, and no gap. It is a glance with extra words.


If you cannot name one drug you would stop, one you would not miss, and one that is absent, you have not looked at the chart.


Check 1: identity, allergies, today's chart


Skip this and you will talk about the wrong person or yesterday's doses.


  • Name and date of birth match the person in the bed.

  • Allergy box actually filled. NKDA is a statement, not a blank. A pencilled "penicillin?" is not cleared.

  • You are on today's page, not last night's, and not a cancelled chart underneath.


If the allergy box is empty, that is the finding. Stop there and get it written before you discuss anything else.


Check 2: the drugs that must not be given today


Do not start with the vitamin. Start with what collides with this morning's patient.


  • Rising creatinine or high potassium: ACE inhibitor, ARB, potassium-sparing diuretic, potassium replacement, NSAID. Hold pending senior. Say it out loud so it happens.

  • Low blood pressure, dizzy, just stood up: the morning antihypertensives. Do not let the next dose go round while you "mention it later."

  • Nil by mouth, vomiting, reduced consciousness: oral drugs they cannot swallow. Flag them. Do not invent a route.

  • Anticoagulant plus a new bleed, a head injury, or a procedure today: stop and get a senior. Do not "keep an eye on it."


A hold without telling the nurse is not a hold.


Check 3: the one drug that explains the person in the bed


The chart is often the history the patient cannot give you.


  • New drowsiness: opioids, benzodiazepines, last night's sedative. When was the last dose.

  • New tremor, rigidity, or "off": Parkinson's drugs delayed or held for "NBM." That is an emergency for that patient, not a scheduling issue.

  • High glucose: steroids. Do not call it mystery hyperglycaemia.

  • Dry, dizzy, urea up: diuretic still running. The tablet may be the problem, not the kidney.


If the patient and the chart do not agree, believe neither until you have checked the times.


Check 4: what is missing that should be there


Students report what is printed. Registrars ask what is not.


  • VTE prophylaxis: prescribed, or a documented reason it is not. "I didn't see it" is not a reason.

  • Oxygen: a target, a device, not a blank next to a patient on 4 litres.

  • Usual time-critical drugs: Parkinson's, insulin, epilepsy, transplant immunosuppression. Delayed is not the same as held for a reason.

  • Analgesia and antiemetics if they are in pain or vomiting. A chart with no PRN and a patient in pain is an incomplete chart.


Name the gap in one line. Do not add a speech about guidelines.


Check 5: one next action, with an owner


"Review meds" is not a plan. "Pharmacy can look later" is not a plan.


Write one of these, specifically:


  • Hold which drug, now, tell the nurse, senior to confirm.

  • Prescribe nothing yourself if you cannot. Get the person who can, with the reason in one sentence.

  • Give the missed time-critical dose per local rule, or escalate if you cannot.

  • No change, because you checked potassium, blood pressure, allergies, and the gaps, and none of them moved.


A chart without Check 5 is theatre.


Three drills (write them, do not just nod)


1. The ACE inhibitor still running

Creatinine 90 two days ago, 210 this morning. K 5.7. Patient still due ramipril at 08:00.

Impression: the tablet is still pushing the kidney and the potassium.

Next action: hold ramipril now, tell the nurse, ECG, senior. Do not wait for the round to "mention the bloods."


2. The Parkinson's doses that slipped

Nil by mouth for a scan. Co-careldopa due at 07:00 and 11:00, both unsigned. Patient stiff, not swallowing well.

Impression: missed time-critical doses, not "he's a bit off this morning."

Next action: senior now, do not leave them without a route. Confirm locally. Never invent a conversion yourself.


3. The blank that is the finding

Allergy box empty. Patient says they had a rash to penicillin years ago. Due co-amoxiclav at lunch.

Impression: you do not have a safe chart yet.

Next action: stop, document the allergy with a senior, do not let the dose go out on a shrug.


Copy the five checks onto a card. Fill them before you say the word fine.


The three ways "meds are fine" becomes a lie


  1. You named a drug you recognised and skipped the one that collides with today's bloods or blood pressure.

  2. You reported what was printed and skipped what was missing.

  3. You decided to "mention it on the round" instead of holding it now.


If any of those happened, rewrite the five checks. Do not add a fourth speech.


How to practise this until it is automatic


  • Before the round, take one chart. Sixty seconds. Identity, holds, the explaining drug, the gap, the next action.

  • After the registrar asks a question, note which check it was. That is the one you skipped.

  • If you cannot name a hold, a gap, or a time-critical, you glanced. Look again.

  • Confirm locally. Never invent findings. Do not prescribe, convert, or restart a drug you are not allowed to.


