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Leila Javidi, MD, MPH, Dr. Brian Radvansky, and Dr. Justine Falcone contributed to this post.

Beginning in a new hospital system in a new role these days opens the floodgates to the memories of how terrifying it was to begin in the hospital in my third year of medical school. I remember only knowing one route to the Emergency Department (no matter how long it was) and only taking that route because if I didn’t, I would get lost. I remember not knowing acronyms, workflow, the electronic medical record system, or even my role in this whole system. Did I mention the goofy short white coat?

In retrospect, some of these memories are hilarious, but if I take a second to think about how terrified I was, I get anxiety all over again about starting my first rotation of third year of medical school. So, if you are about to begin or are already drowning in your first rotation of intern year, take a seat, get your game face on and let’s talk about how to simply survive.

10 Must-Have Items for Clinical Rotations

Keep your white coat stocked with these essential items!

1. Stethoscope

2. Pen light

3. Highlighter

4. Pens

5. Reference book (ex: Pocket Medicine for your medicine rotation, and Pestanas for your surgery rotation)

6. Notebook

7. Install any related apps on your phone that will help you with your current rotation

8. Alcohol swabs and 4x4 pads

9. Pulse oximeter

10. Snacks

How to Succeed on Clinical Rotations and Survive Your Intern Year of Residency:

1. Learn your surroundings.

Figure out where you are! Hospitals are notorious mazes that don’t come with a map. The first step is knowing the best entrance to get to where you're going fastest. The next step is understanding the layout of the floor you're working on. Where is the supply closet? What is the code? Where is the bathroom? These are the basics.

The next level is to figure out where everything else is: the lab, the emergency department, radiology, patient registration. There's nothing worse than being in a short white coat and having a patient ask, “Where is the help desk?” and not knowing the answer. Learning the lay of the land will give you much more confidence walking through the halls!

2. Learn the inside scoop from other students.

Is there a resident who will teach you a ton? One that will give you a hard time? Does one attending prefer a short patient presentation? Is there a question that you are always asked on rounds? What will your schedule be like? What are you expected to do?

These are all things your fellow classmates who have been through it will know. I suggest getting the scoop from a friend before starting any rotation. Know what you're walking into. Having that heads up will give you an advantage and make you look so prepared when you know exactly what you are supposed to be doing.

3. Get organized!

Everyone has a different way to stay organized on rounds. Especially on the medicine rotation, it's essential for you to figure out how to organize all your patient information. Most people like to use the patient census and fold it over to write important lab values, consult updates, or imaging results. Some people have a special notebook. Some people have a template they print out. Look at what everyone else is doing and find a way that works for you. What I highly recommend is getting one of those medical cheat sheet clipboards that folds in half. One thing I advise against is just using random scraps of paper and shoving them into your coat—this is not organized!

4. Make a great first impression.

In this exciting new time, you are going to establish a reputation for yourself among co-interns, residents and attendings. These are the people who you are going to be spending up to 80 hours per week with, for about 50 weeks per year. My best advice is to be wonderful to them all.

While we would love to think that people will give you a chance to show who you really are, you should know by now that the first impression is the lasting impression. In fact, if you make an amazing first impression, often times it gives you a lot more leeway in the future if you make a mistake or slack a little bit. To make a good impression it is essential to try your best to be courteous to everyone, make an effort to learn, pay attention during rounds, be involved in your patient’s care, and always have a great attitude.

If you start off on the right foot, slipping a little bit later on will be forgiven and forgotten. Those who make a lazy, aggressive, rude, or disinterested first impression will have a difficult time shaking it. Every single one of their indiscretions will be added to the pile to support this reputation. Avoid all that by making a fantastic first impression.

5. Ask a thousand questions, but don’t be annoying.

Let’s be real, most people going into third year don’t have major experience working in a hospital, and there are a lot of logistical things to learn. How do I fax something? How should I label the culture tubes? How do I adjust oxygen on a patient? What do all these signs mean outside a patient door? These are all excellent questions and often have a wide variety of answers depending on which hospital you are in.

