Congrats, if you are reading this, you have likely made it to the clinical part of medical school (the best part)! By this point, you have probably spent 18 months – 2 years doing book work and taking exams every couple weeks. Now, you have the opportunity to take the information you learned on paper and apply it to real patients. Interacting with patients is an absolute joy and honor. We help them through some of their toughest, most vulnerable periods of their lives. Below are some general tidbits for excelling in clinical rotations as well as separate links for excelling in each particular clerkship.
How to Succeed in Clinical Rotations
Be Helpful
Always ask the nurses, residents, and attendings what you can do to be helpful. Sometimes there is a fourth year student around who can show you how to be helpful. Being helpful is very clerkship dependent, so it is important to ask your expectations on the rotation day 1 and see where you fit into the team. The nurses are also essential in pointing us in the right direction. As students, we have more time to spend with the patients than the residents and attendings, which can be extremely useful in obtaining a more detailed history, determining if there are any social issues at play and which services we can provide, and even providing nutritional and lifestyle counseling.
Put Yourself Out There But Know Your Limits
Your priority is to learn. Take an active role in patient care. If you want to insert the IV or help with the LP, ask. If you want to catch a baby, ask. You do need to gently insert yourself into the situation if you want to maximize your hands on learning, procedural skills and more. Students can be passive and just get through the rotation or really act like an intern and practice medicine. There will be times that you see the patient with the resident, fellow or attending. If you have a question and it is an appropriate time, ask. You may even lead the entire encounter. If your senior is doing a physical exam, jump right in. There is plenty of room to place another stethoscope. Remember, you are here to learn.
At the same time, keep in mind you are a student. You may wear a short coat, but patients and even other medical professionals will confuse you for a physician. You cannot write orders, give consult instructions, advise other healthcare professionals, or give patients major test results unless your preceptor explicitly instructs you to do so. If you are unsure of how to proceed, ask away.
Be A Team Player
This goes back to being helpful. Find out how the team functions your first couple days and really see how you can fit in, be helpful, and learn from the team. The first week on a new service is probably very different from your last rotation. Soon enough, you will learn the team dynamic, fit right in, and learn to be helpful. Stay positive. There will be cranky patients, residents, attendings, and nurses. You may even be cranky. If someone snaps at you, don’t take it personally, and learn from the situation.
Respect your colleagues. If a classmate is struggling, help out. If there are three new patients admitted and three students on the team, make sure you each follow a new patient.
Show Enthusiasm
Entering the field of medicine is exciting. Caring for patients every day is a joy. Share your passion with grace. Approach every situation with a positive attitude – if someone asks you to do something, do it. Don’t pawn it off on another student. Remember what motivated to go into medicine and let that fuel your passion especially on the harder days
Be Sensitive & Practice Cultural Competent Medicine
Some patients have a major distrust in doctors and the medical field. Others do not speak English and require an interpreter. Some patients are escaping unimaginable situations. Others are homeless, use injection drugs, abuse alcohol, or are inmates. Some patients will have thoughts that do not align with your own. Put your feelings aside and treat the patient as a human being. If you do not think you can practice sensitive medicine with a particular patient, step out of the situation and transfer care to someone else.
Be Honest
We will all forget to ask patients important questions. If we forget, we need to be honest with our preceptors and admit that we forgot but say that we can go ask the patient right away. Next time, we will likely remember to ask our patients some of these key questions. If a patient or preceptor asks you a question you are unsure of, it is okay to admit you do not know the answer. Say you are unsure and will get back to them with the answer.
Seek Support if you’re Struggling
Medicine is rewarding but there will be horrific situations and gut wrenching losses. In my opinion, it is perfectly okay to show emotion with your patients. It shows you are human. If you are struggling, tell someone, seek a counselor, or call the National Suicide Prevention Hotline (1-800-273-8255). Too many students and physicians are lost each year to suicide.
Studying While On Clinical Rotations
Studying will be very much clerkship dependent, but below are some of the popular resources that apply to all clerkships and Step 2 CK studying. You may have free time during the day to read and do some practice problems/flashcards. It can be tough to spend long days at the hospital then study at home. Keep in mind, you learn a lot more than you think “on the job,” so you may not need to spend as much time outside the hospital studying. This all depends on how you learn best.
UWorld – This question bank is gold for all clerkships (except there are no family medicine specific questions). Definitely invest in a text to annotate the questions. I prefer Kaplan's Master the Boards over First Aid for Step 2 CK.
OnlineMedEd – This is essentially Pathoma for third year. There are downloadable videos and study sheets for the major subjects covered on the shelf exams and Step 2 CK.
Firecracker – This is a flashcard and question bank system that many students use for Step 1, Step 2 CK and shelf exam studying.
NBME Practice Exams – These are great to take about halfway through your rotation to see if you are passing. Some of the questions are very similar to what you will see on exam day.
Clerkship Specific Guides
Below are guides I created for each clerkship. Now what worked for me will not work for everyone. I thankfully did very well third year and was able to find great work life balance all year. Not everyone felt the same way. Much of my studying was “on the job” learning, as it should be and less traditional studying at the end of a long day.
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