The Ward Workbook is the daily sheets for this: before clinic, one-patient sheet, after clinic, and the jobs you actually finish. It is $9 on its own, or in the complete set ($33) with How to Study Medicine, How to Read Imaging, and How to Read Labs. Pay once. Study Kit is included free with every purchase.


It does not replace your lectures, your hospital, or a question bank.


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hamzaProfile picture@hamzak5·2d
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Beyond the 90-Second Present: Next Steps on the Ward

You have the 90-second ward present. The next step on the ward is a complete clerking, a clean lab trail, and a handover someone else can pick up without guessing.


1. Finish the clerking, not just the presentation. After the 90-second present, write the full history, exam, impression, and plan so the next person on the team can act. Capture what you said, then fill the gaps you skipped for time.


2. Organize labs so they tell a story. Group results by problem, not by printout order. Note trends, pending tests, and what you already acted on. That is how you stop repeating the same questions at every handover.


3. Use systematic recall on the floor. Same structure every patient: presentation, clerking, labs, plan, outstanding jobs. Repeat it until it is automatic.


The Ward Workbook is the clerking and handover sheets for this sequence. Use it after each 90-second present.



If you are in the free starter, this is the paid next step. Pin this and keep it next to the present.

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hamzaProfile picture@hamzak5·2d

I spent a year re-reading notes and remembered almost none of it

4th year here. In my first years I did what everyone does: highlight, re-read, feel good, forget it all by the exam.

Here’s what I changed:

1. Test yourself before you feel ready. Closing the notes and trying to recall it is uncomfortable, and that discomfort is the point. Re-reading feels easy because your brain is only recognising, not remembering.

2. Study the stuff you got wrong, not the stuff you know. It’s tempting to keep going over the topics you like. Spend your time on the gaps.

3. Spread it out. Coming back to a topic a few days later beats one long session the night before.

4. Practise how you’ll be asked. If the exam is questions or an OSCE, study in that format, not by reading chapters.

5. Plan the week, not the year. A big timetable falls apart in a fortnight. A small realistic one survives.

I wrote my whole method into a short guide, How to Study Medicine ($12): whop.com/high-yield-kit/how-to-study-medicine

The rest of my packs are here:

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hamzaProfile picture@hamzak5·2d

Four questions on every obs chart before you say they are stable

Four questions on every obs chart before you say they are stable


You freeze on observations because you read the last NEWS score and say "fine." A registrar does not want a number. They want whether the patient is actually alright, which parameter is moving, and what you will do before the next set.


This is not a clerking. It is not a 90-second present. It is how you look at the chart so "stable" is a conclusion, not a reflex.


Confirm the patient, the time of the last set, and whether you are looking at the right chart. Treat the patient, not the sticker.


What students actually say


"Obs are stable. NEWS is 1."


That sentence has no trend, no parameter, and no next set. It is the last box on the page with extra words.


A NEWS of 1 three hours ago is not a set of observations. It is a rumour.


Question 1: when was the last set, and is it still true?


Skip this and you will present a well patient who has not been measured since breakfast.


  • Name the time. If it is stale, that is the finding. Repeat them.

  • If they are on oxygen, write the target and the device, not just the saturation.

  • If they just had analgesia, a walk, or a hypotensive drug, the last set is not the current set.


If you cannot name the time, you have not looked at the chart.


Question 2: which parameter is moving, over the last three sets?


Do not start with the total score. Start with the line that is walking.


  • Saturations: 96, 94, 91 on the same device is a story. 91 on 4 litres that was 96 on air yesterday is a different story.

  • Heart rate: 88 all week is not 118 since midnight.

  • Blood pressure: a slow drift down after an ACE inhibitor is not "a bit low."

  • Temperature and consciousness: a new confusion with a new fever is not "NEWS 2."


One parameter moving beats a reassuring total. The total is a filing system. The line is the patient.


Question 3: does this match the person in the bed?


If the numbers and the person do not agree, do not trust either one until you have checked.


  • NEWS 0 who is sweaty, quiet, and not answering is not stable. Repeat, glucose, senior.

  • NEWS 5 who is chatting, eating, and saturating on their usual oxygen may be their baseline. Still name the 5. Do not invent a crisis, and do not invent calm.


Look at work of breathing, skin, and whether they can finish a sentence. Then look back at the chart.


Question 4: what did I do, and when is the next set?


"Monitor" is not an answer. "Keep an eye" is not an answer.


Write one of these, specifically:


  • Repeat obs in X minutes, who is doing them, what would make me phone.

  • Sit up, oxygen to the target on the chart, senior now.