Don’t just sit in the dark, ask these questions! But try to spread it out amongst many different people. There's nothing more annoying than bombarding someone with so many questions that it gets in the way of their work flow. You can also figure out a lot of stuff on your own or by taking a look at a hospital manual (I know it sounds dorky, but it's there for a reason). 

6. Know when to ask for help.

One of the biggest downfalls one makes as an intern is being too proud to ask for help. Whether it's trying to care for a crashing patient on the floor and being to afraid to wake the fellow up at 3 a.m. or feeling incredibly burned out after a stretch of shifts with no days off — it's always okay to ask for help.

At the very least, even the most brilliant and experienced medical mind will need an extra set of hands. And the burgeoning mind of a new intern will need a set of hands and some extra brain power from those who possess not only the algorithmic thinking, but also the logistical knowledge, to handle situations. Sure, you know your desatting COPD-er would appreciate some nebulizers and a BiPap, but how do you get respiratory to the bedside? How long can BiPap be offered on a floor bed? How do you transfer a patient to the ICU?

It is paramount to understand that there is no shame in asking a senior for help, even if they are sleeping, and even when the problem seems trivial.

When I've been on call as an intern, if I had to ask an upper level for assistance, I would usually start the conversation with something along the lines of, “I'm so sorry to bother you at this hour, I just want to double check the plan,” or “I have a concern about this patient.” If all else fails, I've found that using the statement, "I just want to make sure I'm doing what's right for the patient," tends to be well accepted.

If you're feeling physically or emotionally drained after a stretch of shifts without a day off, ask a colleague if they can switch a shift with you.

7. Find enjoyment outside of work.

I've also found it helpful to plan something fun to look forward to after a particularly busy week or stretch of shifts: entering a 5k race, traveling to see family, or planning to have dinner with a friend.

Planning fun and relaxing events in the future will not only give you something to look forward to, but will also help prevent burn out in the long run. It is far too easy to fall into the trap of working all day, ordering-in, watching 15 minutes of mindless TV, and going to bed at 8:30 because you need to be up at 4:30. This spiral, when superimposed on a new city that is far away from your previous social network, can make for a really hard adjustment.

That’s why it is a necessity to claim part of your life for yourself, even if it’s small. This can be something as simple as a 10 minute jog after work, reading a few pages of a pleasure book, dinner with a friend or lover, or holding your child until bedtime. Like the zen masters remind us: “When drinking tea, only drink tea.” Pick something to do and do only that. Do not try to multitask too much when you are home; you will be doing enough of this during the day.

8. Take control of your learning.

Third year can be an amazing learning experience if you take control. Don’t wait for the knowledge to come to you, but look things up. You have the luxury of only being ‘responsible’ for about two patients at a time, and because of this, there is no reason you shouldn’t be reading up on their conditions. For every patient you care for, look up their condition in Uptodate, or Step up to Medicine, or whichever resource you are using, and learn the common causes, signs/symptoms, lab findings, treatments and outcomes for that condition. If you do this every day (literally read about one thing), you will not only be prepared for rounds and impress your attending, but you will be that much more prepared for your Shelf Exams and for the next time you see a patient like this!

9. Be a team player. 

Someone who is hardworking and always willing to help out is much more enjoyable to work with than someone who coasts along and constantly lets others pick up their slack. Many times when I was on call with other residents, I found that it was easier to split the workload and help each other out. Even if it wasn't “my day" to be on call, and I had to stay an hour or two later in the afternoon — helping the on-call intern to do admissions, see consults, etc. makes the process a lot smoother for everyone. Not only are you both more likely to finish your work on-time to leave at a reasonable hour but, when it's your turn to be on call, you'll find it to be a lot less stressful having someone to help you out.