  • Hold the next dose of the hypotensive, tell the nurse, repeat BP.

  • No new action on this chart, because nothing moved, and here is what we are actually treating.


A chart without a next set is theatre.


Three drills (write them, do not just nod)


1. The saturations that walked down

Last three: 96 air 08:00, 94 air 12:00, 91 air 16:00. Patient a bit more breathless, speaking in shorter sentences.

Impression: falling saturations on air, not a NEWS trivia score.

Next action: repeat now with work of breathing, sit up, oxygen to the prescribed target, senior. Do not send them for a walk.


2. The tachycardia you blamed on anxiety

HR 78 yesterday, 102 at 06:00, 124 at 09:00. Temp 38.1. BP holding. Patient says they feel "a bit off."

Impression: new fever and a climbing heart rate. Anxiety is not your first line.

Next action: repeat obs, look at the wound and the urine, senior. Do not chart "anxious" and leave.


3. The blood pressure after the morning tablets

BP 148/82 yesterday. 98/60 at 10:30 after ramipril. Patient dizzy on standing. Heart rate 90.

Impression: post-dose drop, not "baseline hypotension."

Next action: lie them down, repeat lying and standing if they can, hold the next ACE inhibitor pending senior, do not send them to the toilet alone.


Copy the four questions onto a card. Fill them before you say the word stable.


The three ways "stable" becomes a lie


  1. You quoted the last NEWS and skipped the time.

  2. You quoted the total and skipped the line that is moving.

  3. You never wrote when the next set is, or who owns it.


If any of those happened, rewrite the four answers. Do not add a speech.


How to practise this until it is automatic


  • Before the round, take one patient. Answer the four questions in 60 seconds with the chart closed after one look.

  • After every set you take yourself, write the next time and the trigger to phone. If you cannot, you took numbers. You did not finish.

  • After the registrar asks a question, note which question it was. That is the one you skipped.

  • Confirm locally. Never invent findings.


The Ward Workbook is the daily sheets for this: before clinic, one-patient sheet, after clinic, and the jobs you actually finish. It is $9 on its own, or in the complete set ($33) with How to Study Medicine, How to Read Imaging, and How to Read Labs. Pay once. Study Kit is included free with every purchase.


It does not replace your lectures, your hospital, or a question bank.


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hamzaProfile picture@hamzak5·3d

Why you keep missing things on X-rays (and it’s not a knowledge problem)


4th year here. For ages I’d glance at an X-ray, spot the obvious thing, and stop looking.

Then the consultant would point at something else on the same film and I’d feel my face go red.

What fixed it wasn’t learning more. It was changing how I look:

1. Same order every single time. Pick a routine and never skip a step, even when it looks obvious. The obvious finding is the one that makes you stop early.

2. Describe before you diagnose. Say what you can see in plain words first. Naming the diagnosis too early is how you miss the second finding.

3. Check the boring corners. Edges, areas behind other structures, anything you’d normally skip. That’s where things hide.

4. Compare with the previous one if there is one. A change tells you more than a single film.

5. Say what you’re unsure about. “I can’t tell if this is X, I’d want a senior to look” beats a confident wrong answer every time.

I put my full routine into a short guide, How to Read Imaging, along with the rest of my packs:

And if the freezing happens when you present on the round, there’s a free 90-second card for that:

What’s the type of scan you find hardest to read? 👇

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hamzaProfile picture@hamzak5·3d

Three lines on every set of bloods: findings, impression, next action

Three lines on every set of bloods: findings, impression, next action


You freeze on bloods because you read the arrows out loud. A registrar does not want a tour of the printout. They want three lines: what actually changed, what it means in this patient, and what you will do in the next ten minutes.


This is not the four-move hunt, and it is not a trend checklist. Those tell you what to look at. This is how you write the output so you stop sounding like a list of arrows.


Confirm the patient, the time, and whether this is the first set or a repeat. Treat the patient, not the printout.


What students actually say


"U&Es are a bit off. Potassium is high-ish. Creatinine is up. Sodium is a bit low."


That sentence has no baseline, no meaning, and no job. It is the printout with extra words.


If Line 2 is just Line 1 said politely, you have not interpreted anything.


Line 1: findings (the numbers that earn a place)


Only the results that change the next hour, with the last value if it changes the meaning.


  • Name the test. Name the number. Name yesterday or last month if you have it.

  • Drop the mild arrows that do not change the plan. A urea of 7.2 that has been 7.2 is not a finding you present.

  • If the sample is haemolysed, clotted, or from a drip arm, that is the finding. Stop there.


Bad: "Na down, K up, creat up."