Part of being a team player also means arriving on time, or better yet, early. I always arrived several hours before rounds to see all my patients, talk with nurses, review labs, etc. That also made it easier to help with any early morning admissions before rounds. If you're able to see a new patient before rounds, take another admission when the on-call resident is getting slammed, or call a consult for a busy co-intern, not only will it make life easier for everyone, but you'll likely make friends with the people you work with and enjoy the sometimes stressful life of residency a bit more!

10. Help. Your. Resident.

Everyone knows that being a medical student can really stink. You just don’t know what you are supposed to be doing and you're often overwhelmed with the new schedule and balancing when you're supposed to be studying. No matter what you're going through, understand that your resident is going through much more right now! Anything you can do to make his or her life easier (checking on labs, calling a specialist, filling out a form, helping out on an admission) will make you look great.

Furthermore, when your resident sees how helpful you are, he or she will be much more interested in helping you out and teaching you everything you need to know to succeed on this rotation. They also might be more willing to let you go early if nothing is going on!

11. Be kind to everyone.

From custodial workers, to CNAs, to nurses, to your resident colleagues, everyone is working towards a common goal: providing the best care to sick patients in need. If a nurse keeps paging you about an order or abnormal lab result at 3 am when you have 847,347,653 other pages and patients to attend to, it can be easy to get frustrated. However, I've found that remembering that we're all on the same team, and working towards to same goal, can be very helpful. A nurse frequently paging, the ED calling again for an admission, or a hospitalist calling for yet another consult can all add more stress to your shoulders. But these things all happen because someone is trying to do what's best for the patient.

I've found that kindness is one of the strongest tools to apply in residency. Saying thank you to a colleague who helped you out or telling a nurse how much you appreciate their efforts to draw another set of labs goes a long way. Even on a rough day, try to smile and show appreciation to those around you, not only will it make for a more pleasant work environment, but it will probably make you happier too.

12. It’s okay to cry sometimes, but remember to laugh!

Third year is the worst. And not everyone gets emotional about it, but those of us who do will find themselves welling up with tears sometimes even on the floors. It’s okay. It’s good to embrace your emotions rather than bottle them up or stuff them down. It’s better to find a private place to do this, but it’s perfectly normal to cry sometimes.

But if I could go back to third year, I would try to choose laughing over crying many times. When a doctor is screaming in your face and you have no idea what she is talking about, walk away and laugh at how ridiculous that was rather than cry. You have to laugh sometimes or you will implode. This goes for anything in life, but I think it is more important than ever during third year.

13. At times, put yourself first.

You can't adequately, safely, and emotionally care for other people if you don't take care of yourself first. Although it might sound easy to put yourself first, the demands of residency can make it a lot harder than it seems. Amidst multiple 80 hour work weeks, two week stretches without a day off, frequent call, and scattered night shifts, it can seem impossible to find time to eat healthy, exercise, and keep in touch with friends/family... let alone sleep!

During residency, I learned how truly important it can be to say "no." Learning not to take on more than you can handle — and saving a little more time for yourself — can be essential. If it's not something you’re truly passionate about, then it's okay to say no thank you to taking on another research project, serving on a committee, interviewing applicants, etc.

The important thing is to make time for what is truly important to you. I have found that in residency, by taking each day at a time, it is possible to carve some time for oneself: even if it means squeezing in a four mile run on the hospital treadmill after a 16 hour call shift, choosing a salad for dinner, or picking up the phone to call grandma before collapsing in bed. Those moments and memories in life that are important to you should not (and don't have to be) lost just because you are in residency.

14. Don’t forget to call mom.

While you are already used to being overwhelmed with your schedule as a medical student, it seems like third year actually gets worse where you just can’t find a balance at all. I could sit here and tell you all the things you should do to maintain a healthy mind, body and spirit, but until you figure that out for yourself, it just won’t happen. I’m still working on that, myself. So if you do nothing else, make sure to call your mom… and be nice!

 

Further reading:

The Rotation Survival Guide for Med Students

Rotations are Beginning: Your Step 2 CK Study Plan

Away Rotations: Worth the Work

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