Good: "Creatinine 210, was 90 two days ago. K 5.8, not haemolysed. Na 134, unchanged."


Line 2: impression (one clinical sentence)


This line contains no numbers unless the number is the diagnosis you are naming (for example a potassium you are treating).


It answers: what is going on in this person, not what is highlighted in red.


  • Acute kidney injury, not "creatinine up."

  • Expected for known CKD, not "renal function abnormal."

  • Possible haemolysis of the sample, not "high K," if the patient is well and the ECG is fine.

  • If you do not know, say the two leading options and what would split them. Do not invent a syndrome.


If you cannot say Line 2 without looking at the arrows, you are still on Line 1.


Line 3: next action (a job, an owner, a time)


"Monitor" is not a plan. "Keep an eye on it" is not a plan.


Write one of these, specifically:


  • Repeat which test, at what time, who is waiting.

  • Hold which drug, now, and tell the nurse.

  • ECG, senior review, or do not send them for a walk.

  • No new action on this result, because it did not move, and here is what we are actually treating.


A result without Line 3 is theatre.


Three drills (write them, do not just nod)


1. The creatinine that did not move

Findings: creatinine 180, was 170 last month, K 4.6, urine output normal.

Impression: stable known CKD. This is not an acute kidney injury.

Next action: no new action on the creatinine. Find why they are in hospital instead of staring at a number that did not move.


2. The sodium you cannot dump as "Na down"

Findings: Na 122, was 136 two days ago, on sertraline, not obviously dry.

Impression: acute fall. Drug-associated until a senior says otherwise. Do not fluid-restrict on the first look.

Next action: repeat Na, check glucose, hold the SSRI pending senior, do not leave free water at the bedside.


3. The inflammatory numbers that are not a diagnosis

Findings: WCC 14 (was 11 yesterday), CRP 80, new fever overnight, day 3 of co-amoxiclav.

Impression: not improving on current antibiotics. This is treatment failure to flag, not "infection" as a personality trait.

Next action: senior review, cultures if not already sent. Do not add a second antibiotic yourself.


Copy those three headings onto a card. Fill them before you speak.


The three ways Line 2 collapses back into Line 1


  1. You repeat the numbers and call it an impression.

  2. You skip the last result, so a chronic number becomes an emergency, or an emergency becomes "a bit off."

  3. Your plan is "monitor" with no person and no time.


If any of those happened, rewrite the three lines. Do not add a fourth.


How to practise this until it is automatic


  • Cover the panel. Write three lines in 45 seconds. If you over-run, you started listing arrows.

  • If Line 2 contains a number, you have not left findings yet. Rewrite it.

  • After every set of bloods, note the one question the registrar asked. That is the line you skipped.

  • Confirm locally. Never invent findings.


How to Read Labs is the structured method for FBC, U&E, ABG, and the bloods you get asked to interpret. It is $12 on its own, or in the complete set ($33) with How to Study Medicine, Ward Workbook, and How to Read Imaging. Pay once. Study Kit is included free with every purchase.


It does not replace your lectures, your hospital, or a question bank.


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hamzaProfile picture@hamzak5·4d

You’re on the round. The consultant looks at you and says “so, tell me about this patient.”

Your mind goes blank. Here’s what I use when that happens:

1. “This is [age, sex] admitted with [one-line reason].”

2. “Overnight, [what changed, or nothing].”

3. “I think [your assessment], so my plan would be [plan].”

That’s it. Three sentences buys you time, makes you sound organised, and gives the consultant something to build on instead of watching you panic.

I made a free pocket card with the full version, so you can screenshot it before your next placement:

And if you want the rest of what I’ve written for students (studying, labs, imaging):

What’s the question you’re most scared of getting asked on a round? 👇

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hamzaProfile picture@hamzak5·4d

I used to look at bloods and say “um... they’re abnormal.

For ages my lab presenting was just reading numbers off the screen and hoping the consultant didn’t ask a follow-up.

What fixed it was changing the question. I stopped asking “is it normal?” and started asking:

1. Which way is it going? Scroll back before you say anything. One result is a snapshot, three results are a story.

2. How fast did it move? A slow drift and a sudden jump are two different conversations.

3. Does it match the patient? If the numbers and the person in the bed don’t agree, don’t trust either one until you’ve checked.

4. Does it change the plan? If not, don’t spend your 90 seconds on it.

5. What am I waiting on? Know the one result you’re chasing before the round starts, so you’re not caught out.

That’s honestly 80% of sounding like you know what you’re doing with bloods.

I wrote the full method up as a short guide (How to Read Labs), and the rest of my packs are here:

And if the freezing happens when you present in general, I made a free 90-second card for that: